Latest / Becker’s Payer Issues Podcast / Advancing Culturally Competent Medicare Advantage with Karen Walker Johnson of Clever Care Health Plan

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Advancing Culturally Competent Medicare Advantage with Karen Walker Johnson of Clever Care Health Plan · Becker’s Payer Issues Podcast

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  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400
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  payer and health plan executives and more than
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  100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone, and welcome to the Becker's Healthcare
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  Podcast. I'm Scott King. Thrilled today to be
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  joined by a very special guest, Karen Walker
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  Johnson, chief executive officer of CleverCare Health Plan.
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  Karen, how are you doing today? Thanks so
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  much for joining us.
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  Thank you. Good morning, Scott, and it's a
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  pleasure to be here. Thank you. It's a
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  privilege to have you. And, you know, we
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  have a lot of big topics to get
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  to with health plans and and health care
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  as always, of course. But before I do
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  that, Karen, I was wondering if you just
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  kinda tell us a little bit about your
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  background and your, career.
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  Well, I'm happy to do that. First of
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  all, I'm Karen. I'm the chief executive officer
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  here at CleverCare.
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  I started my career actually,
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  in pediatric nursing back in in Detroit.
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  And at that time, had the opportunity to
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  see firsthand
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  a lot of the systemic barriers and and
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  just the lack of cultural understanding
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  that was unfortunately harmful to families. And so
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  since that time, I'm now leading CleverCare, and
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  we are a Medicare Advantage Plan,
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  which is,
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  delivering care from a culturally sensitive
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  and competent perspective. And for your readers who
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  may not be as familiar with that, basically,
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  what that is is that
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  we really take into account understanding
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  how patients' beliefs and their behaviors
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  and their background really influence
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  how they how they seek health and ultimately
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  what their health come outcomes look like. And
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  so as a growing plan we've got right
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  now, we've got approximately about 46,000
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  members.
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  We just had some pretty significant growth,
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  and, we are giving our members access to
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  care that's delivered in their own language.
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  We honor their unique cultural traditions,
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  and it's all from a value based care
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  model. So we're blending eastern and western medicine.
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  Well, I appreciate you sharing your background info
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  there, Karen. And it's great to hear about
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  CleverCare's growth. That's outstanding.
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  The the first the first topic I wanna
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  get your perspective on is I wanna ask,
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  how do you think
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  relationships are or how how is CleverCare's relationships
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  with providers changing, you know, as both sides
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  kind of face cost pressure and workforce shortages?
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  You know, we real realize and I realize
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  that our providers are managing quite a bit
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  right now, Scott.
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  So the best way for us as a
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  health plan
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  really to think about our relationship
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  is really to do it from what we've
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  always done. And that is really showing up
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  for them by being reliable,
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  by being transparent,
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  and at the end of the day, really
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  being a trustworthy partner. And I've been in
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  this business a very long time, and one
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  of the things that I know, my experience
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  has borne out, is that trust is so
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  critically important between a health plan and its
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  providers.
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  And so we're doing everything we can to
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  continue to build upon the trust we've already
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  established.
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  We are doing things like making sure that
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  the benefits that we offer
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  are stable and they're reliable and that our
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  providers can count on them being that way.
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  We know that it's really important that we
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  make sure that they get paid on time,
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  that they're paid accurately, that we are adjudicating
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  claims appropriately.
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  All of those things really
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  build and and just continue to build upon
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  that trust.
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  And for us, that that's what it means
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  to really help our providers manage through a
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  lot of the the cost pressures that you
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  mentioned and and some of what we're seeing
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  just around workforce. If we're one less thing
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  they have to worry about and they can
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  rely upon us, we believe that that's very
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  helpful.
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  Well, do you think on the other side
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  of that relationship, do you think that providers
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  also feel like health plans have a lot
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  going on right now too and they're they're
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  kinda understanding of that? Is that a two
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  way street right now? Yeah. I do believe
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  that. And and, again, I think that's based
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  on
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  developing that trusting and mutual and respectful
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  relationship.
