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
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upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. This is Elizabeth Caslow with the
Becker's Payer Issues podcast.
I'm thrilled today to be joined by Linda
Hines, Virginia's Medicaid market president for Humana.
Linda, thank you so much for chatting with
us today.
Good morning, Liz. Thank you so much for
having me today.
Of course.
So before we dive in, can you tell
us a bit more about yourself, your health
care career backgrounds, and your current role at
Humana?
Absolutely.
So I always like to start off by
saying I am a nurse by background.
I, I'm a registered nurse, and that's where
I started my career, mostly on the provider
side and, hospital space. I had an opportunity
to join,
Medicaid managed care specifically,
oh my goodness, back in 1996, so it's
been thirty years ago.
Joined a very small health plan that was
really just in the Central Virginia market at
that time. We had only had about 3,000
members.
And, I actually joined them managing their medical
management department,
continued to stay with them, progressed,
through the ranks to become the vice president
of clinical services, which encompassed
everything clinical,
pharmacy, quality,
care management, credentialing,
and and stayed in that role for about
sixteen years,
then moved into a chief operating role, then
to CEO of that health plan.
When I left that health plan, we actually
had grown from that 3,000 that we started
with to well over 380,000
members.
Went to another health plan, was the president
of, the Virginia Medicaid market,
the dual special needs.
And then now I am at Humana
as the plan president specifically
for the Health and Horizons, which is Medicaid
and
our integrated dual special needs plan.
So,
you know, that's quite a journey. I know
I often get asked, how did you move
from clinical, so to speak, into the more
administrative? But I do think that it all
fits together.
That clinical experience really shaped,
my experience to move more into the operations
piece, and I think having that I'm more
of an effective leader in this space at
this time.
Yeah. That makes a lot of sense. So
today, we're gonna chat a bit about your
market's youth behavioral health efforts.
And schools are a cornerstone of those efforts
from what I've been reading. Can you elaborate
a bit on your partnerships and initiatives taking
place in those settings?
Sure.
So we often see how distance and travel
can truly impact,
our members being able to specifically access those
services.
Many of our parents,
you know, contrary to popular belief, they are
working, and it is challenging for them to
get off,
during the day. And so we have formed
a partnership
with the Virginia Healthcare Foundation
to focus really on meeting the critical needs
of behavioral health services for our youth in
our communities
especially in those rural communities.
So we invested
$2,500,000
in the nurture NAM program. And specifically, that
program through the Virginia Healthcare Foundation
supports,
the delivery of school based therapy,
and
the pipeline to actually grow the behavioral health
provider workforce.
We truly believe if we can provide that
care in the schools while we have that
captured audience,
it's more effective. They don't have to worry
about transportation. Many times the parents do not
have to worry about taking off from work.
We are able to be more effective.
So in 2023,
Humana,
actually invested 500,000
in that, and we will continue to invest
each year as the program grows.
I can also imagine having these resources in
schools, you know, even parents aside and transportation
access there. It's also easier to keep kids
in schools and not have them physically leave
that space too.
You did mention growing the behavioral health workforce.
So those challenges are prevalent across the country.
Can you elaborate a bit more about what
Humana Healthy Horizons in Virginia is doing to
address this,
especially when it comes to specialists for the
population?
So yes. So this particular grant, actually, the
nurture now grant that we're working with, the
Virginia Healthcare
Foundation, not only is it providing the therapy
in the schools,
but then we are helping more practitioners to
become licensed
and
then be able to get their practicum done
while they are
providing the therapy in the school. So they're
working with,
people who are already licensed,
shadowing them, as well as starting to provide
some of the therapies so that they can
become licensed.
And to date,
they have been successful
in really treating a total of over 1,200
students at six schools
and, providing 2,900
behavioral health visits
as well as medical visits. So that that
has increased
our ability
to really reach more students with increasing the
number of practitioners in schools.
