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upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast. Thrilled today to
be joined by Aaron Henderson Moore, who serves
as the president and CEO of Fidelis Care
of New Jersey.
Erin, thank you so much for taking the
time to be with me on the podcast
today.
Thank you so much for having me. Really
excited to be here. Likewise, Erin. We're excited
to dive into some important topics and hear
a little bit about what's been going on,
under your leadership at Fidelis of New Jersey.
But before we dive into that, just want
to,
have you fill in our audience on, who
you are, what your healthcare career background has
looked like, and if you could give everybody
a quick overview of what your current role
entails.
Yeah. Absolutely.
So as you mentioned, I serve as the
president and CEO of Fidelis Care of New
Jersey.
Fidelis Care is a Centene health plan,
supporting Medicaid,
Medicare, and marketplace. We also are really excited
about our large
long term services and supports population across the
state. So you'll hear me refer to that
that group as the LTSS
population.
So here in New Jersey, my role is
really about aligning access, affordability, and accountability
for our state, our members, our provider partners,
and really building teams
who can execute against that mission. So excited.
I've been here at Fidelis Care of New
Jersey almost three years, but not new to
the health care space. So prior
to Fidelis Care, I was at UnitedHealthcare
for six years. I led their
dual special needs plans in
DC and in Maryland, and I was really
excited to launch
the dual choice program
in DC, which is an integrated Medicare and
Medicaid plan really
aligned and designed to serve duals across the
state, and that was a really innovative program.
Prior to my time at UnitedHealthcare,
I've been in consulting.
I've worked,
in government programs my entire career. So spent
some time at DC Medicaid,
spent some time in consulting, and spent some
time in nonprofit management. But really excited,
to continue to be in the government program
space where I feel like
innovation is really key, and you need people
that are aligned to the mission,
and to the goals of of those specific
programs.
Wonderful. Well, Erin, like I said, we're we're
excited to get to talk with you today.
And let's stay on the topic of Medicaid.
Like you mentioned, you've been in this space
for a bit. You you've served,
this population for a long time, and you've
seen,
trends come and go in this space.
And so I I wanted to ask you
and get us started by talking a little
bit about,
what we've been hearing from Medicaid managed care
plans all over the country
these last few years.
Of course, in the face of everything going
on federally with Medicaid,
we're we're hearing from plans about rate adequacy
concerns on the state level,
increasing state scrutiny of how these dollars are
being managed by companies like yours.
So I wonder, you know, just given all
the context of what's going on policy wise
right now for Medicaid,
what's an issue that's that's keeping you up
at night in this space that isn't talked
about enough right now in the industry that
you don't think,
the the media is hitting on enough that
your colleagues don't touch on enough? What do
you wanna hear more about in Medicaid managed
care?
Yeah. Absolutely. I would say two,
two things keep me up at night.
The first is really integration. I think you're
starting to see a lot of integration of
programs that are not traditional clinical programs.
Two that I'll I'll talk about here are
behavioral health and housing.
You really we're starting to see
huge increases in spikes of behavioral health in
particular, but there is a link between those
two programs. And so you are seeing states
really work with the federal government
to move towards carbons of really making this
such an integral part of the managed care
experience.
Because what we're starting to see is that
we've so traditionally
focused on
physical health, but really where the the cost
are spiking are in behavioral health and how
do we make sure that people, especially if
behavioral health needs, can remain housed and housed
long term because that way we we know
where people are located and how to then
intervene with all the other parts of the
managed care experience,
to make sure that the people are receiving
the care that you need.
The second is really around
support for older adults and individuals with disabilities.
So you're seeing states do a lot,
leveraging the flexibility between their Medicare and their
Medicaid, but I you're gonna start to see
and you're gonna continue to see a lot
of focus on LTSS modernization
and focus for care of those continuity of
care and care for older adults and people
with disabilities in their homes.
You're gonna see that for a couple reasons.
One, we're just having an aging population.
