Latest / Becker’s Payer Issues Podcast / Melanie Fernando on Expanding Women’s Health Access at Aetna Better Health of Illinois

Transcript

Melanie Fernando on Expanding Women’s Health Access at Aetna Better Health of Illinois · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
• 0:10
  payer and health plan executives and more than
• 0:13
  100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George w
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hi, everyone. This is Elizabeth Cassello with the
• 0:36
  Becker's Payer Issues podcast.
• 0:38
  I'm so thrilled today to be joined by
• 0:40
  Melanie Fernando, CEO of Aetna Better Health of
• 0:43
  Illinois.
• 0:44
  Melanie, thanks so much for joining us today.
• 0:46
  Hi. Thank you for having me. Excited to
• 0:48
  be here.
• 0:49
  Of course.
• 0:50
  So before we jump in and chat a
• 0:52
  bit more about your collaboration with Electra Health,
• 0:54
  can you tell us a bit more about
• 0:56
  yourself
• 0:57
  and your health care career background and what
• 0:58
  you currently do, in your role now?
• 1:02
  Sure. So I have been the CEO of
• 1:04
  Aetna Better Health of Illinois
• 1:06
  since October. So I'm nearly stepping into the
• 1:09
  role, and it's truly an honor and privilege
• 1:11
  to lead our Aetna plan in Medicaid.
• 1:13
  I've been with Aetna Medicaid
• 1:15
  since 2020, and prior to that was with
• 1:17
  another Illinois Medicaid managed care organization. And really
• 1:21
  my health
• 1:22
  career has been focused on Medicaid. So
• 1:25
  before joining industry, I was in government sponsored
• 1:28
  program consulting,
• 1:30
  working with both health care providers and payers
• 1:33
  really to optimize
• 1:35
  programs for the Medicaid population, whether that be
• 1:38
  healthcare transformation,
• 1:40
  cost optimization,
• 1:42
  optimizing revenue, process improvement, etcetera. And really,
• 1:46
  I wanted to focus my career on government
• 1:48
  sponsored programs and particularly Medicaid
• 1:51
  because growing up, I was a first generation
• 1:55
  daughter of of immigrant parents and all of
• 1:57
  our family, except for my immediate,
• 2:00
  are still in a developing nation. So experience
• 2:02
  a lot of
• 2:04
  just material
• 2:06
  challenges with access to care,
• 2:08
  subsequent health care issues because of that, and
• 2:11
  it really took a toll on just, you
• 2:13
  know, the overall family and their ability to
• 2:16
  to live healthy and fulfilling lives. So seeing
• 2:18
  that growing up, but then also seeing that
• 2:20
  happening, you know, in our own backyard in
• 2:22
  the most developed nation
• 2:24
  in the world, it it was shocking. So
• 2:27
  that really was a call to action to
• 2:28
  me. And, also, you know, my father and
• 2:31
  my brother all work in the health care
• 2:32
  industry as well. So I think we all
• 2:34
  just felt called to
• 2:36
  work in a an industry that could make
• 2:38
  a difference
• 2:39
  for those who need it most.
• 2:41
  Thank you for giving us some background there.
• 2:44
  So just for our listeners, today, we're gonna
• 2:46
  be chatting a little bit more about your
• 2:48
  organization's work with Electra Health, which is a
• 2:50
  virtual menopause and midlife care provider.
• 2:53
  So, Melanie, can you walk us through how
• 2:55
  this collaboration came to be, who initiated it,
• 2:58
  and what stakeholder needs it's meant to address?
• 3:01
  Sure. So as a part of our normal
• 3:04
  course of business process, we're always looking at
• 3:06
  analyzing our data and trying to understand
• 3:09
  our members and our populations better. So we
• 3:12
  were taking a look at
• 3:13
  what
• 3:14
  areas or demographics
• 3:16
  in our membership are largely unaddressed. Where are
• 3:18
  we seeing health care needs popping up that
• 3:21
  don't have a solution? And so through that
• 3:23
  data analysis, we did identify that particularly in
• 3:27
  women's health, there was an opportunity to build
• 3:29
  out more robust programming.
