Hello, everyone. This is Jacob Emerson with the
Becker's Payor Issues podcast.
Thrilled today to be joined by doctor Sameer
Amin, who serves as chief medical officer at
LA Care Health Plan. Doctor Amin, thank you
so much for taking the time to be
with me on the podcast today. Thank you
very much for the invite. Always happy to
talk about these very,
complicated issues and get some education out to
the public and
strike up a a good conversation.
Absolutely. We're excited to have you here with
us and and like you said, to talk
about a really important topic. But before we
dive into that, can you first tell us
a little bit more about yourself, your background
in health care, and then what it is
that you do today at LA Care?
Happy to. So my name is Sameer Amin.
I'm the chief medical officer of LA Care.
I've been at LA Care for about three,
three and a half years.
I'm an interventional cardiologist by training. I got
into clinical leadership very early on in a
value based care,
delegated provider group and sort of grew into
the health plan space over time.
I've been doing this for for quite some
time. I've worked in the Medicare line of
business, the Medicaid line of business, and the
exchange line of business. Also worked on the
the start up space and have worked in
technology,
but now find myself
very deeply rooted,
in the community here in LA County,
working in a in a health plan that
has a publicly operated status.
We have about 2,700,000
members,
largely in the medical space, but also with
a Medicare Advantage line of business,
and an exchange line of business.
Understood.
Well, Samir, let's, let's talk about
Medicaid plans and what we've heard from them
over the years in terms of
investments for a long time now in social
determinants programming and initiatives,
a a a really diverse array of different
kinds of programs and initiatives all over the
country.
But I think when those investments
are made, have been made in the past,
they assume a stable member population, and and
they've been,
under a period where there's been more stability
than there is now. And I, I know
you know what I'm talking about. I know
our audience knows,
in terms of the context of HR one
and what's coming down the pipeline
next year all over the country,
all over the country and for Medi Cal,
of course, as well. A lot of big
changes there.
So talk to us a little bit about
how you main continuity
for SDOH interventions
when when you're facing large scale disenrollments,
when you know that,
there could be member major membership declines,
and these programs might not have had time
to work because, of course, you know, these
things, they take time. They're they are social
programs.
Some take decades. So talk to us about
how you're thinking about all of that.
Yeah. I mean,
clearly, there are unprecedented
challenges
to the safety net right now. There's a
lot of movement in the member populations, people
coming in and out of medical plans.
But I'll just take a step back and
say that, you know, though these may be
more challenges than we've seen in the past,
though there may be more memberships than we
are we are used to, in the Medi
Cal space, there's always,
you know, an in out for members. You
know, some members come in for a short
period of time,
and, you know,
they change locations, they change jobs, and they're
able to get their insurance in a different
way. And so there's always that ebb and
flow.
I think
taking out some of the noise of all
the the challenges on the horizon, whether they're
federal or state based,
And just coming back to the fact that
Medi Cal is always a population that
that has a lot of transitions in it.
We have to think about our social determinants
of health pop our social determinants of health
programs
as being more about building an infrastructure
than
individual programs for individual people.
So what do I mean by that?
Well,
we've utilized
our
population health pro our population health programming
and our community strategic investments,
the grants that we give,
the the model of care that we put
out through our community resource centers
to really build
stable programs
for whoever may need them.
And by doing that,
we gather the benefit for members, whether they're
in our programs for six months or they're
in our programs for twelve months or they're
they've been in Medi Cal for years.
And by building that infrastructure, we can actually
bolster the safety net,
in a way that's what I would call
durable.
And it also allows for us to maintain
an equity framework such that,
those who are disadvantaged
and are from a particular cultural or ethnic
background are seeing care in a way that
they can that they can, get more fluidly.
And so it's really, again, about building infrastructure
rather than targeted programs. It's also about collaborating
with local partners who are critical for the
community.
We work in tandem with them,
and allied groups to really drive efficiencies and
help prevent any confusion and,
allow for coordination of care in the community.
And when we do this, we're, again, able
to build,
an infrastructure for care, a health care ecosystem
that,
you know, will
last for years and not really be about
an individual member coming in and out of
the system. I hope that makes sense.
