1 00:00:02,240 --> 00:00:05,059 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:12,259 together over 400 payer and health plan executives 4 00:00:12,400 --> 00:00:16,524 and more than 100 speakers to Chicago April. 5 00:00:16,904 --> 00:00:19,785 This year's event includes keynote conversations with the 6 00:00:19,785 --> 00:00:23,064 industry's top leaders and former president George W. 7 00:00:23,064 --> 00:00:25,704 Bush. For the full agenda and event details, 8 00:00:25,704 --> 00:00:27,785 visit beckershospitalreview.com 9 00:00:27,785 --> 00:00:29,224 and click on the events tab in the 10 00:00:29,224 --> 00:00:31,519 upper right. We're looking forward to hosting you 11 00:00:31,519 --> 00:00:32,659 here in Chicago. 12 00:00:33,759 --> 00:00:36,479 Hello, everyone. This is Elizabeth Caslow with the 13 00:00:36,479 --> 00:00:38,179 Becker's Payer Issues podcast. 14 00:00:38,640 --> 00:00:40,640 I'm thrilled today to be joined by Linda 15 00:00:40,640 --> 00:00:43,619 Hines, Virginia's Medicaid market president for Humana. 16 00:00:44,024 --> 00:00:45,625 Linda, thank you so much for chatting with 17 00:00:45,625 --> 00:00:46,364 us today. 18 00:00:46,664 --> 00:00:48,265 Good morning, Liz. Thank you so much for 19 00:00:48,265 --> 00:00:49,164 having me today. 20 00:00:49,545 --> 00:00:50,204 Of course. 21 00:00:50,664 --> 00:00:52,664 So before we dive in, can you tell 22 00:00:52,664 --> 00:00:54,984 us a bit more about yourself, your health 23 00:00:54,984 --> 00:00:57,465 care career backgrounds, and your current role at 24 00:00:57,465 --> 00:00:57,965 Humana? 25 00:00:58,979 --> 00:00:59,479 Absolutely. 26 00:01:00,500 --> 00:01:02,179 So I always like to start off by 27 00:01:02,179 --> 00:01:03,960 saying I am a nurse by background. 28 00:01:04,900 --> 00:01:06,979 I, I'm a registered nurse, and that's where 29 00:01:06,979 --> 00:01:09,540 I started my career, mostly on the provider 30 00:01:09,540 --> 00:01:12,784 side and, hospital space. I had an opportunity 31 00:01:12,924 --> 00:01:13,665 to join, 32 00:01:14,284 --> 00:01:15,984 Medicaid managed care specifically, 33 00:01:16,765 --> 00:01:19,004 oh my goodness, back in 1996, so it's 34 00:01:19,004 --> 00:01:20,465 been thirty years ago. 35 00:01:21,004 --> 00:01:23,325 Joined a very small health plan that was 36 00:01:23,325 --> 00:01:26,045 really just in the Central Virginia market at 37 00:01:26,045 --> 00:01:28,769 that time. We had only had about 3,000 38 00:01:28,769 --> 00:01:29,269 members. 39 00:01:29,969 --> 00:01:32,849 And, I actually joined them managing their medical 40 00:01:32,849 --> 00:01:33,829 management department, 41 00:01:34,769 --> 00:01:36,709 continued to stay with them, progressed, 42 00:01:37,090 --> 00:01:39,349 through the ranks to become the vice president 43 00:01:39,729 --> 00:01:41,989 of clinical services, which encompassed 44 00:01:43,064 --> 00:01:43,805 everything clinical, 45 00:01:44,584 --> 00:01:45,644 pharmacy, quality, 46 00:01:46,344 --> 00:01:47,884 care management, credentialing, 47 00:01:48,905 --> 00:01:50,744 and and stayed in that role for about 48 00:01:50,744 --> 00:01:51,644 sixteen years, 49 00:01:52,024 --> 00:01:55,064 then moved into a chief operating role, then 50 00:01:55,064 --> 00:01:56,969 to CEO of that health plan. 51 00:01:57,530 --> 00:01:59,290 When I left that health plan, we actually 52 00:01:59,290 --> 00:02:01,290 had grown from that 3,000 that we started 53 00:02:01,290 --> 00:02:04,329 with to well over 380,000 54 00:02:04,329 --> 00:02:04,829 members. 