• 3:31
  And that's where a focus on the,
• 3:34
  perimenopausal,
• 3:34
  but then menopausal
• 3:36
  kind of age range of women came up
• 3:38
  as not having
• 3:40
  a very robust pro programmatic solution. And about,
• 3:44
  fifty one percent of the Illinois population is
• 3:47
  women, and every at every stage of life.
• 3:50
  And we found that only about eight percent
• 3:53
  of women
• 3:54
  in the,
• 3:55
  menopausal
• 3:56
  age range
• 3:57
  seek any sort of treatment or seek to
• 4:00
  understand their symptoms, which is just a a
• 4:02
  very low percentage,
• 4:04
  given that every woman, you know, eventually reaches
• 4:07
  that age range. And menopause
• 4:09
  and perimosal
• 4:10
  perimenopausal
• 4:11
  symptoms aren't widely talked about,
• 4:15
  just in the
• 4:17
  health care education space either. So it's kind
• 4:20
  of like a silent suffering and and no
• 4:22
  one talks about it. And that also was
• 4:24
  a part of the conversation we had with
• 4:26
  our our doctors was what opportunities can we
• 4:29
  have to just create public awareness about a
• 4:31
  condition, again, that every woman faces, but,
• 4:35
  and oftentimes have very little support. So that's
• 4:37
  when we started looking out into the the
• 4:39
  landscape to see, what types of solutions are
• 4:42
  available. We found Elektra,
• 4:44
  talked to Janine, and there was a a
• 4:46
  fantastic
• 4:47
  solution that was available that kind of checked
• 4:49
  all the boxes of what we're looking for,
• 4:51
  something that,
• 4:52
  offered clinician support.
• 4:54
  So, you know, evidence based medicine,
• 4:56
  we could actually have electronic office visits. So
• 4:59
  accessible. There are, multiple languages offered, and there's
• 5:03
  a lot of, high touch support. So coaching
• 5:05
  that was available as well as education, which,
• 5:08
  again, I think is important because,
• 5:10
  just from our, surveys with members,
• 5:14
  there's definitely an opportunity,
• 5:15
  especially in the Medicaid population, for understanding
• 5:19
  the symptoms and what they mean about women's
• 5:21
  bodies.
• 5:22
  Yeah. And I wanna ask about some of
• 5:24
  those, gaps with women's health you see in
• 5:26
  the Medicaid population in a minute. But since
• 5:28
  talking to Elektra CEO, Janine, who you mentioned
• 5:31
  earlier, what was the timeline for rolling out
• 5:33
  this initiative?
• 5:35
  Sure. So, typically, what we do is
• 5:38
  a
• 5:39
  one month or so assessment process to just
• 5:42
  really understand the vendors. That's kind of like
• 5:44
  a meet and greet, getting to know the
• 5:45
  solution. And then the the contracting process usually
• 5:48
  takes anywhere from three to four months because
• 5:50
  we really wanna do our due diligence on
• 5:52
  identifying the right control population,
• 5:55
  creating a program that's meaningful in terms of
• 5:59
  guaranteeing
• 6:00
  outcomes and
• 6:02
  ensuring the proper coverage of services for our
• 6:04
  members and ease of utilization.
• 6:06
  So that part is probably the most time
• 6:08
  intensive.
• 6:09
  And then we actually get into implementation, which
• 6:12
  might be anywhere from, you know,
• 6:14
  sixty to ninety days depending on how much
• 6:16
  technology has to be set up, data sharing,
• 6:19
  and then ultimately,
• 6:20
  setting up outreach modalities as well. So all
• 6:23
  in all, I would say around a year
• 6:25
  to go through the end to end process,
• 6:27
  and then we launch the program.
