1 00:00:02,240 --> 00:00:04,980 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 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:33,649 --> 00:00:36,289 Hi, everyone. This is Elizabeth Cassello with the 14 00:00:36,289 --> 00:00:37,989 Becker's Payer Issues podcast. 15 00:00:38,530 --> 00:00:40,129 I'm so thrilled today to be joined by 16 00:00:40,129 --> 00:00:43,090 Melanie Fernando, CEO of Aetna Better Health of 17 00:00:43,090 --> 00:00:43,590 Illinois. 18 00:00:44,024 --> 00:00:46,125 Melanie, thanks so much for joining us today. 19 00:00:46,505 --> 00:00:48,104 Hi. Thank you for having me. Excited to 20 00:00:48,104 --> 00:00:48,765 be here. 21 00:00:49,225 --> 00:00:49,965 Of course. 22 00:00:50,344 --> 00:00:52,184 So before we jump in and chat a 23 00:00:52,184 --> 00:00:54,664 bit more about your collaboration with Electra Health, 24 00:00:54,664 --> 00:00:56,265 can you tell us a bit more about 25 00:00:56,265 --> 00:00:56,765 yourself 26 00:00:57,120 --> 00:00:58,960 and your health care career background and what 27 00:00:58,960 --> 00:01:01,460 you currently do, in your role now? 28 00:01:02,560 --> 00:01:04,959 Sure. So I have been the CEO of 29 00:01:04,959 --> 00:01:06,420 Aetna Better Health of Illinois 30 00:01:06,719 --> 00:01:09,040 since October. So I'm nearly stepping into the 31 00:01:09,040 --> 00:01:11,305 role, and it's truly an honor and privilege 32 00:01:11,305 --> 00:01:13,084 to lead our Aetna plan in Medicaid. 33 00:01:13,625 --> 00:01:15,245 I've been with Aetna Medicaid 34 00:01:15,704 --> 00:01:17,865 since 2020, and prior to that was with 35 00:01:17,865 --> 00:01:21,545 another Illinois Medicaid managed care organization. And really 36 00:01:21,545 --> 00:01:22,204 my health 37 00:01:22,579 --> 00:01:25,000 career has been focused on Medicaid. So 38 00:01:25,380 --> 00:01:28,740 before joining industry, I was in government sponsored 39 00:01:28,740 --> 00:01:29,880 program consulting, 40 00:01:30,420 --> 00:01:33,319 working with both health care providers and payers 41 00:01:33,700 --> 00:01:35,000 really to optimize 42 00:01:35,775 --> 00:01:38,575 programs for the Medicaid population, whether that be 43 00:01:38,575 --> 00:01:39,715 healthcare transformation, 44 00:01:40,495 --> 00:01:41,314 cost optimization, 45 00:01:42,015 --> 00:01:45,635 optimizing revenue, process improvement, etcetera. And really, 46 00:01:46,015 --> 00:01:48,495 I wanted to focus my career on government 47 00:01:48,495 --> 00:01:50,755 sponsored programs and particularly Medicaid 48 00:01:51,370 --> 00:01:54,270 because growing up, I was a first generation 49 00:01:55,049 --> 00:01:57,849 daughter of of immigrant parents and all of 50 00:01:57,849 --> 00:01:59,709 our family, except for my immediate, 51 00:02:00,170 --> 00:02:02,670 are still in a developing nation. So experience 52 00:02:02,810 --> 00:02:03,549 a lot of 53 00:02:04,604 --> 00:02:05,344 just material 54 00:02:06,125 --> 00:02:07,825 challenges with access to care, 55 00:02:08,604 --> 00:02:11,324 subsequent health care issues because of that, and 56 00:02:11,324 --> 00:02:13,164 it really took a toll on just, you 57 00:02:13,164 --> 00:02:16,044 know, the overall family and their ability to 58 00:02:16,044 --> 00:02:18,789 to live healthy and fulfilling lives. So seeing 59 00:02:18,789 --> 00:02:20,949 that growing up, but then also seeing that 60 00:02:20,949 --> 00:02:22,870 happening, you know, in our own backyard in 61 00:02:22,870 --> 00:02:24,169 the most developed nation 62 00:02:24,469 --> 00:02:26,969 in the world, it it was shocking. So 63 00:02:27,030 --> 00:02:28,629 that really was a call to action to 64 00:02:28,629 --> 00:02:31,125 me. And, also, you know, my father and 65 00:02:31,125 --> 00:02:32,965 my brother all work in the health care 66 00:02:32,965 --> 00:02:34,164 industry as well. So I think we all 67 00:02:34,164 --> 00:02:35,704 just felt called to 68 00:02:36,084 --> 00:02:38,164 work in a an industry that could make 69 00:02:38,164 --> 00:02:38,745 a difference 70 00:02:39,044 --> 00:02:40,424 for those who need it most. 71 00:02:41,284 --> 00:02:43,500 Thank you for giving us some background there. 72 00:02:44,060 --> 00:02:46,300 So just for our listeners, today, we're gonna 73 00:02:46,300 --> 00:02:48,060 be chatting a little bit more about your 74 00:02:48,060 --> 00:02:50,780 organization's work with Electra Health, which is a 75 00:02:50,780 --> 00:02:53,120 virtual menopause and midlife care provider. 