Two,
the infrastructure
is not designed for people. We just don't
have the capacity
for people to be in facilities, and so
you're going to see this move away from
people meeting,
different environments to age safely in place. And
then thirdly, people just that's a better experience.
So,
I recently, you know, lost my parents, and
it was really important that they were able
to stay in their homes
and,
die with dignity and care in places that
are comfortable for them. And a lot of
times that means at home and putting services
around them. And so,
you're starting to see a lot of cost
again
at behavioral health services and nontraditional
clinical services to allow people to age in
place at home.
Well, I I'm very sorry to hear that
about about your parents, Erin, but thank you
for for sharing that with us, for connecting
that back to why it's so important to
continue to expand support for older adults, for
people with disabilities,
enrolled in these programs.
And and if we're sticking on this topic
in terms of,
everything going on right now in terms of,
Medicaid policy, of course, as you know,
a lot coming down the pipeline,
at the federal level, work requirements next year
across the country.
Nearby in New York, you've got the essential
plan rollback,
expired ACA enhanced subsidies at the end of
last year and, you know, stalling of any
kind of solution there in Congress. So just
a lot going on for for individuals like
yourself to be tracking. So I wonder, given
all of that, how are you navigating
member retention right now when when so many
coverage pathways
are shifting at once?
That's an amazing question, and the the answer
is we're using a multi pronged approach. We
have not
figured this out at, Fidelis Care, but we
are working you know, we haven't figured out
the bullet. Like, what what is the thing
that that keeps people connected to care, especially
with all the different things coming at them
in the news and social media and other
ways? But one of the things that I
would say is really working with the state
partners to make sure that the
information that we have is correct.
So, you know, one of the things is
we've traditionally relied on mailing addresses and mailing
things to people, but we're finding increasingly
across the entire span is that people get
their
information differently. So one thing that generally doesn't
change is email addresses, and so making sure
that we have up to date email addresses
for for people. Right? Like, stores have gotten
this,
down packed, and so figuring out how can
we leverage things that are that other part
of,
other retailers or other companies have really figured
out, email addresses being one of them. How
can we leverage text messages? It's one of
the things that we found is across our
population,
regardless of income and regardless of ages, people
have phones. And so how do we use
text message? And then how do we then
work with the data when we have the
data that's better or more,
more up to date than our state partners?
How do we figure out a way to
make sure that that data is being updated
in their systems and not being replaced by
daily eight thirty four eligibility files? So those
are three things that are just really, really
crucial
to making sure people stay connected to care.
The second is really making sure,
and I say second, but another thing is
really making sure that the state systems, because
that's where we get or federal systems if
we're talking about marketplace or,
Medicare, is making sure
our data has a redetermination
date. So right now, one of the things
that we don't have that date, right, so
the state is kind of reengineering how do
they give that date so that we're really
always kind of keeping up to date with
our members saying, don't forget to renew. Don't
forget, here's how you do it. Here's how
you can check the system. So really working
with our state partners to figure out ways
that we can
also have that date and so that there's
not this kind of I think it's around
this time,
and so that we can really,
walk our members through the process.
And finally, one of the things that we
would say is we think it's probably a
good idea for states to really be thinking
much more creatively in how plans
can,
help members
get connected to care. There's a lot of
really interesting and innovative,
partners,
vendors
that are doing really
cool work and and to use
a, you know, more colloquial term of doing
really innovative work, leveraging AI, leveraging all the
data that we have on our members. And
I think we need more flexibility in how
we work with those members to keep them
connected to care because what we're finding is
when there's gaps in care, it's more
expensive for the entire system
and it doesn't serve people well to be
disconnected. Right? So then now you're getting them
back to the system. There's more expense And
just that muscle,
it takes a while to get that kind
of muscle back of making sure people are,
you know, taking their medicine and going to
their doctor, and it causes a lot of
downstream impacts to the system.
Certainly. And I think that's such an interesting
point that you make there, Aaron, in terms
of we're hearing similar all over the country
from leaders like yourself in in terms of
get creative
in a time of of uncertainty for the
industry and and for some of your members.