• 6:30
  So what early usage data and trends have
• 6:32
  you been seeing with member engagement in terms
• 6:35
  of adding these resources?
• 6:38
  So far, our leading indicators have been just
• 6:41
  click throughs into the ads. So we do
• 6:44
  a a broader marketing campaign.
• 6:46
  And so it's it's still a little early
• 6:48
  because we just launched,
• 6:50
  about a a month or two ago.
• 6:54
  But we are looking at digital engagement. So
• 6:56
  we are starting to see a ramp up
• 6:58
  in the number of users who are opening
• 7:00
  up on the text messages that are going
• 7:02
  out, the emails that are going out, etcetera.
• 7:04
  And my hope is we we typically
• 7:07
  like to see
• 7:08
  above a 30% engagement rate in a Medicaid
• 7:11
  population.
• 7:12
  Medicaid is, historically
• 7:14
  and currently
• 7:15
  the hardest
• 7:16
  population to reach because of, you know, evolving,
• 7:20
  contact information.
• 7:21
  And some people are transient and they,
• 7:24
  lose
• 7:26
  phones, things like that. Their addresses change because
• 7:28
  they're changing to live with family members.
• 7:31
  So
• 7:32
  30%
• 7:33
  floor, I would say. But if we exceed
• 7:36
  that, then it's a home run.
• 7:39
  So how do you plan to address those
• 7:41
  technological and logistical barriers? Also, just thinking about
• 7:44
  the age range of people who may be
• 7:46
  using these services,
• 7:47
  and what are some long term indicators you're
• 7:50
  going to look to as this program progresses?
• 7:53
  So we always think an omnichannel approach to
• 7:56
  any kind of communication
• 7:57
  modality of a new solution. So to your
• 7:59
  point about the age range,
• 8:02
  anywhere from 40 to 64 is typically,
• 8:05
  that perimenopausal
• 8:07
  or menopausal age group. So we expect some
• 8:10
  technological adoption. And so email,
• 8:13
  tends to be the highest,
• 8:15
  rate modality followed closely by text message.
• 8:18
  And so we're constantly using skip tracing vendors,
• 8:22
  data scrub and data integrity vendors to try
• 8:24
  to get the latest contact information.
• 8:27
  We're also just building in checkpoints
• 8:29
  in every,
• 8:31
  channel in which a member can interact with
• 8:33
  us. So it could include whenever a member
• 8:35
  calls in, we ask them for updated contact
• 8:38
  information. Whenever they log in to the member
• 8:40
  portal, there's a prompt that asks them for
• 8:43
  updated information, so on and so forth. So
• 8:46
  always trying to just have a pulse on
• 8:47
  that directly with our members. But then, also,
• 8:50
  again, trying to do different
• 8:53
  outreaches is key. So in addition to digital,
• 8:56
  we do have a lot of community events
• 8:58
  and some that are
• 9:00
  more geared towards women. We have, things like
• 9:02
  baby showers where
• 9:05
  whole families come and, typically, again, it's large
• 9:08
  groups of women. So we add, our women's
• 9:11
  health programs to those types of events as
• 9:13
  well. So then we get that in person
• 9:15
  component in the community. We have community based
• 9:18
  partners where we can drop off flyers,
• 9:20
  QR codes, things like that.
• 9:23
  And then also we have our care management
• 9:25
  staff. So our care managers are actually staff
• 9:27
  that,
• 9:29
  work closely with our higher acuity membership. And
• 9:33
  so they have a higher touch program and
• 9:35
  are able to,
• 9:37
  actually interface with members on a more frequent
• 9:39
  basis. So they too can share information,
• 9:43
  more regularly because they're in more regular contact
• 9:45
  with, our our members, and they're able to
• 9:48
  tell them about new programs because that's another
• 9:51
  thing. There are different programs for different types
• 9:53
  of people. We don't wanna overwhelm our members.