76 00:02:53,419 --> 00:02:55,419 So, Melanie, can you walk us through how 77 00:02:55,419 --> 00:02:58,235 this collaboration came to be, who initiated it, 78 00:02:58,235 --> 00:03:00,814 and what stakeholder needs it's meant to address? 79 00:03:01,675 --> 00:03:03,614 Sure. So as a part of our normal 80 00:03:04,155 --> 00:03:06,634 course of business process, we're always looking at 81 00:03:06,634 --> 00:03:08,974 analyzing our data and trying to understand 82 00:03:09,275 --> 00:03:12,074 our members and our populations better. So we 83 00:03:12,074 --> 00:03:13,375 were taking a look at 84 00:03:13,810 --> 00:03:14,310 what 85 00:03:14,610 --> 00:03:15,830 areas or demographics 86 00:03:16,210 --> 00:03:18,849 in our membership are largely unaddressed. Where are 87 00:03:18,849 --> 00:03:21,490 we seeing health care needs popping up that 88 00:03:21,490 --> 00:03:23,750 don't have a solution? And so through that 89 00:03:23,889 --> 00:03:27,224 data analysis, we did identify that particularly in 90 00:03:27,224 --> 00:03:29,305 women's health, there was an opportunity to build 91 00:03:29,305 --> 00:03:30,764 out more robust programming. 92 00:03:31,145 --> 00:03:33,084 And that's where a focus on the, 93 00:03:34,025 --> 00:03:34,525 perimenopausal, 94 00:03:34,905 --> 00:03:35,805 but then menopausal 95 00:03:36,264 --> 00:03:38,745 kind of age range of women came up 96 00:03:38,745 --> 00:03:39,965 as not having 97 00:03:40,310 --> 00:03:43,849 a very robust pro programmatic solution. And about, 98 00:03:44,629 --> 00:03:47,669 fifty one percent of the Illinois population is 99 00:03:47,669 --> 00:03:50,489 women, and every at every stage of life. 100 00:03:50,629 --> 00:03:52,810 And we found that only about eight percent 101 00:03:53,189 --> 00:03:53,930 of women 102 00:03:54,229 --> 00:03:54,889 in the, 103 00:03:55,485 --> 00:03:55,985 menopausal 104 00:03:56,365 --> 00:03:57,185 age range 105 00:03:57,805 --> 00:04:00,685 seek any sort of treatment or seek to 106 00:04:00,685 --> 00:04:02,685 understand their symptoms, which is just a a 107 00:04:02,685 --> 00:04:03,905 very low percentage, 108 00:04:04,844 --> 00:04:07,564 given that every woman, you know, eventually reaches 109 00:04:07,564 --> 00:04:09,185 that age range. And menopause 110 00:04:09,485 --> 00:04:10,305 and perimosal 111 00:04:10,889 --> 00:04:11,389 perimenopausal 112 00:04:11,849 --> 00:04:14,590 symptoms aren't widely talked about, 113 00:04:15,770 --> 00:04:16,750 just in the 114 00:04:17,290 --> 00:04:20,730 health care education space either. So it's kind 115 00:04:20,730 --> 00:04:22,810 of like a silent suffering and and no 116 00:04:22,810 --> 00:04:24,410 one talks about it. And that also was 117 00:04:24,410 --> 00:04:26,170 a part of the conversation we had with 118 00:04:26,170 --> 00:04:29,425 our our doctors was what opportunities can we 119 00:04:29,425 --> 00:04:31,664 have to just create public awareness about a 120 00:04:31,664 --> 00:04:34,625 condition, again, that every woman faces, but, 121 00:04:35,104 --> 00:04:37,264 and oftentimes have very little support. So that's 122 00:04:37,264 --> 00:04:39,610 when we started looking out into the the 123 00:04:39,610 --> 00:04:42,009 landscape to see, what types of solutions are 124 00:04:42,009 --> 00:04:43,470 available. We found Elektra, 125 00:04:44,169 --> 00:04:46,329 talked to Janine, and there was a a 126 00:04:46,329 --> 00:04:46,829 fantastic 127 00:04:47,689 --> 00:04:49,529 solution that was available that kind of checked 128 00:04:49,529 --> 00:04:51,209 all the boxes of what we're looking for, 129 00:04:51,209 --> 00:04:52,029 something that, 130 00:04:52,495 --> 00:04:54,115 offered clinician support. 131 00:04:54,495 --> 00:04:56,355 So, you know, evidence based medicine, 132 00:04:56,814 --> 00:04:59,855 we could actually have electronic office visits. So 133 00:04:59,855 --> 00:05:03,295 accessible. There are, multiple languages offered, and there's 134 00:05:03,295 --> 00:05:05,610 a lot of, high touch support. So coaching 135 00:05:05,610 --> 00:05:08,009 that was available as well as education, which, 136 00:05:08,009 --> 00:05:09,629 again, I think is important because, 137 00:05:10,889 --> 00:05:13,149 just from our, surveys with members, 138 00:05:14,089 --> 00:05:15,550 there's definitely an opportunity, 139 00:05:15,930 --> 00:05:18,990 especially in the Medicaid population, for understanding 140 00:05:19,595 --> 00:05:21,355 the symptoms and what they mean about women's 141 00:05:21,355 --> 00:05:21,855 bodies. 