55 00:02:05,689 --> 00:02:07,709 Went to another health plan, was the president 56 00:02:08,009 --> 00:02:10,270 of, the Virginia Medicaid market, 57 00:02:10,889 --> 00:02:12,349 the dual special needs. 58 00:02:12,655 --> 00:02:14,435 And then now I am at Humana 59 00:02:15,134 --> 00:02:17,555 as the plan president specifically 60 00:02:17,854 --> 00:02:20,194 for the Health and Horizons, which is Medicaid 61 00:02:20,735 --> 00:02:21,235 and 62 00:02:21,614 --> 00:02:23,875 our integrated dual special needs plan. 63 00:02:24,414 --> 00:02:24,894 So, 64 00:02:25,455 --> 00:02:27,555 you know, that's quite a journey. I know 65 00:02:27,710 --> 00:02:29,469 I often get asked, how did you move 66 00:02:29,469 --> 00:02:32,270 from clinical, so to speak, into the more 67 00:02:32,270 --> 00:02:34,370 administrative? But I do think that it all 68 00:02:34,830 --> 00:02:35,650 fits together. 69 00:02:36,270 --> 00:02:38,530 That clinical experience really shaped, 70 00:02:39,389 --> 00:02:41,889 my experience to move more into the operations 71 00:02:42,030 --> 00:02:44,414 piece, and I think having that I'm more 72 00:02:44,414 --> 00:02:46,894 of an effective leader in this space at 73 00:02:46,894 --> 00:02:47,634 this time. 74 00:02:48,175 --> 00:02:50,094 Yeah. That makes a lot of sense. So 75 00:02:50,094 --> 00:02:51,854 today, we're gonna chat a bit about your 76 00:02:51,854 --> 00:02:53,875 market's youth behavioral health efforts. 77 00:02:54,574 --> 00:02:56,655 And schools are a cornerstone of those efforts 78 00:02:56,655 --> 00:02:58,719 from what I've been reading. Can you elaborate 79 00:02:58,719 --> 00:03:01,040 a bit on your partnerships and initiatives taking 80 00:03:01,040 --> 00:03:02,259 place in those settings? 81 00:03:02,800 --> 00:03:03,300 Sure. 82 00:03:03,840 --> 00:03:07,219 So we often see how distance and travel 83 00:03:07,680 --> 00:03:08,979 can truly impact, 84 00:03:09,680 --> 00:03:12,560 our members being able to specifically access those 85 00:03:12,560 --> 00:03:13,060 services. 86 00:03:13,925 --> 00:03:15,305 Many of our parents, 87 00:03:15,844 --> 00:03:18,165 you know, contrary to popular belief, they are 88 00:03:18,165 --> 00:03:20,564 working, and it is challenging for them to 89 00:03:20,564 --> 00:03:21,305 get off, 90 00:03:21,605 --> 00:03:23,764 during the day. And so we have formed 91 00:03:23,764 --> 00:03:24,425 a partnership 92 00:03:24,724 --> 00:03:26,745 with the Virginia Healthcare Foundation 93 00:03:27,590 --> 00:03:30,009 to focus really on meeting the critical needs 94 00:03:30,069 --> 00:03:32,709 of behavioral health services for our youth in 95 00:03:32,709 --> 00:03:33,449 our communities 96 00:03:33,989 --> 00:03:35,769 especially in those rural communities. 97 00:03:36,949 --> 00:03:37,930 So we invested 98 00:03:38,789 --> 00:03:40,569 $2,500,000 99 00:03:40,955 --> 00:03:43,995 in the nurture NAM program. And specifically, that 100 00:03:43,995 --> 00:03:46,094 program through the Virginia Healthcare Foundation 101 00:03:46,875 --> 00:03:47,375 supports, 102 00:03:48,395 --> 00:03:50,254 the delivery of school based therapy, 103 00:03:51,435 --> 00:03:51,935 and 104 00:03:52,235 --> 00:03:55,290 the pipeline to actually grow the behavioral health 105 00:03:55,290 --> 00:03:56,270 provider workforce. 