It does make sense. And I I I
think my natural follow-up to that, Sameer, would
be, you know, when you're building, when you're
investing in that infrastructure,
how are you making the case internally,
to to stakeholders within the health plan that
that's spending on SDOH on this infrastructure?
Is is how do you defend it? How
do you make sure that this is the
direction
you wanna keep going? And are there metrics
that you're using that demonstrate a return on
those investments,
to your internal stakeholders, to your board,
to whoever whoever else,
might need to know that these investments are
worthwhile?
I think, you know, at our plan, we're
perhaps slightly different because we are coming from
a public space.
And social determinants of health are core to
the safety net and to equity. They're they're
not really
discretionary things that we go after. We're a
public plan. We have no shareholders. Our return
on investment is measured
in our community thriving in developing better health
outcomes, reducing hospitalization.
These are all things that are, you know,
quantifiably
critical to showing a return on the dollars
we are, you know, sort of mindfully investing
as fiduciaries of the funds entrusted to us.
And so I think one is just the
fact that we're looking at it from a
lens as a as a public plan.
But I think to the other point, you
know, people oftentimes
look at returns on investment
as something that has a very long,
a very long bend to it. So, you
know, hey. You're gonna deliver on a heart
failure program. You're gonna deliver on an asthma
program.
Those decrease in readmissions or those that decrease
in cost of care is gonna potentially hit
for years down the line.
But some of the real
thorny social determinants of health that we're investing
in, that we're building that infrastructure that I
talked about, actually,
that's gonna make a measurable difference in a
much shorter period of time. Let's take housing,
for example, or food insecurity.
Those issues are
short term. If you can get somebody housed
and you can you can more easily get
them into care,
the benefit of that is actually going to
to accrue at a much earlier time. Same
thing with food insecurity. When somebody doesn't have
any food to eat, it's very hard to
get them to concentrate on closing care gaps
like getting their mammogram done or or getting
their colonoscopy done. And so
when when I look at the social determinants
of health that we're investing in, building infrastructure
on, creating durable process processes with our safety
net and with our community partners,
I'm thinking about things that, you know, actually
will have KPI or key performance index that's
gonna that's gonna shift in a very short
period of time. And so we've been able
to make a lot of those ROI calculations
and investments, understanding that whether a member is
with us for six months or a year
or five years,
that ultimately,
we will get back our investment,
in spades because there we're gonna be able
to bend that cost curve of health care
over time, and it won't take very long.
I'll also just point out that whether there
are quality care gaps that we're closing by
way of creating these
or putting in these investments
or it's decrease in emergency room usage or
inpatient usage
or it's just strain on our network.
We have to be holistic in how we
actually look at the metrics that we're looking
to improve,
because it's not necessarily gonna be the cost
of an admission always. It may be that,
you know, you improve quality,
and, you know,
you get better remuneration
from the government based on
improved performance in their quality based programs or
with their quality withhold.
Same thing with network that, you know, hey.
Listen. You know, we expand the network. We're
able to get people into care, in a
culturally competent way at a at a better
clip. It's gonna reduce all the grievances and
calls that we get, from members,
and we can have more efficient and more
productive staffing that way. And so it it's
really also about
finding the right metric
that actually shows the benefit of the good
investments that we want to make.
I'll also just, you know, in closing, point
out the fact that, you know, again, as
a public
plan that's holding the public trust, we also
have a very unique ROI.
Our,
board is made up of member representatives,
and member advocates,
and, you know, they hold us accountable for
not just the actual dollar amount that we
may be saving on total cost of care,
but also improvement on the community itself.
So as a plan as as, you know,
that publicly operated plan, it's on us. It's
our responsibility. It's our accountability
to be something more than an insurance company.
Absolutely. And I and I do appreciate that
clarification there, Sameer, for our audience in terms
of how this is all a bit different
for LA Care given that you are a
a publicly funded entity,
and how that kind of shakes out with
ROI and how you track all of this.
I think for our other health plan executives
listening in right
now, you know, many are not coming from
a public funding source, but they are still
as managed care organizations.