142 00:05:22,634 --> 00:05:24,235 Yeah. And I wanna ask about some of 143 00:05:24,235 --> 00:05:26,475 those, gaps with women's health you see in 144 00:05:26,475 --> 00:05:28,875 the Medicaid population in a minute. But since 145 00:05:28,875 --> 00:05:31,435 talking to Elektra CEO, Janine, who you mentioned 146 00:05:31,435 --> 00:05:33,675 earlier, what was the timeline for rolling out 147 00:05:33,675 --> 00:05:34,335 this initiative? 148 00:05:35,339 --> 00:05:37,599 Sure. So, typically, what we do is 149 00:05:38,139 --> 00:05:38,639 a 150 00:05:39,019 --> 00:05:42,139 one month or so assessment process to just 151 00:05:42,139 --> 00:05:44,379 really understand the vendors. That's kind of like 152 00:05:44,379 --> 00:05:45,819 a meet and greet, getting to know the 153 00:05:45,819 --> 00:05:48,714 solution. And then the the contracting process usually 154 00:05:48,714 --> 00:05:50,634 takes anywhere from three to four months because 155 00:05:50,634 --> 00:05:52,654 we really wanna do our due diligence on 156 00:05:52,875 --> 00:05:54,814 identifying the right control population, 157 00:05:55,915 --> 00:05:59,355 creating a program that's meaningful in terms of 158 00:05:59,355 --> 00:05:59,855 guaranteeing 159 00:06:00,235 --> 00:06:01,535 outcomes and 160 00:06:02,009 --> 00:06:04,649 ensuring the proper coverage of services for our 161 00:06:04,649 --> 00:06:06,110 members and ease of utilization. 162 00:06:06,490 --> 00:06:08,970 So that part is probably the most time 163 00:06:08,970 --> 00:06:09,470 intensive. 164 00:06:09,930 --> 00:06:12,089 And then we actually get into implementation, which 165 00:06:12,089 --> 00:06:13,709 might be anywhere from, you know, 166 00:06:14,024 --> 00:06:16,345 sixty to ninety days depending on how much 167 00:06:16,345 --> 00:06:18,524 technology has to be set up, data sharing, 168 00:06:19,225 --> 00:06:19,964 and then ultimately, 169 00:06:20,504 --> 00:06:23,305 setting up outreach modalities as well. So all 170 00:06:23,305 --> 00:06:25,485 in all, I would say around a year 171 00:06:25,625 --> 00:06:27,564 to go through the end to end process, 172 00:06:27,625 --> 00:06:29,649 and then we launch the program. 173 00:06:30,750 --> 00:06:32,990 So what early usage data and trends have 174 00:06:32,990 --> 00:06:35,310 you been seeing with member engagement in terms 175 00:06:35,310 --> 00:06:36,529 of adding these resources? 176 00:06:38,029 --> 00:06:40,875 So far, our leading indicators have been just 177 00:06:41,115 --> 00:06:44,154 click throughs into the ads. So we do 178 00:06:44,154 --> 00:06:46,415 a a broader marketing campaign. 179 00:06:46,954 --> 00:06:48,795 And so it's it's still a little early 180 00:06:48,795 --> 00:06:50,014 because we just launched, 181 00:06:50,875 --> 00:06:53,134 about a a month or two ago. 182 00:06:54,209 --> 00:06:56,370 But we are looking at digital engagement. So 183 00:06:56,370 --> 00:06:58,129 we are starting to see a ramp up 184 00:06:58,129 --> 00:07:00,209 in the number of users who are opening 185 00:07:00,209 --> 00:07:02,209 up on the text messages that are going 186 00:07:02,209 --> 00:07:04,470 out, the emails that are going out, etcetera. 187 00:07:04,849 --> 00:07:06,789 And my hope is we we typically 188 00:07:07,089 --> 00:07:07,910 like to see 189 00:07:08,235 --> 00:07:11,194 above a 30% engagement rate in a Medicaid 190 00:07:11,194 --> 00:07:11,694 population. 191 00:07:12,394 --> 00:07:13,935 Medicaid is, historically 192 00:07:14,634 --> 00:07:15,454 and currently 193 00:07:15,834 --> 00:07:16,574 the hardest 194 00:07:16,954 --> 00:07:19,615 population to reach because of, you know, evolving, 195 00:07:20,394 --> 00:07:21,454 contact information. 196 00:07:21,754 --> 00:07:24,319 And some people are transient and they, 197 00:07:24,960 --> 00:07:25,460 lose 198 00:07:26,080 --> 00:07:28,800 phones, things like that. Their addresses change because 199 00:07:28,800 --> 00:07:30,980 they're changing to live with family members. 