106 00:03:56,969 --> 00:03:59,370 We truly believe if we can provide that 107 00:03:59,370 --> 00:04:01,530 care in the schools while we have that 108 00:04:01,530 --> 00:04:02,430 captured audience, 109 00:04:02,889 --> 00:04:04,409 it's more effective. They don't have to worry 110 00:04:04,409 --> 00:04:07,129 about transportation. Many times the parents do not 111 00:04:07,129 --> 00:04:09,014 have to worry about taking off from work. 112 00:04:09,495 --> 00:04:11,594 We are able to be more effective. 113 00:04:12,055 --> 00:04:13,814 So in 2023, 114 00:04:13,814 --> 00:04:14,314 Humana, 115 00:04:14,854 --> 00:04:16,954 actually invested 500,000 116 00:04:17,495 --> 00:04:19,595 in that, and we will continue to invest 117 00:04:19,735 --> 00:04:21,915 each year as the program grows. 118 00:04:22,899 --> 00:04:25,540 I can also imagine having these resources in 119 00:04:25,540 --> 00:04:28,120 schools, you know, even parents aside and transportation 120 00:04:28,980 --> 00:04:31,300 access there. It's also easier to keep kids 121 00:04:31,300 --> 00:04:33,939 in schools and not have them physically leave 122 00:04:33,939 --> 00:04:35,160 that space too. 123 00:04:35,794 --> 00:04:38,454 You did mention growing the behavioral health workforce. 124 00:04:38,995 --> 00:04:41,495 So those challenges are prevalent across the country. 125 00:04:41,954 --> 00:04:44,034 Can you elaborate a bit more about what 126 00:04:44,034 --> 00:04:46,435 Humana Healthy Horizons in Virginia is doing to 127 00:04:46,435 --> 00:04:47,254 address this, 128 00:04:47,714 --> 00:04:49,875 especially when it comes to specialists for the 129 00:04:49,875 --> 00:04:50,375 population? 130 00:04:51,750 --> 00:04:54,550 So yes. So this particular grant, actually, the 131 00:04:54,550 --> 00:04:57,029 nurture now grant that we're working with, the 132 00:04:57,029 --> 00:04:57,850 Virginia Healthcare 133 00:04:58,230 --> 00:05:01,209 Foundation, not only is it providing the therapy 134 00:05:01,430 --> 00:05:02,250 in the schools, 135 00:05:02,709 --> 00:05:05,509 but then we are helping more practitioners to 136 00:05:05,509 --> 00:05:06,490 become licensed 137 00:05:07,245 --> 00:05:07,745 and 138 00:05:08,125 --> 00:05:10,384 then be able to get their practicum done 139 00:05:10,845 --> 00:05:11,985 while they are 140 00:05:12,365 --> 00:05:14,365 providing the therapy in the school. So they're 141 00:05:14,365 --> 00:05:15,105 working with, 142 00:05:15,645 --> 00:05:17,105 people who are already licensed, 143 00:05:18,605 --> 00:05:21,099 shadowing them, as well as starting to provide 144 00:05:21,099 --> 00:05:22,699 some of the therapies so that they can 145 00:05:22,699 --> 00:05:23,599 become licensed. 146 00:05:24,139 --> 00:05:25,120 And to date, 147 00:05:26,220 --> 00:05:27,439 they have been successful 148 00:05:28,220 --> 00:05:31,019 in really treating a total of over 1,200 149 00:05:31,019 --> 00:05:32,479 students at six schools 150 00:05:33,224 --> 00:05:36,104 and, providing 2,900 151 00:05:36,104 --> 00:05:37,164 behavioral health visits 152 00:05:37,544 --> 00:05:40,344 as well as medical visits. So that that 153 00:05:40,344 --> 00:05:41,245 has increased 154 00:05:41,625 --> 00:05:42,365 our ability 155 00:05:42,745 --> 00:05:45,625 to really reach more students with increasing the 156 00:05:45,625 --> 00:05:47,485 number of practitioners in schools. 