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  And so my providers, you know, they say
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  sit down with us and say, what can
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  we do collaboratively
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  to address some of these these these, you
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  know, headwinds that we all see. One of
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  the examples would be, we employ
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  people on our teams who reach out and
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  do outreach to our members. You know, what
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  we're trying to do with our providers and
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  our providers recognize that that's a benefit for
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  them. Right? That we're reaching out to their
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  patients. We're doing it in collaboration with them,
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  and we're doing it in alignment with what
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  the physician thinks is important for their patient.
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  But that's one way that we are helping
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  each other.
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  And so
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  they may not have that that,
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  that person, if you will, on their payroll,
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  but
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  we do. And so we are sharing the
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  responsibility
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  and the accountability
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  all within mind, making sure that that member
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  and their patient gets the best outcome.
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  Yeah. I think that collaboration and and understanding
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  goes a long way right now with both
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  sides. And, Taryn, I also want to ask
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  you, where do you see the biggest gap
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  today between payer strategy and operational execution?
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  Well, one of the ones that I would
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  identify is just,
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  goes back to, like, the core of what
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  CleverCare is, and that is
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  not
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  viewing
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  the cultural needs
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  of their membership
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  as something more than just an extra.
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  So for example, our, you know, our members
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  have access to providers who speak their language,
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  and they understand their cultural traditions.
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  That's essential
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  for them to get the care.
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  And so it's fundamental to our model of
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  care. So we have this very large network
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  that includes, you know,
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  the top provider facilities and hospitals.
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  We have bilingual physicians.
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  We've got,
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  acupuncturists that we directly contract with. And so
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  all of that is something that is addressing
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  that gap where plans that are not
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  viewing the cultural needs of their members as
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  something that's essential.
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  Another example I would say is the partnerships
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  that you have with with your vendors. And
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  and in our case, I'm gonna use nation's
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  benefits as an example.
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  That's one where we are able to
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  through our work with nations, we've added
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  culturally tailored supermarket benefits.
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  And that's important because it supports the needs
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  of our local communities.
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  You know, when when they think about the
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  foods that they wanna cook and and the
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  herbal medicines,
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  etcetera, that they want to take.
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  By us enhancing
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  the
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  access through nation's benefit with these national stores
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  like a Costco or
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  ninety nine Ranch market, which may not be
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  as familiar to your listeners. But it is
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  a very
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  big national chain for us in our communities.
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  And so those are the types of things
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  that we're focused on. Again, you know, when
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  you get back to your question about what
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  is a gap that you're we're seeing with
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  payer strategies in their operational excellence,
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  It is thinking about
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  those benefits that are key to meet their
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  members, where their members are, and it's also
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  making sure that that strategy that you're doing
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  is aligned
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  with how you execute in practice. And for
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  us, again, it is being able to offer
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  things like
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  the foods that,
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  are important
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  to our membership
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  because we're recognizing those cultural needs that they
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  have.
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  What's one investment or initiative you believe will
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  most reshape how health plans operate over the
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  next two to three years?
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  I think it's how we continue to engage
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  members
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  and knowing and recognizing that engagement really drives
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  everything.
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  So for us, it, you know, it means
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  that
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  members are able to access their care in
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  their own language.
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  It means that they're able to be engaged
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  in a way that they are getting that
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  care that coincides with the way they're actually
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  living.
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  We've got, for example, these community centers. We've
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  got four community centers. And those community centers,
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  Scott, are in
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  communities that we're serving, but those community centers
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  are built around cultural competence.
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  They help to connect our members with the
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  communities so that
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  those members feel that they can stay in
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  control of their health.
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  Those those centers, they have and offer a
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  blend of of western approaches to wellness as
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  well as eastern. And so our members can
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  go into those into those centers, and they
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  can do things like take a tai chi
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  class, for example. Right. And,
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  participate in in a course on dental health.
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  We do things that build the community. So
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  we invite people to come in for things
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  like a book club or a birthday celebration.
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  All of that, again, is time to engagement,
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  and that's an investment and an initiative that's
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  really important for a health plan. It allows
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  that health plan to to continue to grow,
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  but more importantly, it allows them to continue
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  to help their members get the best health
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  outcomes.
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  You know, we recently as I think about
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  it, we recently brought on two new provider
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  partners,
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  one being,
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  Blue Zones Health, and the other is is
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  CareMore Health. And the reason we did that
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  is because both of those groups
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  really align with our philosophy around the blend
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  of eastern and western medicine,
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  around holistic care. Blue Zones, for example, you
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  know, is really focused on lifestyle changes and
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  longevity practices, and that's fairly important
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  in in in our membership.