200 00:07:31,439 --> 00:07:31,939 So 201 00:07:32,639 --> 00:07:33,540 30% 202 00:07:33,839 --> 00:07:36,375 floor, I would say. But if we exceed 203 00:07:36,375 --> 00:07:38,314 that, then it's a home run. 204 00:07:39,254 --> 00:07:41,175 So how do you plan to address those 205 00:07:41,175 --> 00:07:44,475 technological and logistical barriers? Also, just thinking about 206 00:07:44,615 --> 00:07:46,214 the age range of people who may be 207 00:07:46,214 --> 00:07:47,274 using these services, 208 00:07:47,759 --> 00:07:50,080 and what are some long term indicators you're 209 00:07:50,080 --> 00:07:52,420 going to look to as this program progresses? 210 00:07:53,439 --> 00:07:56,160 So we always think an omnichannel approach to 211 00:07:56,160 --> 00:07:57,220 any kind of communication 212 00:07:57,600 --> 00:07:59,839 modality of a new solution. So to your 213 00:07:59,839 --> 00:08:01,540 point about the age range, 214 00:08:02,314 --> 00:08:04,814 anywhere from 40 to 64 is typically, 215 00:08:05,514 --> 00:08:06,415 that perimenopausal 216 00:08:07,754 --> 00:08:10,395 or menopausal age group. So we expect some 217 00:08:10,395 --> 00:08:12,574 technological adoption. And so email, 218 00:08:13,435 --> 00:08:14,814 tends to be the highest, 219 00:08:15,460 --> 00:08:17,960 rate modality followed closely by text message. 220 00:08:18,420 --> 00:08:21,480 And so we're constantly using skip tracing vendors, 221 00:08:22,259 --> 00:08:24,819 data scrub and data integrity vendors to try 222 00:08:24,819 --> 00:08:26,759 to get the latest contact information. 223 00:08:27,245 --> 00:08:29,585 We're also just building in checkpoints 224 00:08:29,964 --> 00:08:30,785 in every, 225 00:08:31,165 --> 00:08:33,245 channel in which a member can interact with 226 00:08:33,245 --> 00:08:35,485 us. So it could include whenever a member 227 00:08:35,485 --> 00:08:38,205 calls in, we ask them for updated contact 228 00:08:38,205 --> 00:08:40,910 information. Whenever they log in to the member 229 00:08:40,910 --> 00:08:43,330 portal, there's a prompt that asks them for 230 00:08:43,470 --> 00:08:46,029 updated information, so on and so forth. So 231 00:08:46,029 --> 00:08:47,789 always trying to just have a pulse on 232 00:08:47,789 --> 00:08:50,830 that directly with our members. But then, also, 233 00:08:50,830 --> 00:08:52,610 again, trying to do different 234 00:08:53,144 --> 00:08:55,965 outreaches is key. So in addition to digital, 235 00:08:56,345 --> 00:08:58,445 we do have a lot of community events 236 00:08:58,745 --> 00:08:59,884 and some that are 237 00:09:00,185 --> 00:09:02,985 more geared towards women. We have, things like 238 00:09:02,985 --> 00:09:04,285 baby showers where 239 00:09:05,320 --> 00:09:08,600 whole families come and, typically, again, it's large 240 00:09:08,600 --> 00:09:11,480 groups of women. So we add, our women's 241 00:09:11,480 --> 00:09:13,799 health programs to those types of events as 242 00:09:13,799 --> 00:09:15,799 well. So then we get that in person 243 00:09:15,799 --> 00:09:18,120 component in the community. We have community based 244 00:09:18,120 --> 00:09:20,059 partners where we can drop off flyers, 245 00:09:20,674 --> 00:09:22,695 QR codes, things like that. 246 00:09:23,154 --> 00:09:25,315 And then also we have our care management 247 00:09:25,315 --> 00:09:27,794 staff. So our care managers are actually staff 248 00:09:27,794 --> 00:09:28,294 that, 249 00:09:29,875 --> 00:09:33,394 work closely with our higher acuity membership. And 250 00:09:33,394 --> 00:09:35,620 so they have a higher touch program and 251 00:09:35,620 --> 00:09:36,519 are able to, 252 00:09:37,059 --> 00:09:39,460 actually interface with members on a more frequent 253 00:09:39,460 --> 00:09:42,040 basis. So they too can share information, 254 00:09:43,059 --> 00:09:45,860 more regularly because they're in more regular contact 255 00:09:45,860 --> 00:09:48,600 with, our our members, and they're able to 256 00:09:48,815 --> 00:09:51,214 tell them about new programs because that's another 257 00:09:51,214 --> 00:09:53,855 thing. There are different programs for different types 258 00:09:53,855 --> 00:09:56,174 of people. We don't wanna overwhelm our members. 