Latest / Becker’s Payer Issues Podcast / Dr. Sameer Amin on Sustaining Medicaid and Social Determinants of Health Investments

Transcript

Dr. Sameer Amin on Sustaining Medicaid and Social Determinants of Health Investments · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Emerson with the
• 0:02
  Becker's Payor Issues podcast.
• 0:04
  Thrilled today to be joined by doctor Sameer
• 0:06
  Amin, who serves as chief medical officer at
• 0:09
  LA Care Health Plan. Doctor Amin, thank you
• 0:12
  so much for taking the time to be
• 0:13
  with me on the podcast today. Thank you
• 0:15
  very much for the invite. Always happy to
• 0:17
  talk about these very,
• 0:18
  complicated issues and get some education out to
• 0:20
  the public and
• 0:22
  strike up a a good conversation.
• 0:24
  Absolutely. We're excited to have you here with
• 0:26
  us and and like you said, to talk
• 0:27
  about a really important topic. But before we
• 0:30
  dive into that, can you first tell us
• 0:32
  a little bit more about yourself, your background
• 0:34
  in health care, and then what it is
• 0:36
  that you do today at LA Care?
• 0:38
  Happy to. So my name is Sameer Amin.
• 0:41
  I'm the chief medical officer of LA Care.
• 0:43
  I've been at LA Care for about three,
• 0:45
  three and a half years.
• 0:47
  I'm an interventional cardiologist by training. I got
• 0:49
  into clinical leadership very early on in a
• 0:51
  value based care,
• 0:53
  delegated provider group and sort of grew into
• 0:55
  the health plan space over time.
• 0:58
  I've been doing this for for quite some
• 0:59
  time. I've worked in the Medicare line of
• 1:02
  business, the Medicaid line of business, and the
• 1:04
  exchange line of business. Also worked on the
• 1:07
  the start up space and have worked in
• 1:09
  technology,
• 1:10
  but now find myself
• 1:12
  very deeply rooted,
• 1:13
  in the community here in LA County,
• 1:16
  working in a in a health plan that
• 1:18
  has a publicly operated status.
• 1:20
  We have about 2,700,000
• 1:23
  members,
• 1:24
  largely in the medical space, but also with
• 1:26
  a Medicare Advantage line of business,
• 1:28
  and an exchange line of business.
• 1:31
  Understood.
• 1:32
  Well, Samir, let's, let's talk about
• 1:34
  Medicaid plans and what we've heard from them
• 1:37
  over the years in terms of
• 1:40
  investments for a long time now in social
• 1:43
  determinants programming and initiatives,
• 1:46
  a a a really diverse array of different
• 1:48
  kinds of programs and initiatives all over the
• 1:50
  country.
• 1:51
  But I think when those investments
• 1:53
  are made, have been made in the past,
• 1:55
  they assume a stable member population, and and
• 1:58
  they've been,
• 1:59
  under a period where there's been more stability
• 2:02
  than there is now. And I, I know
• 2:04
  you know what I'm talking about. I know
• 2:06
  our audience knows,
• 2:07
  in terms of the context of HR one
• 2:09
  and what's coming down the pipeline
• 2:11
  next year all over the country,
• 2:13
  all over the country and for Medi Cal,
• 2:15
  of course, as well. A lot of big
• 2:16
  changes there.
• 2:17
  So talk to us a little bit about
• 2:19
  how you main continuity
• 2:22
  for SDOH interventions
• 2:23
  when when you're facing large scale disenrollments,
• 2:26
  when you know that,
• 2:28
  there could be member major membership declines,
• 2:31
  and these programs might not have had time
• 2:34
  to work because, of course, you know, these
• 2:35
  things, they take time. They're they are social
• 2:38
  programs.
• 2:39
  Some take decades. So talk to us about
• 2:41
  how you're thinking about all of that.
• 2:44
  Yeah. I mean,
• 2:45
  clearly, there are unprecedented
• 2:47
  challenges
• 2:49
  to the safety net right now. There's a
• 2:51
  lot of movement in the member populations, people
• 2:53
  coming in and out of medical plans.
• 2:55
  But I'll just take a step back and
• 2:57
  say that, you know, though these may be
• 2:59
  more challenges than we've seen in the past,
• 3:02
  though there may be more memberships than we
• 3:04
  are we are used to, in the Medi
• 3:07
  Cal space, there's always,
• 3:08
  you know, an in out for members. You
• 3:11
  know, some members come in for a short
• 3:12
  period of time,
• 3:14
  and, you know,
• 3:15
  they change locations, they change jobs, and they're
• 3:19
  able to get their insurance in a different
• 3:20
  way. And so there's always that ebb and
• 3:22
  flow.
