This is where health insurance leadership comes together.
Becker's fourth annual spring payer issues roundtable brings
together over 400 payer and health plan executives
and more than 100 speakers to Chicago April.
This year's event includes keynote conversations with the
industry's top leaders and former president George W.
Bush. For the full agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by doctor Alice
Chen, who is executive vice president and chief
health officer at Centene.
Doctor Chen, thank you so much for taking
the time to be with me on the
podcast today. Jacob, thanks for having me. I
am delighted to be here. Absolutely. It's a
pleasure to get to sit down with you,
doctor Chen. And before we dive into everything
we wanna talk with you about, a lot
of the impactful work that's going on with
you and your team at Centene. First, can
you tell our listeners a little bit more
about yourself, your background in health care, and
what it is that you do today at
Centene? Absolutely. So doctor Alice Chen, I'm the
chief health officer at Centene. And just a
little bit about Centene for those
of your, listeners who may not know us.
We are what I think of as a
three m company,
Medicare, Medicaid marketplace, so focused on government programs.
Last year, we serve more than 20,000,000 people
across all 50 states. That's about one in
15 Americans.
And when you look at our footprint, it's
about the same across three all three lines
of business. But in Medicare, 32 states, Medicaid,
30 states, and in Ambetter, our marketplace
product, 29 states.
As for me, I would say my career
could be described as,
focused on ensuring access and quality of care
for underserved Americans.
And I come to the payer space,
joined Centene
almost exactly three years ago, 2023,
with experience across multiple sectors. I think some
people might call it a checkered history.
I'm a primary care internist by training who's
worked in community health centers, public hospitals now,
at a free clinic volunteering,
but I spent time in academia,
philanthropy, public health, had leadership roles in delivery
systems, government, purchaser, and out payer. And here
at Centene,
my role is tied directly
to our mission, which is transforming the health
of the communities we serve one person at
a time. And by that, I mean, I
oversee Centene's clinical policies and programs to improve
population health for our members,
specifically leading
medical affairs, health equity, drivers of health, and
clinical strategy. And just a word about how
we do this because I think it'll inform
our discussion, which is,
given
our footprint,
the way we approach population health, and frankly,
our, I think, unique identity is around
leveraging national size and scale
for local impact through our state health plans.
So
it comes in many flavors, but two two
big buckets are, one, we're really big on
data. How do we use data across in
Medicaid, for example, 30 states to identify trends,
guide evidence based interventions that address community specific
needs? So it's both
a bird's eye view across multiple markets, but
then tailoring them to the specific nuances of
any given community.
And that second part ties to that nuance
piece, which is we look to partner with
local, regional, and national organizations to have a
similar mission,
a focus on low income Americans and improving
their health.
Understood. Well, I I really appreciate you taking
us through that, Alice. You had a fascinating
career before Centene, and and now you're you're
with one of the largest insurers in the
country. You mentioned,
serving around one in 15 Americans. That's absolutely
incredible
across your different your different product lines all
over the country. And I'm and I'm excited
to get to talk with you today because
I I really wanted to dive in first
by talking about something really an exciting announcement
from the company last year,
that Centene helped launch the Maternal and Child
Health Center for Policy and Practice as a
founding member,
which for our listeners who might not be
familiar,
it ultimately aims to improve maternal and child
health outcomes
in rural parts of the country in many
states, but starting in Arkansas.
So, Alice, can you can you fill us
in on exactly how this all came about
and why ultimately Centene
wanted to be a part of it? Yeah.
You know, it ties to what I was
describing before about who we serve
and how we approach our work. So as
the largest Medicaid MCU in the country and
by dint of that, the largest TANF payer,
we have,
very naturally
a focus on pregnant women, new mothers,
infants, children.
In 2020,
'4, I think was the last complete year
of data, we were responsible for more than
three hundred and thirty thousand births,
a third percent of whom are high risk.
So, again, when you look at who we
care for and,
where the vulnerabilities line, where we need to
lean in, maternal childcare is clearly,
a priority for us. So we have a
multi pronged approach,
to
just call it perinatal care, maternal child health.
We have internal care management programs. We have
value based care programs to partner with our
providers to incentivize pre and postnatal visits.
We have, partnerships
with a whole variety of entities, including what
we'll be talking about,
to to expand access to evidence based models.
And then another piece, which I think is
really relevant because it's really in the water
right now when you look at CMS, MMI,
We focus on introducing and scaling technology
enabled interventions, so things like telehealth, virtual
health tools, remote patient monitoring,
with a real focus on how do you
strike the right balance
of high-tech, high touch care.
And this is particularly relevant when you talk
about the Heartland
Forward.