259 00:09:56,174 --> 00:09:57,615 We wanna make sure that they get the 260 00:09:57,615 --> 00:09:58,115 right 261 00:09:58,495 --> 00:10:01,054 fit for their condition in life. And so 262 00:10:01,054 --> 00:10:02,899 that's why as a part of our, 263 00:10:03,360 --> 00:10:05,919 communication strategy, we're also just always looking at 264 00:10:05,919 --> 00:10:09,059 better understanding how we can make those communications 265 00:10:09,360 --> 00:10:11,360 more tailored to the individual. And I think 266 00:10:11,360 --> 00:10:12,500 that's just a movement 267 00:10:12,879 --> 00:10:14,740 overall, right, in terms of, 268 00:10:15,735 --> 00:10:19,014 communications and, all industries is how do we 269 00:10:19,014 --> 00:10:20,695 use our data? How do we even look 270 00:10:20,695 --> 00:10:21,355 at AI 271 00:10:21,815 --> 00:10:24,215 to, tailor that messaging to make sure we're 272 00:10:24,215 --> 00:10:26,235 fulfilling member interests and member needs? 273 00:10:27,029 --> 00:10:29,990 How do you plan to translate those findings 274 00:10:29,990 --> 00:10:32,309 with the marketing efforts, the early marketing efforts 275 00:10:32,309 --> 00:10:34,709 you have going, and also eventually your care 276 00:10:34,709 --> 00:10:35,209 insights 277 00:10:35,750 --> 00:10:39,190 into broader quality improvement or care coordination programs 278 00:10:39,190 --> 00:10:40,169 that y'all host? 279 00:10:41,245 --> 00:10:43,245 So we are able to take, 280 00:10:43,884 --> 00:10:46,605 care insights. Meaning, we can, from the coaching 281 00:10:46,605 --> 00:10:48,625 sessions that Elektra has, 282 00:10:49,004 --> 00:10:50,304 take, and process, 283 00:10:50,764 --> 00:10:52,945 qualitative and quantitative information 284 00:10:53,429 --> 00:10:54,629 to be able to then, 285 00:10:55,509 --> 00:10:57,529 create a a more or less a profile 286 00:10:57,589 --> 00:10:59,029 for the member. So we already have a 287 00:10:59,029 --> 00:11:01,769 profile based on just their health care, 288 00:11:02,629 --> 00:11:04,870 setting utilization data. And so then we can 289 00:11:04,870 --> 00:11:06,975 build upon it whether they cite that maybe 290 00:11:06,975 --> 00:11:08,894 they have a health related social need. Maybe 291 00:11:08,894 --> 00:11:09,554 they have, 292 00:11:10,254 --> 00:11:10,754 symptoms, 293 00:11:11,774 --> 00:11:14,414 outside of the realm of menopause that need 294 00:11:14,414 --> 00:11:17,375 to be unaddressed that haven't been historically. Maybe 295 00:11:17,375 --> 00:11:19,794 they have, an ask for a multilingual, 296 00:11:21,089 --> 00:11:23,009 care manager, or they want to engage in 297 00:11:23,009 --> 00:11:25,570 care management and don't know how. So it 298 00:11:25,570 --> 00:11:28,049 depends on the type of feedback, but, really, 299 00:11:28,370 --> 00:11:30,929 this is the, the benefit of having different 300 00:11:30,929 --> 00:11:33,625 types of partners that are connecting with our 301 00:11:33,625 --> 00:11:36,504 different member demographics is they can take different 302 00:11:36,504 --> 00:11:40,044 approaches and their own unique engagement strategies 303 00:11:40,424 --> 00:11:42,824 to obtain information that can just, again, better 304 00:11:42,824 --> 00:11:45,964 help us tailor our programming for membership. So, 305 00:11:46,679 --> 00:11:49,179 when it comes to, for instance, trying to, 306 00:11:49,720 --> 00:11:53,000 close HEDIS care gaps, which ultimately translate into 307 00:11:53,000 --> 00:11:55,340 improved quality scores and health plan ratings, 308 00:11:55,799 --> 00:11:58,919 again, another a key barrier to being able 309 00:11:58,919 --> 00:12:01,555 to do that is effectively communicating with our 310 00:12:01,555 --> 00:12:03,815 members, help them appreciate the importance 311 00:12:04,195 --> 00:12:06,514 of, you know, going to get certain screenings 312 00:12:06,514 --> 00:12:08,695 or going to certain health care visits. So 313 00:12:08,754 --> 00:12:10,514 when we have partners who are able to 314 00:12:10,514 --> 00:12:12,855 build trust through care navigation, 315 00:12:13,634 --> 00:12:14,455 through coaching, 316 00:12:14,870 --> 00:12:17,669 It just improves the overall member experience and 317 00:12:17,669 --> 00:12:19,289 engagement in all of our programs. 318 00:12:20,389 --> 00:12:22,970 And how are you expecting to see ROI 319 00:12:23,110 --> 00:12:24,089 on this initiative? 