• 9:56
  We wanna make sure that they get the
• 9:57
  right
• 9:58
  fit for their condition in life. And so
• 10:01
  that's why as a part of our,
• 10:03
  communication strategy, we're also just always looking at
• 10:05
  better understanding how we can make those communications
• 10:09
  more tailored to the individual. And I think
• 10:11
  that's just a movement
• 10:12
  overall, right, in terms of,
• 10:15
  communications and, all industries is how do we
• 10:19
  use our data? How do we even look
• 10:20
  at AI
• 10:21
  to, tailor that messaging to make sure we're
• 10:24
  fulfilling member interests and member needs?
• 10:27
  How do you plan to translate those findings
• 10:29
  with the marketing efforts, the early marketing efforts
• 10:32
  you have going, and also eventually your care
• 10:34
  insights
• 10:35
  into broader quality improvement or care coordination programs
• 10:39
  that y'all host?
• 10:41
  So we are able to take,
• 10:43
  care insights. Meaning, we can, from the coaching
• 10:46
  sessions that Elektra has,
• 10:49
  take, and process,
• 10:50
  qualitative and quantitative information
• 10:53
  to be able to then,
• 10:55
  create a a more or less a profile
• 10:57
  for the member. So we already have a
• 10:59
  profile based on just their health care,
• 11:02
  setting utilization data. And so then we can
• 11:04
  build upon it whether they cite that maybe
• 11:06
  they have a health related social need. Maybe
• 11:08
  they have,
• 11:10
  symptoms,
• 11:11
  outside of the realm of menopause that need
• 11:14
  to be unaddressed that haven't been historically. Maybe
• 11:17
  they have, an ask for a multilingual,
• 11:21
  care manager, or they want to engage in
• 11:23
  care management and don't know how. So it
• 11:25
  depends on the type of feedback, but, really,
• 11:28
  this is the, the benefit of having different
• 11:30
  types of partners that are connecting with our
• 11:33
  different member demographics is they can take different
• 11:36
  approaches and their own unique engagement strategies
• 11:40
  to obtain information that can just, again, better
• 11:42
  help us tailor our programming for membership. So,
• 11:46
  when it comes to, for instance, trying to,
• 11:49
  close HEDIS care gaps, which ultimately translate into
• 11:53
  improved quality scores and health plan ratings,
• 11:55
  again, another a key barrier to being able
• 11:58
  to do that is effectively communicating with our
• 12:01
  members, help them appreciate the importance
• 12:04
  of, you know, going to get certain screenings
• 12:06
  or going to certain health care visits. So
• 12:08
  when we have partners who are able to
• 12:10
  build trust through care navigation,
• 12:13
  through coaching,
• 12:14
  It just improves the overall member experience and
• 12:17
  engagement in all of our programs.
• 12:20
  And how are you expecting to see ROI
• 12:23
  on this initiative?
• 12:25
  Some of through which I I already mentioned,
• 12:27
  just the improved member engagement. Improved member engagement
• 12:30
  leads to,
• 12:32
  health plan, member retention.
• 12:34
  It leads to, again, higher engagement in all
• 12:37
  required activities, whether that be contractual with the
• 12:40
  state or,
• 12:42
  quality improvement initiatives. It improves likelihood
• 12:45
  of our members going to PCP visits.
• 12:48
  There's a very clear link between,
• 12:50
  our members going to their PCP and and
• 12:53
  regular scheduled health appointments and their ultimate health
• 12:55
  outcomes,
• 12:57
  just regular
• 12:58
  engagement in programming, whether it be virtual visits,
• 13:02
  virtual coaching, or even digesting and reading through
• 13:06
  and engaging in kind of gamified
• 13:09
  health education
• 13:10
  is all linked back to better engagement
• 13:13
  in the health care system and better understanding
• 13:15
  of how to manage health. And so
• 13:18
  we see and track ROI
• 13:20
  on just the for the members that are
• 13:22
  actually using the platform and, you know, engaging
• 13:26
  with Electra,
• 13:27
  what how do we see,
• 13:29
  their usage of the health care system change?