This is what the group that's sponsoring the
Maternal Child Health Center for Policy and Practice.
So just a little PSA about Heartland Forward.
It they describe themselves as a do and
think tank,
focused advanced economic success for states in the
primarily Midwest but also South. And so as
part of that, the health land,
Heartland Health Caucus,
decided to focus on rural health. And when
you look at rural health, a few things
really rise to the forum. One is maternal
child health,
one is
mental health, and a third is,
workforce shortages.
And so how this came about was, our
CEO, Sarah London, was approached a few years
ago given, again, who we serve, what our
focus
is about participating in how Heartland Health Caucus,
which is in the process of establishing
the center.
And just when you look at the alignment
in terms of priorities and focus areas,
and members and people who are trying to,
improve the health of it, made
intuitive sense for us to join forces. And
so we really welcome the opportunity,
to bring in, an all one Centene, all
of Centene approach. So it's our local health
plan. It's our national team,
both on the clinical side and the drivers
of health and health equity side as well
as our foundation.
And the partnership itself focuses
on midwifery
as a proven high quality cost effective model
to improve access and outcomes, particularly for women
in rural areas. And our main goal is
to expand education
and improve the workforce pipeline there. So
launched mid last year, already made some great
progress.
Wow. And and it does it makes a
lot of sense approaching Centene specifically for this
type of partnership.
Like you said, Alice, given that you are
the largest Medicaid MCO in the country, you
you,
provide coverage to hundreds of thousands of births,
every year. And so you you mentioned the
the senator is really focused on expanding access
to community health workers, to doulas,
to midwifery care,
especially as in areas where labor and delivery
units have closed. And I and I know
when I when I speak from our perspective
here at Becker's, that is something that we
almost see, I'd say, every week at this
point,
across the country, a a maternity unit that
is closed somewhere in the country. It's something
that we track very closely, and it seems
to be a very,
a growing trend nationally.
So I wonder from from a population health
perspective,
you were you were mentioning mentioning earlier about
some of the interventions that are important here.
What what is the evidence telling you right
now about which interventions move the needle most
in these
rural,
Medicaid dominant populations?
Yeah.
And to level set our listeners,
you know, you may see the headlines around
rural health crises
or,
maternity deserts. Like you said, every week, there
seems to be,
another facility closing. But right now, 35%
of counties are considered maternity deserts.
Wow. I mean, where they lack any obstetric
clinician.
And in over a thousand counties, there's not
a single birthing facility
available.
So when you think about
rural Medicaid
populations, actually, so it's not just rural, but,
like, within Medicaid populations, rural communities face unique
barriers. And so when you put together the
fact that the women themselves are oftentimes
higher risk profiles in terms of medical, behavioral,
social risk factors plus
maternity deserts and care fragmentation, you
pretty logically get poor outcomes. And so,
love that you asked about the evidence,
because, again, we're really focused on both
using our data across 30 markets to identify
themes and issues, but then implementing models that
have evidence of impact. Because
just as an aside, as a government payer,
we really do take our fiduciary responsibility
very seriously. And so if we're using,
taxpayer dollars to fund government programs, we wanna
make sure those dollars go to evidence based
interventions and then also ensure that we're evaluating
the impact of our intervention. So in terms
of the top three care models that we're
looking to invest in,
one is, for average risk pregnancies,
midwifery led models,
because they're associated with lower rates of c
section, preterm births, low birth weight infants. And
again, that's why we, with Heartland Forward, are
really focused on expanding the workforce for rural
areas.
Second would be community based doula care.
Lots of observational studies and Medicaid demonstrations showing,
again, reductions in low risk c sections and
preterm birth along with improved,
engagement in patient reported experience.
What's interesting there is that the greatest benefits
are reported in some of the most vulnerable
populations, so Medicaid insured, rural,
black, native population. So it really does seem
to have a mitigating effect on some of
the structural barriers. And then the third, what
I'd say, strongly evidence based care model would
be, group prenatal visits,
which, again, particularly among Medicaid populations and communities
with limited access to traditional
prenatal care, have been shown to reduce,
preterm
births,
as well as
patient or member engagement,
and satisfaction.
Aside from those models, I just wanna make,
another really key point, which is when you
look at the moms,
the majority of maternal deaths actually occur after
delivery. Over half of them occur
between, you know, seven days to a year
postpartum, and it's largely driven
by cardiovascular,
maternal,
cardiovascular conditions,
mental health, and substance use disorder. So really
CBD and behavioral health. And so that then
leads to looking at, like, what are the
evidence based interventions
from a policy side? It's about continuous,
coverage
and proactive engagement
through twelve months. What's
the really good news is almost every single
state
has expanded,
Medicaid eligibility
for women, twelve months postpartum.