320 00:12:25,589 --> 00:12:27,764 Some of through which I I already mentioned, 321 00:12:27,764 --> 00:12:30,565 just the improved member engagement. Improved member engagement 322 00:12:30,565 --> 00:12:31,384 leads to, 323 00:12:32,404 --> 00:12:34,184 health plan, member retention. 324 00:12:34,804 --> 00:12:37,524 It leads to, again, higher engagement in all 325 00:12:37,524 --> 00:12:40,164 required activities, whether that be contractual with the 326 00:12:40,164 --> 00:12:41,225 state or, 327 00:12:42,329 --> 00:12:45,350 quality improvement initiatives. It improves likelihood 328 00:12:45,809 --> 00:12:47,909 of our members going to PCP visits. 329 00:12:48,210 --> 00:12:50,389 There's a very clear link between, 330 00:12:50,769 --> 00:12:53,090 our members going to their PCP and and 331 00:12:53,090 --> 00:12:55,730 regular scheduled health appointments and their ultimate health 332 00:12:55,730 --> 00:12:56,230 outcomes, 333 00:12:57,585 --> 00:12:58,325 just regular 334 00:12:58,784 --> 00:13:02,325 engagement in programming, whether it be virtual visits, 335 00:13:02,784 --> 00:13:06,384 virtual coaching, or even digesting and reading through 336 00:13:06,384 --> 00:13:08,804 and engaging in kind of gamified 337 00:13:09,184 --> 00:13:10,004 health education 338 00:13:10,610 --> 00:13:12,870 is all linked back to better engagement 339 00:13:13,330 --> 00:13:15,430 in the health care system and better understanding 340 00:13:15,490 --> 00:13:17,750 of how to manage health. And so 341 00:13:18,129 --> 00:13:20,389 we see and track ROI 342 00:13:20,769 --> 00:13:22,930 on just the for the members that are 343 00:13:22,930 --> 00:13:26,205 actually using the platform and, you know, engaging 344 00:13:26,205 --> 00:13:26,945 with Electra, 345 00:13:27,644 --> 00:13:29,004 what how do we see, 346 00:13:29,404 --> 00:13:31,964 their usage of the health care system change? 347 00:13:31,964 --> 00:13:33,745 Do we find that previously, 348 00:13:34,524 --> 00:13:37,085 they were not seeking care at all or 349 00:13:37,085 --> 00:13:38,764 only seeking care once a year in the 350 00:13:38,764 --> 00:13:41,759 emergency room for non acute conditions. And now 351 00:13:41,759 --> 00:13:45,120 they're actually feeling empowered through Electra and through 352 00:13:45,120 --> 00:13:46,740 being able to trust the clinician 353 00:13:47,200 --> 00:13:48,500 to start to see others 354 00:13:48,879 --> 00:13:50,960 and, go to their PCP visit, for instance. 355 00:13:50,960 --> 00:13:53,200 So we do have some criteria, you know, 356 00:13:53,200 --> 00:13:55,575 in our contracts that speak to what we 357 00:13:55,575 --> 00:13:57,274 would expect to see for, 358 00:13:57,735 --> 00:13:59,274 members who engage in the platform. 359 00:14:00,455 --> 00:14:03,034 Absolutely. That makes a lot of sense. So 360 00:14:03,095 --> 00:14:05,334 what other opportunities are you seeing in women's 361 00:14:05,334 --> 00:14:07,115 health for Medicaid right now, 362 00:14:07,629 --> 00:14:09,570 but also other life stage conditions? 363 00:14:10,269 --> 00:14:12,289 And where else are you looking to next? 364 00:14:13,070 --> 00:14:14,269 That is a great question. 365 00:14:14,750 --> 00:14:16,750 The sky is the limit in terms of 366 00:14:16,750 --> 00:14:17,409 of opportunity. 367 00:14:18,190 --> 00:14:20,350 I think, one thing that we're continuing to 368 00:14:20,350 --> 00:14:21,970 dive in and focus on 369 00:14:22,535 --> 00:14:23,675 is not to 370 00:14:24,695 --> 00:14:26,695 reiterate or reemphasize the same thing over and 371 00:14:26,695 --> 00:14:29,175 over again, but just that unable to reach 372 00:14:29,175 --> 00:14:31,654 population. That has always been kind of the 373 00:14:31,654 --> 00:14:32,715 Achilles' heel 374 00:14:33,335 --> 00:14:35,595 of, Medicaid payer organizations 375 00:14:35,975 --> 00:14:38,320 and that they tend to have 376 00:14:38,779 --> 00:14:39,279 the, 377 00:14:40,299 --> 00:14:44,059 lowest performing health outcomes. But because of life 378 00:14:44,059 --> 00:14:45,360 condition and circumstances, 379 00:14:46,220 --> 00:14:49,179 they're the harder or hardest to reach and 380 00:14:49,179 --> 00:14:50,959 hardest to engage. So, 381 00:14:51,495 --> 00:14:54,215 that continues to be a focus where, you 382 00:14:54,215 --> 00:14:54,715 know, 383 00:14:55,174 --> 00:14:58,634 they might only be receiving care in inpatient 384 00:14:58,695 --> 00:15:01,254 or emergency room and have never seen a 385 00:15:01,254 --> 00:15:03,514 primary care physician or a specialist. 