• 3:23
  I think
• 3:24
  taking out some of the noise of all
• 3:26
  the the challenges on the horizon, whether they're
• 3:28
  federal or state based,
• 3:30
  And just coming back to the fact that
• 3:31
  Medi Cal is always a population that
• 3:35
  that has a lot of transitions in it.
• 3:38
  We have to think about our social determinants
• 3:40
  of health pop our social determinants of health
• 3:43
  programs
• 3:44
  as being more about building an infrastructure
• 3:47
  than
• 3:48
  individual programs for individual people.
• 3:51
  So what do I mean by that?
• 3:54
  Well,
• 3:55
  we've utilized
• 3:56
  our
• 3:57
  population health pro our population health programming
• 4:01
  and our community strategic investments,
• 4:03
  the grants that we give,
• 4:05
  the the model of care that we put
• 4:07
  out through our community resource centers
• 4:09
  to really build
• 4:11
  stable programs
• 4:13
  for whoever may need them.
• 4:15
  And by doing that,
• 4:17
  we gather the benefit for members, whether they're
• 4:20
  in our programs for six months or they're
• 4:22
  in our programs for twelve months or they're
• 4:25
  they've been in Medi Cal for years.
• 4:28
  And by building that infrastructure, we can actually
• 4:31
  bolster the safety net,
• 4:33
  in a way that's what I would call
• 4:35
  durable.
• 4:36
  And it also allows for us to maintain
• 4:39
  an equity framework such that,
• 4:41
  those who are disadvantaged
• 4:44
  and are from a particular cultural or ethnic
• 4:47
  background are seeing care in a way that
• 4:49
  they can that they can, get more fluidly.
• 4:52
  And so it's really, again, about building infrastructure
• 4:55
  rather than targeted programs. It's also about collaborating
• 4:58
  with local partners who are critical for the
• 5:00
  community.
• 5:01
  We work in tandem with them,
• 5:04
  and allied groups to really drive efficiencies and
• 5:07
  help prevent any confusion and,
• 5:09
  allow for coordination of care in the community.
• 5:12
  And when we do this, we're, again, able
• 5:14
  to build,
• 5:16
  an infrastructure for care, a health care ecosystem
• 5:19
  that,
• 5:20
  you know, will
• 5:21
  last for years and not really be about
• 5:23
  an individual member coming in and out of
• 5:25
  the system. I hope that makes sense.
• 5:27
  It does make sense. And I I I
• 5:29
  think my natural follow-up to that, Sameer, would
• 5:31
  be, you know, when you're building, when you're
• 5:33
  investing in that infrastructure,
• 5:36
  how are you making the case internally,
• 5:38
  to to stakeholders within the health plan that
• 5:42
  that's spending on SDOH on this infrastructure?
• 5:46
  Is is how do you defend it? How
• 5:47
  do you make sure that this is the
• 5:49
  direction
• 5:50
  you wanna keep going? And are there metrics
• 5:52
  that you're using that demonstrate a return on
• 5:55
  those investments,
• 5:57
  to your internal stakeholders, to your board,
• 5:59
  to whoever whoever else,
• 6:01
  might need to know that these investments are
• 6:03
  worthwhile?
• 6:05
  I think, you know, at our plan, we're
• 6:07
  perhaps slightly different because we are coming from
• 6:10
  a public space.
• 6:12
  And social determinants of health are core to
• 6:14
  the safety net and to equity. They're they're
• 6:16
  not really
• 6:18
  discretionary things that we go after. We're a
• 6:20
  public plan. We have no shareholders. Our return
• 6:23
  on investment is measured
• 6:25
  in our community thriving in developing better health
• 6:28
  outcomes, reducing hospitalization.
• 6:30
  These are all things that are, you know,
• 6:31
  quantifiably
• 6:32
  critical to showing a return on the dollars
• 6:35
  we are, you know, sort of mindfully investing
• 6:37
  as fiduciaries of the funds entrusted to us.
• 6:39
  And so I think one is just the
• 6:42
  fact that we're looking at it from a
• 6:43
  lens as a as a public plan.
• 6:46
  But I think to the other point, you
• 6:47
  know, people oftentimes
• 6:49
  look at returns on investment
• 6:52
  as something that has a very long,
• 6:55
  a very long bend to it. So, you
• 6:58
  know, hey. You're gonna deliver on a heart
• 7:00
  failure program. You're gonna deliver on an asthma
• 7:03
  program.
• 7:04
  Those decrease in readmissions or those that decrease
• 7:07
  in cost of care is gonna potentially hit
• 7:09
  for years down the line.