157 00:05:48,800 --> 00:05:51,040 As a follow-up to that, I'm curious. What 158 00:05:51,040 --> 00:05:53,300 are you seeing in the long term 159 00:05:54,160 --> 00:05:54,660 with 160 00:05:55,120 --> 00:05:57,600 working with these providers and being able to 161 00:05:57,600 --> 00:05:59,540 build out a more robust base of providers? 162 00:06:00,400 --> 00:06:02,639 How are you seeing that interplay with other 163 00:06:02,639 --> 00:06:03,699 aspects of 164 00:06:04,014 --> 00:06:05,875 health care outcomes for youth? 165 00:06:06,175 --> 00:06:08,115 Is it changing utilization, 166 00:06:09,375 --> 00:06:11,395 cost? What are you seeing there? 167 00:06:12,415 --> 00:06:13,935 So, I mean, Liz, I think all of 168 00:06:13,935 --> 00:06:15,375 the above. I think that, you know, the 169 00:06:15,375 --> 00:06:17,810 metrics that we look at, yes, of course, 170 00:06:18,110 --> 00:06:20,269 is utilization. And when we say utilization, I 171 00:06:20,269 --> 00:06:21,949 know a lot of people think for managed 172 00:06:21,949 --> 00:06:24,769 care that's keeping people from utilizing the services. 173 00:06:25,149 --> 00:06:27,550 Quite the opposite. We really want people to 174 00:06:27,550 --> 00:06:30,209 utilize these services because when they do, 175 00:06:30,564 --> 00:06:33,524 we see the opportunity to identify other areas. 176 00:06:33,524 --> 00:06:36,564 It's not just behavior health. It's also their 177 00:06:36,564 --> 00:06:38,904 medical concerns, primary care concerns. 178 00:06:39,845 --> 00:06:42,004 And so we're able to do that. Then 179 00:06:42,004 --> 00:06:45,089 that has increased preventive care as well. We're 180 00:06:45,089 --> 00:06:47,189 seeing children receive more of their immunizations, 181 00:06:47,810 --> 00:06:49,029 their well child visits. 182 00:06:49,410 --> 00:06:51,649 It decreases anxiety. We are able to get 183 00:06:51,649 --> 00:06:52,149 people 184 00:06:52,850 --> 00:06:53,350 really 185 00:06:53,730 --> 00:06:56,149 off of medications if they don't need them 186 00:06:56,610 --> 00:06:58,550 or to improve compliance 187 00:06:59,115 --> 00:07:01,774 with their medication, which is also very important. 188 00:07:01,995 --> 00:07:04,714 We also measure things like days absent from 189 00:07:04,714 --> 00:07:05,214 school. 190 00:07:05,754 --> 00:07:07,675 We've seen a decrease in that for our 191 00:07:07,675 --> 00:07:08,175 children. 192 00:07:09,194 --> 00:07:10,894 More compliant with their schoolwork, 193 00:07:11,274 --> 00:07:14,310 being able to sit and listen and participate 194 00:07:14,449 --> 00:07:15,269 in the classroom. 195 00:07:15,730 --> 00:07:18,550 So it really has a very far reaching 196 00:07:18,610 --> 00:07:21,110 effect that, you know, when we think about 197 00:07:21,170 --> 00:07:21,670 sometimes 198 00:07:22,449 --> 00:07:25,194 just the health care, you're thinking only about, 199 00:07:25,194 --> 00:07:26,955 well, has it improved their mental status? Well, 200 00:07:26,955 --> 00:07:29,915 mental status really, you know, touches a lot 201 00:07:29,915 --> 00:07:32,314 of different points, improves the quality of life 202 00:07:32,314 --> 00:07:33,935 for not only the student, 203 00:07:34,395 --> 00:07:36,574 but the parents as well as the community. 