386 00:15:04,080 --> 00:15:06,559 So we're continuing to explore and test and 387 00:15:06,559 --> 00:15:08,420 experiment different, again, modalities 388 00:15:08,879 --> 00:15:09,700 of how to, 389 00:15:10,639 --> 00:15:11,620 reach and engage, 390 00:15:12,000 --> 00:15:13,139 this type of person. 391 00:15:13,600 --> 00:15:16,180 Additionally, we're in terms of women's health, 392 00:15:17,205 --> 00:15:19,384 Chicago is one of the most disproportionately 393 00:15:20,325 --> 00:15:22,345 impacted areas in terms of, 394 00:15:22,964 --> 00:15:27,144 maternal child, and infant morbidity morbidity and mortality. 395 00:15:27,284 --> 00:15:29,605 And so women's health in terms of the 396 00:15:29,605 --> 00:15:30,585 maternal population 397 00:15:31,230 --> 00:15:32,450 continues to be a focus. 398 00:15:33,149 --> 00:15:36,450 The TANF or, in Illinois, it's called NDCA 399 00:15:36,830 --> 00:15:39,230 population, which is moms and babies, tends to 400 00:15:39,230 --> 00:15:41,330 make up a significant portion of Medicaid 401 00:15:41,789 --> 00:15:42,769 in any state. 402 00:15:43,085 --> 00:15:45,404 And so it's a continued focus in an 403 00:15:45,404 --> 00:15:47,164 area where, again, we're continuing to try to 404 00:15:47,164 --> 00:15:49,804 learn and test different types of solutions. And 405 00:15:49,804 --> 00:15:52,845 Illinois has been extremely progressive in expanding access 406 00:15:52,845 --> 00:15:56,225 to care for moms. So they've, recently covered 407 00:15:56,559 --> 00:15:59,860 doulas under Medicaid, lactation consultants, midwives, 408 00:16:00,480 --> 00:16:02,720 which is fantastic, and we're really excited about 409 00:16:02,720 --> 00:16:04,639 that. So we've been looking at solutions that 410 00:16:04,639 --> 00:16:06,180 can you continue to expand, 411 00:16:07,120 --> 00:16:08,340 those types of nontraditional 412 00:16:08,800 --> 00:16:09,300 services 413 00:16:09,985 --> 00:16:11,904 and really see if that helps build trust 414 00:16:11,904 --> 00:16:12,644 and engagement. 415 00:16:13,585 --> 00:16:15,585 Outside of that, we're just continuing to look 416 00:16:15,585 --> 00:16:17,924 at where are there, again, gaps 417 00:16:18,465 --> 00:16:20,085 in, health care 418 00:16:20,544 --> 00:16:22,085 engagement and or 419 00:16:22,409 --> 00:16:24,809 outcomes performance. So if we're seeing that, you 420 00:16:24,809 --> 00:16:27,389 know, a certain age group, for instance, children 421 00:16:27,929 --> 00:16:28,429 ages 422 00:16:28,889 --> 00:16:31,610 18 to 30 aren't going to their well 423 00:16:31,610 --> 00:16:34,089 child visits and we're seeing that, again, more 424 00:16:34,089 --> 00:16:36,110 care is being sought in acute settings. 425 00:16:36,835 --> 00:16:38,674 That's an area where we're looking to fill 426 00:16:38,674 --> 00:16:41,014 the gap and and create a program. So, 427 00:16:41,715 --> 00:16:44,034 I'd say, again, it's really based on what 428 00:16:44,034 --> 00:16:46,115 we're seeing in the current state and our 429 00:16:46,115 --> 00:16:49,235 populations are continuing to change. Right? We we 430 00:16:49,235 --> 00:16:50,294 just went through 431 00:16:50,600 --> 00:16:53,340 the post, public health emergency redetermination 432 00:16:53,800 --> 00:16:54,300 where, 433 00:16:54,840 --> 00:16:56,600 a lot of people lost coverage and, 434 00:16:57,320 --> 00:16:58,620 we're seeing the membership 435 00:16:59,160 --> 00:17:01,399 and the, health care trends shift a little. 436 00:17:01,399 --> 00:17:04,440 And, I anticipate that's gonna continue as we 437 00:17:04,440 --> 00:17:05,960 see some of the other changes that have 438 00:17:05,960 --> 00:17:08,815 come through federal policy as well. So just 439 00:17:08,815 --> 00:17:10,275 keeping a pulse on that. 440 00:17:11,055 --> 00:17:13,775 But really our intent and objective is to 441 00:17:13,775 --> 00:17:16,275 have true population health programming 442 00:17:16,734 --> 00:17:18,974 for every age and every stage. I actually, 443 00:17:19,214 --> 00:17:20,115 one of my 444 00:17:20,809 --> 00:17:22,750 friends from, a health care 445 00:17:23,369 --> 00:17:24,829 provider said from 446 00:17:25,210 --> 00:17:27,769 twinkle to wrinkle, which I absolutely loved. I 447 00:17:27,769 --> 00:17:31,150 hadn't heard that that terminology before. But, surely, 448 00:17:31,210 --> 00:17:33,309 every age in life, every, 449 00:17:33,984 --> 00:17:36,164 acuity stage across the continuum, 450 00:17:36,704 --> 00:17:39,025 whether you're walking well or whether you have 451 00:17:39,025 --> 00:17:40,005 a chronic condition, 452 00:17:40,464 --> 00:17:43,125 we're looking to have a tailored solution for 453 00:17:43,825 --> 00:17:46,325 every kind of subgroup that we can identify. 