Think outside the box and meet them where
they are, and really, I think, communicate differently
is what we're hearing around the country with
the members, with the state. And like you
said, get innovative with with how you're interacting
with them. And I think in that vein,
kinda going back to what you were saying
earlier about,
thinking outside the box outside the clinical box
and,
really going,
to address social determinants.
I know that Fidelis last year announced half
$1,000,000
in health equity grants
through this year for things like food security,
maternal health access,
expanding rural care access.
So, you know, those things are amazing. Talk
to us about the the business case here
for investing in social determinants work during what
we just talked about, during this period of
coverage instability for so many.
Yeah. Absolutely.
I think what it's really about getting upstream.
You know, what we are seeing
is that
a lot of the factors
driving
cost
in the system
is not the clinical cost. Clinical is a
is a reactionary.
It's a lagging indicator of of how people
are doing. And so one of the things
that we're really trying to do is really
get upstream
and really address social,
social determinants of health, housing instability,
behavioral health fragmentation,
and all the caregiving burden on families. So
if we don't up address those upstream levers,
the system will continue paying downstream
in the emergency department and long term care
institutional settings. So a lot of the grants
that we put up there, both at Centene
nationally and at Fidelis Care, is really
shifting spend upstream and not just lowering rates.
Right? Getting really creative,
you know, and really getting creative and paying
differently
to drive affordability in the system.
Well, it's great to hear. And I know
from our perspective, Centene has certainly been one
of the more innovative companies in terms of
how and where you decide to,
use social determinants,
grants,
equity grants. So wonderful to hear about that
at the New Jersey level as well, Aaron.
Before we go,
what else are we missing today? You've got
the ears of a lot of other Medicaid,
Medicare,
insurance leaders overall all over the country facing
similar dynamics as you. So,
final bits of advice that you'd share with
them.
Yeah. I would say two things. I think
we really need to focus
on integration.
I would you're you're seeing it in in
large
fragmentations
of the integration of
systems,
you know, large systems, Medicare and Medicaid, but
also medical, behavioral, social services, how that we
operationalize
those together.
And the second thing I would say,
is states are being asked
states are being asked for measurable outcomes, not
just access metrics or metrics. And so what
you're going to be seeing is that what
what states are asking what the federal government
is asking of states, what this federal government
is asking for providers, what the federal and
state governments are asking for their MCO partners.
That is changing. And so,
to me, you're gonna start to see
more data share sharing, more out come based
contracting both with our with the health plan
partners but also with our downstream partners. And
so I think you're going to see a
confluence or a mix of integration plus accountability
that will really define the next decade of
Medicaid or and and much larger government sponsored
programs. And I think you're starting to see
that really in the signals
at the federal level, but we're seeing it
local across the country how states are asking
more
integration,
person centered care, and how we think
about how we think about that to be
really differently. And that's not just how we
pay providers, but really how we drive accountability
in the system. So that's really what I
would think about. And then the last thing
I would just say, is really about this
population aging.
I think you're starting to see that across
the book of business, nonclinical
services
are driving the cost to Medicaid.
And so you'll really start to see that
demand continue to outpace
traditional physical health demands,
and we're gonna see people continue and we're
gonna need to continue to enable aging at
home. So lot of focus on that in
the next decade, and I'm really excited,
to kind of be at the table to
see how we continue to change,
Medicaid and and what we expect of the
program.
Wonderful. Well, it's some really great advice for
our audience, before we go. So, Erin, I
wanna thank you for taking the time to
sit down with me today and for sharing
your insights,
and everything about what's going on under your
leadership at Fidelis Care of New Jersey.
We really appreciate you taking the time. So
thank you. Thanks so much for having me.
Look forward to the next one. Absolutely. And
and to our listeners, if you'd like to
listen to more podcasts from Becker's Healthcare, you
can visit beckershospitalreview.com.