204 00:07:37,670 --> 00:07:39,930 That's great to hear. And thinking more broadly, 205 00:07:40,149 --> 00:07:42,310 at least in the communities that you're serving, 206 00:07:42,310 --> 00:07:44,410 so I know you mentioned rural Virginia, 207 00:07:44,870 --> 00:07:47,110 what sorts of supports are most lacking for 208 00:07:47,110 --> 00:07:48,089 youth in Medicaid, 209 00:07:48,389 --> 00:07:50,310 and how is your team working to address 210 00:07:50,310 --> 00:07:51,050 those gaps? 211 00:07:52,415 --> 00:07:54,415 So, really, it is about the partnerships. You 212 00:07:54,415 --> 00:07:56,915 know, we we don't deliver direct care. 213 00:07:57,694 --> 00:07:59,235 It is through the support 214 00:07:59,694 --> 00:08:01,875 that we can provide to our providers, 215 00:08:02,495 --> 00:08:05,319 to our community partners that also touch the 216 00:08:05,319 --> 00:08:06,220 social determinants 217 00:08:06,680 --> 00:08:08,139 of health and social factors. 218 00:08:08,520 --> 00:08:10,920 So, yes, we need to grow the behavioral 219 00:08:10,920 --> 00:08:13,160 health pipeline of providers as well as our 220 00:08:13,160 --> 00:08:14,699 medical pipeline providers. 221 00:08:15,080 --> 00:08:17,339 But we also look at housing needs, 222 00:08:17,735 --> 00:08:19,194 food and nutrition needs. 223 00:08:19,574 --> 00:08:22,235 The transportation, again, is is very important. 224 00:08:22,535 --> 00:08:23,274 And so 225 00:08:24,055 --> 00:08:25,675 our initiatives focus, 226 00:08:26,214 --> 00:08:28,314 yes, on all of the health care needs, 227 00:08:28,615 --> 00:08:30,855 the benefits that we provide. We want to 228 00:08:30,855 --> 00:08:33,115 make sure that people understand those benefits, 229 00:08:33,450 --> 00:08:35,950 that they are availing themselves of those benefits. 230 00:08:36,649 --> 00:08:39,230 But we also look what are the barriers 231 00:08:39,290 --> 00:08:42,090 that are keeping people from utilizing those, from 232 00:08:42,090 --> 00:08:44,169 getting the services, and we try to fill 233 00:08:44,169 --> 00:08:46,590 in that gap. We have housing specialists 234 00:08:46,975 --> 00:08:49,154 that are not only looking for the particular 235 00:08:49,215 --> 00:08:49,715 partnerships, 236 00:08:50,174 --> 00:08:52,434 but then if someone has an immediate need. 237 00:08:52,815 --> 00:08:54,754 We work closely with the food pantries. 238 00:08:55,455 --> 00:08:58,014 We we've worked with our, food banks to 239 00:08:58,014 --> 00:08:59,955 look at the food as medicine initiatives. 240 00:09:00,790 --> 00:09:02,870 We have lots of baby care programs, and 241 00:09:02,870 --> 00:09:04,730 those baby care programs go beyond 242 00:09:05,429 --> 00:09:08,250 making sure that, our members are getting 243 00:09:08,790 --> 00:09:11,029 great prenatal care because that's really where it 244 00:09:11,029 --> 00:09:12,950 starts. We need to make sure that they're 245 00:09:12,950 --> 00:09:16,134 getting that care. But what's keeping them from 246 00:09:16,134 --> 00:09:18,214 receiving that care so that they can have 247 00:09:18,214 --> 00:09:19,595 a healthy birth outcome 248 00:09:19,894 --> 