They are still stewards of a lot of
taxpayer dollars. And so I wonder what you
would say to them in terms of they
they might be tempted to deprioritize
social determinants,
programs entirely,
as they see their Medicaid budgets tighten either
within their state or because of what we're
seeing at the federal level. So what would
you say to a peer CMO who is
weighing these decisions right now,
either at an organization similarly structured as yours
or at at some of the larger,
nonprofits, publicly traded, just the the the gamut
of the different kinds of insurers that are
out there. Yeah. And I think whether you're
at a for profit health plan,
you're at a, you know, publicly traded one,
or you're at one that's government associated like
ours,
I think that the challenge is still the
same.
And that challenge is really to identify what
matters most to members.
What is really going to change the trajectory
of their care? And whether that person, again,
is in your program for
six months
or two years, that doesn't change
the value of the program that you're delivering.
And so I don't think that we can
be shortsighted to suggest, hey. Listen. There's a
lot of budgetary pressure right now.
And therefore, we're going to,
you know, abandon some of these long term
programs that actually deliver on better cost of
care for membership down the line. And so
I think it's less about, hey. We're gonna
abandon ship on these things that are gonna
bend that cost curve and more about finding
the highest yield programs that we can actually
invest in. And, you know, again, I'm I'm
a very practical person. For me, it's, you
know, I have a general sense as to,
like, what what we should actually be investing
in. You know, food is health. Housing is
health. You know, there's a number of very
important places where we can put our money
that are gonna make a very
quick,
change in the trajectory of the care for
our members. And I think it a lot
of it is about having the right analytics
to find the right folks who are gonna
benefit.
A lot of it is setting up the
right,
key performance indexes, the right metrics so that
you can actually watch the improvement.
And the third thing is just really being
very practical about what you're gonna invest in.
I would say that, you know, programs that
are disease management programs, oftentimes building a population
health infrastructure,
those things do take a ton of time
and the met you do need to have
some consistency with your membership
for those really to start benefiting members.
But if you're gonna just build build a
better community, if you're gonna invest in these
things,
that are very social determinant heavy, you're actually
gonna build a health a healthier health care
ecosystem
for the membership to reside in. And when
that happens,
there's benefit.
And, again, it can be very short term
in terms of the benefit that you're getting.
And even if and I I would also
encourage other CMOs to really look at, like,
what is the full gamut
of benefit that you're deriving?
Because it's not just, hey. Listen. There's gonna
be less hospitalizations.
It's a commitment to saying, hey. Listen. You
know, we are gonna actually reduce the vicious
cycle of having an inadequate network,
of having difficult access to care, of having,
you know, folks not being able to actually
access the care because they don't have a
home to live in.
And
having all those members
reach out to us by way of the
call center,
grievances,
appeals,
all the angry like, all that stuff is
a bunch of burden
administrative burden on the plan. It's not good
for members, not good for the plan. And
if you can cut that vicious cycle off
by creating that health, healthier health care ecosystem,
you can actually
have more efficiency and productivity at your actual
plan. So you have to wrap some of
those costs in to, hey. Listen. We're gonna
actually reduce complaints on our line for the
call center. We're gonna reduce appeals and grievances
that come in through the door. We're gonna
create, you know, a healthier flywheel here, and
we're gonna do that by way of significant
investments in network and social determinants of health.
And so you take that ROI into account
as well so that we're not just putting
Band Aids on problems and spending money on
administrative burden, but actually, again, making members healthier.
Nobody wants to spend their life in a
hospital or in a skilled nursing facility. They'd
rather get their their care earlier and upfront,
in a less expensive way. It's good for
members. It's good for the plan.
And when you can do that effectively
by making the right investments, the right time,
targeted to the right folks,
you can actually
significantly reduce costs
on the administrative side as well as on
the health care medical expense side.
Fantastic. Well, I think that's a great place
to leave things, Sameer. Some great bits of
advice there for our audience,
who are, you know, of course, facing similar,
challenges as you and,
a a lot
of a lot of, I think tough conversations
to come for plans all over the country.
So I wanna thank you for,
taking the time to chat with us about
this and offering some some really good strategies
on how to navigate,
how to navigate this industry over the the
coming year. Thank you very much. Appreciate it.
It's been a great conversation. I really appreciate
the time.
Absolutely. And to our listeners, if you'd like
to listen to more podcasts from Becker's Healthcare,
you can visit beckershospitalreview.com.