So that enables us as a Medicare managed
care plan to really lean in and engage
them around
blood pressure control, you know,
diagnosing and addressing postpartum depression, addressing substance use
disorders. And then that leads to the second
piece, which is integrated care models
where you actually integrate chronic care, physical health,
behavioral health,
substance use
disorder services,
are really strongly supported by the evidence in
terms of not
again, for these high risk women,
creating more holistic whole person care models as
opposed to kind of fragmented
parallel interventions,
is
are the types of models that we're looking
to.
Understood. So more midwifery
doula group prenatal
care models,
hopefully scaled across the country and across Centene's
Medicaid markets. And I have to say, it's
also been very interesting, Alice, over these last
few years, seen
state Medicaid programs incorporate
things like doula coverage,
into their into their clinical pathways.
It really seems to be
a government private industry effort here, to incorporate
more of these interventions all over. I think
that's a wonderful development because, again, I think
following the evidence,
figuring out what the,
most cost effective
member patient person centric interventions
is a place where
having a Medicaid agency
incentivize it allows us as MCOs to step
up and really be that partner. Yeah. Definitely.
Definitely. And I wonder
going back to you mentioned
you have a fiduciary duty,
to to get the best outcomes,
on behalf of of providing this this government
service all over the country. And so what
are some of the the maternal and and
child health metrics that,
Centene is really prioritizing
internally right now? And and how does this
partnership with Heartland
help you build a better data infrastructure so
that you can track these outcomes that really
matter beyond,
just the care delivery?
Yeah. Absolutely. So data has been a strong
focus for us over the last few years
writ large,
focusing on a core set of
outcome and quality metrics
that
we feel represent
safety and effectiveness
of maternity care across the perinatal continuum. And
working with a group like Heartland enables us
to really hone in on
starting with a state but then a region,
to then use that data
in a,
proactive way to kind of tailor our interventions,
continuing to evolve the programs, and make sure
that those outcomes continue to improve over time.
So some of the key,
so obviously, all health plans,
look to HEDIS.
And so we have the obstetrical specific HEDIS
metrics. But in addition to that and this
is where, again, partnering with other
entities, whether it's providers
or
regional leaders like Heartland Forward who are potentially
able to to
aggregate
more
diverse types of data is very helpful because
some of these aren't claims based. I mean,
the ones I'm about to talk about. So
we need to look at charts and we
need to partner with providers, but things like
low risk c section rates are a key
measure of obstetric quality because we know that,
c section bursts can be associated with increased
maternal morbidity, higher risk in subsequent pregnancies, and,
of course, increased costs. And so if we
can avoid those, that is a good thing.
We also track preterm birth and low birth
weight rates,
which we see as a measure of the
efficacy of prenatal and perinatal care.
We track severe maternal morbidity rates
because that gives us a signal around how
effective has the prenatal
care been in terms
of proactively
and aggressively identifying gaps in diagnosis response care
coordination.
The ultimate metric,
mortality rates, so maternal and infant mortality rates
is something that we track as a sentinel,
indicator of, you know, the most severe and
preventable
adverse outcomes as,
when possible. Not all of them obviously are
preventable, but,
given
our rates compared to other industrialized countries, clearly,
we have a lot of
room for improvement.
And then lastly,
neonatal intensive care, you know, or NICU admission
rates,
which,
again, not all are preventable, but are also
a
indication for us of prenatal
care comprehensiveness
and quality. So
taking
a broader view than just HEDIS and making
sure that we,
have
complete
high integrity data and then
sharing that data with our providers and our
other partners
is core to how we think we're gonna
be able to create a shared accountability framework
and truly move the dial in terms of
outcomes.
Well, clearly, a lot that goes into this
beyond just the claims data, Alice. And and
to your point, a lot of work still
needs to be done, to improve
improve these maternal health outcomes compared to, other
industrialized
countries. And so in that vein,
this is such a massive topic.
So are there other strategies or initiatives you
could share with us that Centene has been
pursuing recently,
to really address the these maternal and and
child health outcomes overall?
Yeah. Thanks for asking that because this is
a this is an area where I'm really
proud of our teams,
because we really have we're not where we
need to be. I don't think any anyone
is in The United States, but I think
we really have stepped back and created,
a comprehensive,
holistic approach,
that includes,
focusing on access,
on member engagement,
education, self management,
on our care management resources, as well as
care coordination,
provider partnerships,
technology enabled.