454 00:17:46,544 --> 00:17:47,044 So 455 00:17:47,349 --> 00:17:48,869 that's the aim. That's what we're continuing to 456 00:17:48,869 --> 00:17:50,649 focus on and, of course, all tied 457 00:17:51,190 --> 00:17:53,929 to value and tied to improving health outcomes. 458 00:17:54,789 --> 00:17:56,569 I've also never heard that terminology 459 00:17:56,869 --> 00:17:59,109 either, but, that's a really interesting way to 460 00:17:59,109 --> 00:17:59,769 put it. 461 00:18:00,755 --> 00:18:02,115 I would love to hear if you have 462 00:18:02,115 --> 00:18:03,255 any final thoughts, 463 00:18:03,715 --> 00:18:06,035 or advice for other industry leaders, you know, 464 00:18:06,035 --> 00:18:08,695 in Medicaid or even beyond as they navigate 465 00:18:08,755 --> 00:18:09,735 these types of solutions. 466 00:18:11,235 --> 00:18:13,029 Yeah. Yeah. Definitely. I mean, I would say 467 00:18:13,109 --> 00:18:14,549 and I think many of us or most 468 00:18:14,549 --> 00:18:16,069 of us know this. There really is no 469 00:18:16,069 --> 00:18:18,630 one size fits all. Medicaid is such a 470 00:18:18,630 --> 00:18:21,450 unique population, and there are so many exacerbated 471 00:18:21,829 --> 00:18:24,410 social needs layered throughout that, 472 00:18:24,869 --> 00:18:27,434 many approaches that work for other lines of 473 00:18:27,434 --> 00:18:29,755 business and insurance don't work for the Medicaid 474 00:18:29,755 --> 00:18:31,274 population. And so we all just need to 475 00:18:31,274 --> 00:18:33,674 be cognizant of that and continue to tailor 476 00:18:33,674 --> 00:18:35,054 our solutions to include 477 00:18:35,434 --> 00:18:37,694 cultural competence, building trust, 478 00:18:38,075 --> 00:18:40,920 meeting members where they are in the modalities 479 00:18:40,980 --> 00:18:43,539 that they prefer, and not assuming that we 480 00:18:43,539 --> 00:18:45,240 know them, but truly having, 481 00:18:46,099 --> 00:18:50,019 responsive bidirectional feedback channels that allow us to 482 00:18:50,019 --> 00:18:50,519 understand 483 00:18:51,299 --> 00:18:53,220 the current state of our members and how 484 00:18:53,220 --> 00:18:55,240 they wanna engage. And then offering 485 00:18:55,904 --> 00:18:58,244 nimble platforms that are self-service, 486 00:18:58,625 --> 00:19:01,265 but also high touch where needed. So again, 487 00:19:01,265 --> 00:19:04,225 it's really all all centered on simplifying the 488 00:19:04,225 --> 00:19:05,045 member experience, 489 00:19:05,904 --> 00:19:08,625 enabling our members to feel empowered and taking 490 00:19:08,625 --> 00:19:10,085 control of their health care. 491 00:19:10,630 --> 00:19:13,349 And that really just leads to success all 492 00:19:13,349 --> 00:19:13,849 around. 493 00:19:14,230 --> 00:19:15,529 So that would be 494 00:19:15,990 --> 00:19:16,490 my 495 00:19:16,869 --> 00:19:19,130 advice for industry leaders is, 496 00:19:19,589 --> 00:19:22,650 even if something has existed for thirty years, 497 00:19:23,234 --> 00:19:25,315 if it hasn't worked the way you wanted 498 00:19:25,315 --> 00:19:27,634 it to, sometimes you just have to dismantle 499 00:19:27,634 --> 00:19:28,855 it and rebuild it. 500 00:19:29,474 --> 00:19:31,315 Well, thank you so much, Melanie, for joining 501 00:19:31,315 --> 00:19:33,174 us today. This was such a great conversation. 502 00:19:33,875 --> 00:19:36,009 Thank you for having me. It was fun 503 00:19:36,009 --> 00:19:36,750 to participate, 504 00:19:37,450 --> 00:19:40,569 and I hope everyone derives some value from 505 00:19:40,569 --> 00:19:41,710 from a part of it. 506 00:19:42,089 --> 00:19:42,910 Oh, absolutely. 507 00:19:43,450 --> 00:19:45,130 And to our listeners, if you'd like to 508 00:19:45,130 --> 00:19:47,529 listen to more podcasts from Becker's Healthcare, you 509 00:19:47,529 --> 00:19:49,769 can visit beckershospitalreview.com. 510 00:19:49,769 --> 00:19:50,509 Thank you.