• 13:31
  Do we find that previously,
• 13:34
  they were not seeking care at all or
• 13:37
  only seeking care once a year in the
• 13:38
  emergency room for non acute conditions. And now
• 13:41
  they're actually feeling empowered through Electra and through
• 13:45
  being able to trust the clinician
• 13:47
  to start to see others
• 13:48
  and, go to their PCP visit, for instance.
• 13:50
  So we do have some criteria, you know,
• 13:53
  in our contracts that speak to what we
• 13:55
  would expect to see for,
• 13:57
  members who engage in the platform.
• 14:00
  Absolutely. That makes a lot of sense. So
• 14:03
  what other opportunities are you seeing in women's
• 14:05
  health for Medicaid right now,
• 14:07
  but also other life stage conditions?
• 14:10
  And where else are you looking to next?
• 14:13
  That is a great question.
• 14:14
  The sky is the limit in terms of
• 14:16
  of opportunity.
• 14:18
  I think, one thing that we're continuing to
• 14:20
  dive in and focus on
• 14:22
  is not to
• 14:24
  reiterate or reemphasize the same thing over and
• 14:26
  over again, but just that unable to reach
• 14:29
  population. That has always been kind of the
• 14:31
  Achilles' heel
• 14:33
  of, Medicaid payer organizations
• 14:35
  and that they tend to have
• 14:38
  the,
• 14:40
  lowest performing health outcomes. But because of life
• 14:44
  condition and circumstances,
• 14:46
  they're the harder or hardest to reach and
• 14:49
  hardest to engage. So,
• 14:51
  that continues to be a focus where, you
• 14:54
  know,
• 14:55
  they might only be receiving care in inpatient
• 14:58
  or emergency room and have never seen a
• 15:01
  primary care physician or a specialist.
• 15:04
  So we're continuing to explore and test and
• 15:06
  experiment different, again, modalities
• 15:08
  of how to,
• 15:10
  reach and engage,
• 15:12
  this type of person.
• 15:13
  Additionally, we're in terms of women's health,
• 15:17
  Chicago is one of the most disproportionately
• 15:20
  impacted areas in terms of,
• 15:22
  maternal child, and infant morbidity morbidity and mortality.
• 15:27
  And so women's health in terms of the
• 15:29
  maternal population
• 15:31
  continues to be a focus.
• 15:33
  The TANF or, in Illinois, it's called NDCA
• 15:36
  population, which is moms and babies, tends to
• 15:39
  make up a significant portion of Medicaid
• 15:41
  in any state.
• 15:43
  And so it's a continued focus in an
• 15:45
  area where, again, we're continuing to try to
• 15:47
  learn and test different types of solutions. And
• 15:49
  Illinois has been extremely progressive in expanding access
• 15:52
  to care for moms. So they've, recently covered
• 15:56
  doulas under Medicaid, lactation consultants, midwives,
• 16:00
  which is fantastic, and we're really excited about
• 16:02
  that. So we've been looking at solutions that
• 16:04
  can you continue to expand,
• 16:07
  those types of nontraditional
• 16:08
  services
• 16:09
  and really see if that helps build trust
• 16:11
  and engagement.
• 16:13
  Outside of that, we're just continuing to look
• 16:15
  at where are there, again, gaps
• 16:18
  in, health care
• 16:20
  engagement and or
• 16:22
  outcomes performance. So if we're seeing that, you
• 16:24
  know, a certain age group, for instance, children
• 16:27
  ages
• 16:28
  18 to 30 aren't going to their well
• 16:31
  child visits and we're seeing that, again, more
• 16:34
  care is being sought in acute settings.