But I think it was pro vendors. Like,
sometimes people will call them vendors, but they're
really also providing care, and then community based
organizations as well as, you know,
think do tanks like,
Heartland Forward. And so
some specific
examples,
we have
a very robust
care management program called Start Smart for Baby
where we,
leverage data
to identify
pregnancy
as early as possible, do risk stratification,
and then reach out to members in a
very tailored way
driven by their needs and their assessments.
And, again, and in a whole person integrated
physical
behavioral, meaning mental and substance use disorder, social
care model
that includes comprehensive education
and
also
integrate some of our drivers of health initiatives
like, food is medicine.
So, for example, we're piloting a program as
part of Start Smart for Baby
to provide funding to high risk members
so they can order healthy food, blood pressure
cuffs for folks who have high blood pressure
and prenatal vitamins. All the things we know
are
core to just having a healthy pregnancy, but,
like,
trying to reduce or eliminate the barriers to
being able to take those actions.
We also just rolled out a first years
of life program to support kids, from birth
to two years taking advantage of that continuous
eligibility postpartum
to engage the mom and then hopefully keep
those kids, covered.
I mentioned before,
technology
is a big piece of our strategy,
particularly when you think about rural communities,
and just how do you leverage scarce resources,
in the community and then
outside the community,
so that they don't have to spend hours
traveling. So
we do,
traditional virtual health and telehealth where we,
use that to enable
earlier prenatal care and access to specialty services
like maternal funeral medicine or perinatal
mental health or substance use treatment, which may
not be available in your community. But then
we also have been leaning heavily into,
remote patient monitoring,
and we have a great project in,
with Silver Summit Health Plan in Nevada
where members are monitoring their blood pressure at
home with nursing support,
so that, again, because you only have that
nine month window, if you can have someone
check their blood pressure at home because they're
even if they're plugged into care, they're not
in their
doctor's office that much. So the remote patient
monitoring allows us to kinda keep a finger
on the pulse of how people are doing
and then proactively reach out and get them
in and make sure that we can,
get their blood pressure and diabetes controlled.
And then,
you know, we talked about midwives,
which are a big,
area of focus. The doulas are another,
that I also had mentioned before. We have
partnerships with community based doulas
where we actively work with, again, community based
organizations to help them understand how do you
even partner with an MCO. How do you
bill an MCO? So we do a lot
of technical assistance
in order to enable CBOs and community
organizations to effectively partner with us. And then
the last thing I would mention is we,
partner with community health centers. So we have
a three year
project with the National Association of Community Health
Centers
and together,
launched the maternal child
health innovation initiative
to identify
best practices and create a forum for exchange
and adoption across community health centers, which are
the single largest source
of primary care for low income Americans and
particularly Medicaid. I think they serve one in
five Medicaid members right now.
So the focus will be, leveraging
again, or hear hear similar themes across all
these initiative, a virtual care model
to improve blood pressure control,
during pregnancy for community health center members.
Wow. I mean, just so much exciting and
impactful things going on across the company, Alice.
So I hope you will keep us updated
on on what some of these, pediatric
remote monitoring,
maternal
health initiatives,
besides what we talked about with Heartland, what
you ultimately achieve through all of these. Before
we go I love that. What what else
are we missing? Any other final thoughts you
wanna share with us or final bits of
advice you wanna share, while you have the
ears of a lot of other health plan
leaders from across the country?
Not so much advice, but,
probably a ask, which is
I think of Medicaid
as a canary in the coal mine for
US health care.
And within Medicaid, I think of rural health
as a canary in the coal mine,
you know, within Medicaid.
The challenges
to maternal child health and rural settings is
not unique, but the interventions
that are successful there can oftentimes
be scaled to less
vulnerable
settings. And so,
you know, the way we've
leveraged national insights and resources for local impact,
data technology provider, pro vendor partnerships,
is something
that I would love to see
our peer organizations do as well. You know,
there's not a lot of lot going on
in health care these days. Right?
Just kidding.
There's so much going on in health care,
but to me,
in this time where a lot
of payers
and providers, particularly in the government space, but
frankly across the ecosystem because we're all tied
together,
in times of pressure, I think
this is a time to double down
on maternal child health,
because it is the future,
of our country. And I think we'd love
to see providers, payers, and policymakers
converge around
the right policies, the right practices,
the right support,
similar to how we're doing with Heartland Forward.
It's a great call out for this current
moment in time, doctor Chen. So I wanna
thank you so much for taking the time
to sit down with us, for sharing your
insights with our listeners, and for telling us
a little bit about all the impactful work
going on under your team at Centene. We
we really appreciate it. My pleasure. Thank you
so much for having me. Absolutely. And to
our listeners, if you'd like to listen to
more podcasts from Becker's Healthcare, you can visit
beckers hospital review dot com.