• 7:11
  But some of the real
• 7:13
  thorny social determinants of health that we're investing
• 7:16
  in, that we're building that infrastructure that I
• 7:18
  talked about, actually,
• 7:21
  that's gonna make a measurable difference in a
• 7:22
  much shorter period of time. Let's take housing,
• 7:25
  for example, or food insecurity.
• 7:28
  Those issues are
• 7:30
  short term. If you can get somebody housed
• 7:33
  and you can you can more easily get
• 7:35
  them into care,
• 7:37
  the benefit of that is actually going to
• 7:40
  to accrue at a much earlier time. Same
• 7:42
  thing with food insecurity. When somebody doesn't have
• 7:44
  any food to eat, it's very hard to
• 7:45
  get them to concentrate on closing care gaps
• 7:47
  like getting their mammogram done or or getting
• 7:50
  their colonoscopy done. And so
• 7:53
  when when I look at the social determinants
• 7:55
  of health that we're investing in, building infrastructure
• 7:58
  on, creating durable process processes with our safety
• 8:01
  net and with our community partners,
• 8:04
  I'm thinking about things that, you know, actually
• 8:06
  will have KPI or key performance index that's
• 8:09
  gonna that's gonna shift in a very short
• 8:11
  period of time. And so we've been able
• 8:13
  to make a lot of those ROI calculations
• 8:16
  and investments, understanding that whether a member is
• 8:19
  with us for six months or a year
• 8:22
  or five years,
• 8:24
  that ultimately,
• 8:25
  we will get back our investment,
• 8:28
  in spades because there we're gonna be able
• 8:30
  to bend that cost curve of health care
• 8:32
  over time, and it won't take very long.
• 8:35
  I'll also just point out that whether there
• 8:38
  are quality care gaps that we're closing by
• 8:41
  way of creating these
• 8:42
  or putting in these investments
• 8:44
  or it's decrease in emergency room usage or
• 8:47
  inpatient usage
• 8:48
  or it's just strain on our network.
• 8:51
  We have to be holistic in how we
• 8:52
  actually look at the metrics that we're looking
• 8:56
  to improve,
• 8:58
  because it's not necessarily gonna be the cost
• 9:00
  of an admission always. It may be that,
• 9:02
  you know, you improve quality,
• 9:05
  and, you know,
• 9:06
  you get better remuneration
• 9:09
  from the government based on
• 9:11
  improved performance in their quality based programs or
• 9:14
  with their quality withhold.
• 9:16
  Same thing with network that, you know, hey.
• 9:17
  Listen. You know, we expand the network. We're
• 9:20
  able to get people into care, in a
• 9:22
  culturally competent way at a at a better
• 9:24
  clip. It's gonna reduce all the grievances and
• 9:26
  calls that we get, from members,
• 9:29
  and we can have more efficient and more
• 9:31
  productive staffing that way. And so it it's
• 9:33
  really also about
• 9:35
  finding the right metric
• 9:37
  that actually shows the benefit of the good
• 9:39
  investments that we want to make.
• 9:43
  I'll also just, you know, in closing, point
• 9:45
  out the fact that, you know, again, as
• 9:47
  a public
• 9:48
  plan that's holding the public trust, we also
• 9:52
  have a very unique ROI.
• 9:55
  Our,
• 9:56
  board is made up of member representatives,
• 10:00
  and member advocates,
• 10:02
  and, you know, they hold us accountable for
• 10:04
  not just the actual dollar amount that we
• 10:07
  may be saving on total cost of care,
• 10:09
  but also improvement on the community itself.
• 10:12
  So as a plan as as, you know,
• 10:14
  that publicly operated plan, it's on us. It's
• 10:17
  our responsibility. It's our accountability
• 10:19
  to be something more than an insurance company.
• 10:22
  Absolutely. And I and I do appreciate that
• 10:24
  clarification there, Sameer, for our audience in terms
• 10:26
  of how this is all a bit different
• 10:28
  for LA Care given that you are a
• 10:31
  a publicly funded entity,
• 10:32
  and how that kind of shakes out with
• 10:34
  ROI and how you track all of this.
• 10:36
  I think for our other health plan executives
• 10:39
  listening in right
• 10:41
  now, you know, many are not coming from
• 10:44
  a public funding source, but they are still
• 10:47
  as managed care organizations.