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  CareMore, for example, is, you know, a very
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  large primary care practice, but they really are
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  committed to some of the core values that
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  CleverCare is. That is caring for people from
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  a whole person perspective
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  and not just whatever their ultimate condition is.
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  And so our our members
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  are benefiting by these initiatives and these investments
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  that we're making in the community, and I
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  think that's something that other health plans will
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  have to do as well.
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  Yeah. I think they might have to adjust.
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  Now, Karen, if you could change one
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  regulatory or industry industry practice tomorrow to improve
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  affordability and access,
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  what would it be and why?
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  Wow.
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  That's a great question.
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  You know?
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  I I guess I would say that if
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  if I if I only had one thing.
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  You can you can throw out two if
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  you want. But, yeah, let's let's hit one
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  first if you can.
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  Well, if I go back to my, you
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  know, my start in in my career as
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  a nurse,
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  you know, one of the priorities that I
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  found and I was a public health nurse
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  as well, Scott. One of the things that
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  was really important was what could we do
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  to help keep our patients healthy even when
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  they had lots of challenges?
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  So when I think about something that would
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  be, I think, a really beneficial change, it
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  would be you know, this we have the
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  STARS program, and it's really a helpful way
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  to help ensure that health plans are are
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  delivering on the promise to focus on the
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  right thing. But
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  those star programs don't measure cultural competence.
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  And so what I'd like to see would
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  be a quality metric in star ratings that
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  accounts for
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  the the additional resources that a plan like
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  ours uses. If, for example, our community centers,
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  I'd like to see that be something that's
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  measured
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  so that we could
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  ensure that resources are there to serve, you
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  know, diverse and linguistically
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  isolated populations like ours,
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  that we have the ability to continue to
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  make sure that we have bilingual providers in
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  our network,
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  that we can offer
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  health education that really is tailored to
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  populations that have maybe different needs.
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  So if I could have a crystal ball
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  and say that's something that could be,
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  a a change or an ad, that would
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  be it. Okay. I think that's a good
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  one.
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  And the last the last question I have
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  for you, Karen,
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  what issue do you think is putting the
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  most pressure
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  on health plan margins right now,
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  and how are you responding differently in 2026?
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  Well, I I can't speak for the industry
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  as a whole, but I can say that,
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  you know, we've seen cost cost, excuse me,
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  grow up across the industry. You know?
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  Everyone is is aware of that. And the
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  way we've been able to deal with that,
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  Scott, is by doing, you know, what we've
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  been doing best and that's
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  providing, you know, cost effective
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  care. So, you know, we work very closely
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  with our members. We're making sure that they're
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  getting the right care, that they they can
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  stay healthy,
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  and all of that will help to reduce
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  cost.
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  And it also, more importantly, I think, improves
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  health outcomes.
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  You know, this year, we're investing in in
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  strengthening our our provider partnerships. We think that's
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  a really important investment.
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  We're investing in clinical programs that help us
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  to identify and engage our high risk members.
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  You know, that's that gets back to population
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  health and really looking at populations
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  as opposed to just looking at, you know,
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  your membership, you know, from a a very,
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  myopic way.
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  We're also,
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  really keeping in mind that rather than kinda
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  cutting our benefits or narrowing our network
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  in response to some of those margin pressures,
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  we're able to maintain our commitment to those
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  stable benefits. Gets back to what I said
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  to you earlier about the trust that we've
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  established with providers. We've also established trust in
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  the marketplace
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  as a whole despite the fact that we
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  know that there are some, you know,
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  some pressures around around cost and margins,
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  but we're still maintaining and staying true to,
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  you know, our North Star. And that being
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  that we wanna be able to provide stable
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  benefits.
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  We wanna make sure that we can continue
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  to expand so that we can provide access
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  to culturally appropriate care. And, ultimately, we think
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  that gives
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  and fosters healthier communities.
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  Absolutely. I think that focus will go a
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  long way, and and hopefully others can adapt
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  like that. Karen, thank you so much for
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  joining the podcast and and for a great
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  conversation. I look forward to working with you
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  again soon. Thank you as well, Scott. You
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  have a really good day. You too.