As a follow-up to that, I'm curious. What
are you seeing in the long term
with
working with these providers and being able to
build out a more robust base of providers?
How are you seeing that interplay with other
aspects of
health care outcomes for youth?
Is it changing utilization,
cost? What are you seeing there?
So, I mean, Liz, I think all of
the above. I think that, you know, the
metrics that we look at, yes, of course,
is utilization. And when we say utilization, I
know a lot of people think for managed
care that's keeping people from utilizing the services.
Quite the opposite. We really want people to
utilize these services because when they do,
we see the opportunity to identify other areas.
It's not just behavior health. It's also their
medical concerns, primary care concerns.
And so we're able to do that. Then
that has increased preventive care as well. We're
seeing children receive more of their immunizations,
their well child visits.
It decreases anxiety. We are able to get
people
really
off of medications if they don't need them
or to improve compliance
with their medication, which is also very important.
We also measure things like days absent from
school.
We've seen a decrease in that for our
children.
More compliant with their schoolwork,
being able to sit and listen and participate
in the classroom.
So it really has a very far reaching
effect that, you know, when we think about
sometimes
just the health care, you're thinking only about,
well, has it improved their mental status? Well,
mental status really, you know, touches a lot
of different points, improves the quality of life
for not only the student,
but the parents as well as the community.
That's great to hear. And thinking more broadly,
at least in the communities that you're serving,
so I know you mentioned rural Virginia,
what sorts of supports are most lacking for
youth in Medicaid,
and how is your team working to address
those gaps?
So, really, it is about the partnerships. You
know, we we don't deliver direct care.
It is through the support
that we can provide to our providers,
to our community partners that also touch the
social determinants
of health and social factors.
So, yes, we need to grow the behavioral
health pipeline of providers as well as our
medical pipeline providers.
But we also look at housing needs,
food and nutrition needs.
The transportation, again, is is very important.
And so
our initiatives focus,
yes, on all of the health care needs,
the benefits that we provide. We want to
make sure that people understand those benefits,
that they are availing themselves of those benefits.
But we also look what are the barriers
that are keeping people from utilizing those, from
getting the services, and we try to fill
in that gap. We have housing specialists
that are not only looking for the particular
partnerships,
but then if someone has an immediate need.
We work closely with the food pantries.
We we've worked with our, food banks to
look at the food as medicine initiatives.
We have lots of baby care programs, and
those baby care programs go beyond
making sure that, our members are getting
great prenatal care because that's really where it
starts. We need to make sure that they're
getting that care. But what's keeping them from
receiving that care so that they can have
a healthy birth outcome
and also get connected to those services so
that the children will continue to receive services
throughout,
their span of time?
So as we wrap up, I would love
to hear what advice you have for other
industry leaders, particularly those
in the Medicaid space,
when it comes to
handling
issues with youth behavioral health and establishing those
partnerships.
One, I would say, really listen to your
partners. Listen to the community,
and your members. And, you know, when I
say members,
yes, it's important that we talk to the
parents, but it's also important to talk to
our youth and to understand
what are the challenges. I mean, going to
school today is a lot different. You know?
I will say when we were in school,
just even, you know, all the AI challenges,
the social media, all the other things that
will impact it. So we like to listen
to, you know, what are they facing and
how can we help? Where are the gaps?
Start there, you know, whether you do focus
groups or it's just a listening session. And,
of course, our providers, what are they seeing
in in the community? How can we decrease
provider operation for them so that they can
treat and see more of our members?
So I would just say be really good
stewards
of what we've been entrusted, especially in the
Commonwealth of Virginia,
but also to be good partners,
with all of our stakeholders.
I absolutely love that point about making sure
the youth voice is included and heard.
Well, thank you so much, Linda, for chatting
with us today. We really appreciate having you
on. Thank you so much again for having
me.
And to our listeners, if you'd like to
listen to more podcasts from Becker's Healthcare, you
can visit beckershospitalreview.com.
Thank you.