• 16:36
  That's an area where we're looking to fill
• 16:38
  the gap and and create a program. So,
• 16:41
  I'd say, again, it's really based on what
• 16:44
  we're seeing in the current state and our
• 16:46
  populations are continuing to change. Right? We we
• 16:49
  just went through
• 16:50
  the post, public health emergency redetermination
• 16:53
  where,
• 16:54
  a lot of people lost coverage and,
• 16:57
  we're seeing the membership
• 16:59
  and the, health care trends shift a little.
• 17:01
  And, I anticipate that's gonna continue as we
• 17:04
  see some of the other changes that have
• 17:05
  come through federal policy as well. So just
• 17:08
  keeping a pulse on that.
• 17:11
  But really our intent and objective is to
• 17:13
  have true population health programming
• 17:16
  for every age and every stage. I actually,
• 17:19
  one of my
• 17:20
  friends from, a health care
• 17:23
  provider said from
• 17:25
  twinkle to wrinkle, which I absolutely loved. I
• 17:27
  hadn't heard that that terminology before. But, surely,
• 17:31
  every age in life, every,
• 17:33
  acuity stage across the continuum,
• 17:36
  whether you're walking well or whether you have
• 17:39
  a chronic condition,
• 17:40
  we're looking to have a tailored solution for
• 17:43
  every kind of subgroup that we can identify.
• 17:46
  So
• 17:47
  that's the aim. That's what we're continuing to
• 17:48
  focus on and, of course, all tied
• 17:51
  to value and tied to improving health outcomes.
• 17:54
  I've also never heard that terminology
• 17:56
  either, but, that's a really interesting way to
• 17:59
  put it.
• 18:00
  I would love to hear if you have
• 18:02
  any final thoughts,
• 18:03
  or advice for other industry leaders, you know,
• 18:06
  in Medicaid or even beyond as they navigate
• 18:08
  these types of solutions.
• 18:11
  Yeah. Yeah. Definitely. I mean, I would say
• 18:13
  and I think many of us or most
• 18:14
  of us know this. There really is no
• 18:16
  one size fits all. Medicaid is such a
• 18:18
  unique population, and there are so many exacerbated
• 18:21
  social needs layered throughout that,
• 18:24
  many approaches that work for other lines of
• 18:27
  business and insurance don't work for the Medicaid
• 18:29
  population. And so we all just need to
• 18:31
  be cognizant of that and continue to tailor
• 18:33
  our solutions to include
• 18:35
  cultural competence, building trust,
• 18:38
  meeting members where they are in the modalities
• 18:40
  that they prefer, and not assuming that we
• 18:43
  know them, but truly having,
• 18:46
  responsive bidirectional feedback channels that allow us to
• 18:50
  understand
• 18:51
  the current state of our members and how
• 18:53
  they wanna engage. And then offering
• 18:55
  nimble platforms that are self-service,
• 18:58
  but also high touch where needed. So again,
• 19:01
  it's really all all centered on simplifying the
• 19:04
  member experience,
• 19:05
  enabling our members to feel empowered and taking
• 19:08
  control of their health care.
• 19:10
  And that really just leads to success all
• 19:13
  around.
• 19:14
  So that would be
• 19:15
  my
• 19:16
  advice for industry leaders is,
• 19:19
  even if something has existed for thirty years,
• 19:23
  if it hasn't worked the way you wanted
• 19:25
  it to, sometimes you just have to dismantle
• 19:27
  it and rebuild it.
• 19:29
  Well, thank you so much, Melanie, for joining
• 19:31
  us today. This was such a great conversation.
• 19:33
  Thank you for having me. It was fun
• 19:36
  to participate,
• 19:37
  and I hope everyone derives some value from
• 19:40
  from a part of it.
• 19:42
  Oh, absolutely.
• 19:43
  And to our listeners, if you'd like to
• 19:45
  listen to more podcasts from Becker's Healthcare, you
• 19:47
  can visit beckershospitalreview.com.
• 19:49
  Thank you.