00:09:22,455 and also get connected to those services so 249 00:09:22,455 --> 00:09:25,195 that the children will continue to receive services 250 00:09:25,735 --> 00:09:26,235 throughout, 251 00:09:26,774 --> 00:09:27,995 their span of time? 252 00:09:28,980 --> 00:09:30,740 So as we wrap up, I would love 253 00:09:30,740 --> 00:09:32,580 to hear what advice you have for other 254 00:09:32,580 --> 00:09:34,519 industry leaders, particularly those 255 00:09:34,899 --> 00:09:36,440 in the Medicaid space, 256 00:09:36,820 --> 00:09:37,960 when it comes to 257 00:09:38,340 --> 00:09:38,840 handling 258 00:09:39,460 --> 00:09:42,259 issues with youth behavioral health and establishing those 259 00:09:42,259 --> 00:09:42,759 partnerships. 260 00:09:43,774 --> 00:09:45,934 One, I would say, really listen to your 261 00:09:45,934 --> 00:09:47,555 partners. Listen to the community, 262 00:09:48,815 --> 00:09:50,654 and your members. And, you know, when I 263 00:09:50,654 --> 00:09:51,315 say members, 264 00:09:51,615 --> 00:09:53,134 yes, it's important that we talk to the 265 00:09:53,134 --> 00:09:55,055 parents, but it's also important to talk to 266 00:09:55,055 --> 00:09:56,995 our youth and to understand 267 00:09:57,570 --> 00:09:59,169 what are the challenges. I mean, going to 268 00:09:59,169 --> 00:10:01,090 school today is a lot different. You know? 269 00:10:01,090 --> 00:10:02,789 I will say when we were in school, 270 00:10:03,090 --> 00:10:05,350 just even, you know, all the AI challenges, 271 00:10:05,809 --> 00:10:07,889 the social media, all the other things that 272 00:10:07,889 --> 00:10:10,049 will impact it. So we like to listen 273 00:10:10,049 --> 00:10:12,315 to, you know, what are they facing and 274 00:10:12,315 --> 00:10:14,495 how can we help? Where are the gaps? 275 00:10:15,274 --> 00:10:17,434 Start there, you know, whether you do focus 276 00:10:17,434 --> 00:10:19,915 groups or it's just a listening session. And, 277 00:10:19,915 --> 00:10:22,315 of course, our providers, what are they seeing 278 00:10:22,315 --> 00:10:24,669 in in the community? How can we decrease 279 00:10:24,669 --> 00:10:27,409 provider operation for them so that they can 280 00:10:27,549 --> 00:10:29,970 treat and see more of our members? 281 00:10:30,589 --> 00:10:32,429 So I would just say be really good 282 00:10:32,429 --> 00:10:32,929 stewards 283 00:10:33,389 --> 00:10:35,470 of what we've been entrusted, especially in the 284 00:10:35,470 --> 00:10:36,450 Commonwealth of Virginia, 285 00:10:36,990 --> 00:10:38,690 but also to be good partners, 286 00:10:39,565 --> 00:10:41,024 with all of our stakeholders. 287 00:10:42,205 --> 00:10:44,524 I absolutely love that point about making sure 288 00:10:44,524 --> 00:10:46,784 the youth voice is included and heard. 289 00:10:47,245 --> 00:10:49,565 Well, thank you so much, Linda, for chatting 290 00:10:49,565 --> 00:10:51,565 with us today. We really appreciate having you 291 00:10:51,565 --> 00:10:53,725 on. Thank you so much again for having 292 00:10:53,725 --> 00:10:54,225 me. 293 00:10:54,679 --> 00:10:56,279 And to our listeners, if you'd like to 294 00:10:56,279 --> 00:10:58,919 listen to more podcasts from Becker's Healthcare, you 295 00:10:58,919 --> 00:11:01,240 can visit beckershospitalreview.com. 296 00:11:01,240 --> 00:11:01,980 Thank you.