• 10:49
  They are still stewards of a lot of
• 10:51
  taxpayer dollars. And so I wonder what you
• 10:53
  would say to them in terms of they
• 10:56
  they might be tempted to deprioritize
• 10:59
  social determinants,
• 11:00
  programs entirely,
• 11:02
  as they see their Medicaid budgets tighten either
• 11:04
  within their state or because of what we're
• 11:06
  seeing at the federal level. So what would
• 11:09
  you say to a peer CMO who is
• 11:11
  weighing these decisions right now,
• 11:14
  either at an organization similarly structured as yours
• 11:17
  or at at some of the larger,
• 11:20
  nonprofits, publicly traded, just the the the gamut
• 11:23
  of the different kinds of insurers that are
• 11:25
  out there. Yeah. And I think whether you're
• 11:27
  at a for profit health plan,
• 11:29
  you're at a, you know, publicly traded one,
• 11:32
  or you're at one that's government associated like
• 11:34
  ours,
• 11:35
  I think that the challenge is still the
• 11:37
  same.
• 11:38
  And that challenge is really to identify what
• 11:41
  matters most to members.
• 11:43
  What is really going to change the trajectory
• 11:45
  of their care? And whether that person, again,
• 11:48
  is in your program for
• 11:50
  six months
• 11:51
  or two years, that doesn't change
• 11:54
  the value of the program that you're delivering.
• 11:56
  And so I don't think that we can
• 11:58
  be shortsighted to suggest, hey. Listen. There's a
• 12:00
  lot of budgetary pressure right now.
• 12:03
  And therefore, we're going to,
• 12:05
  you know, abandon some of these long term
• 12:08
  programs that actually deliver on better cost of
• 12:11
  care for membership down the line. And so
• 12:14
  I think it's less about, hey. We're gonna
• 12:16
  abandon ship on these things that are gonna
• 12:19
  bend that cost curve and more about finding
• 12:21
  the highest yield programs that we can actually
• 12:24
  invest in. And, you know, again, I'm I'm
• 12:26
  a very practical person. For me, it's, you
• 12:29
  know, I have a general sense as to,
• 12:30
  like, what what we should actually be investing
• 12:33
  in. You know, food is health. Housing is
• 12:35
  health. You know, there's a number of very
• 12:38
  important places where we can put our money
• 12:41
  that are gonna make a very
• 12:43
  quick,
• 12:45
  change in the trajectory of the care for
• 12:46
  our members. And I think it a lot
• 12:48
  of it is about having the right analytics
• 12:50
  to find the right folks who are gonna
• 12:51
  benefit.
• 12:52
  A lot of it is setting up the
• 12:53
  right,
• 12:54
  key performance indexes, the right metrics so that
• 12:57
  you can actually watch the improvement.
• 12:59
  And the third thing is just really being
• 13:01
  very practical about what you're gonna invest in.
• 13:04
  I would say that, you know, programs that
• 13:06
  are disease management programs, oftentimes building a population
• 13:09
  health infrastructure,
• 13:11
  those things do take a ton of time
• 13:12
  and the met you do need to have
• 13:13
  some consistency with your membership
• 13:15
  for those really to start benefiting members.
• 13:19
  But if you're gonna just build build a
• 13:21
  better community, if you're gonna invest in these
• 13:23
  things,
• 13:24
  that are very social determinant heavy, you're actually
• 13:28
  gonna build a health a healthier health care
• 13:30
  ecosystem
• 13:31
  for the membership to reside in. And when
• 13:34
  that happens,
• 13:35
  there's benefit.
• 13:37
  And, again, it can be very short term
• 13:39
  in terms of the benefit that you're getting.
• 13:41
  And even if and I I would also
• 13:42
  encourage other CMOs to really look at, like,
• 13:44
  what is the full gamut
• 13:47
  of benefit that you're deriving?
• 13:49
  Because it's not just, hey. Listen. There's gonna
• 13:51
  be less hospitalizations.
• 13:53
  It's a commitment to saying, hey. Listen. You
• 13:55
  know, we are gonna actually reduce the vicious
• 13:58
  cycle of having an inadequate network,
• 14:01
  of having difficult access to care, of having,
• 14:04
  you know, folks not being able to actually
• 14:06
  access the care because they don't have a
• 14:08
  home to live in.
• 14:10
  And
• 14:11
  having all those members
• 14:13
  reach out to us by way of the
• 14:15
  call center,
• 14:16
  grievances,
• 14:17
  appeals,
• 14:18
  all the angry like, all that stuff is
• 14:21
  a bunch of burden
• 14:22
  administrative burden on the plan. It's not good
• 14:24
  for members, not good for the plan. And
• 14:26
  if you can cut that vicious cycle off
• 14:28
  by creating that health, healthier health care ecosystem,
• 14:31
  you can actually
• 14:33
  have more efficiency and productivity at your actual
• 14:36
  plan. So you have to wrap some of
• 14:37
  those costs in to, hey. Listen. We're gonna
• 14:39
  actually reduce complaints on our line for the
• 14:41
  call center. We're gonna reduce appeals and grievances
• 14:44
  that come in through the door. We're gonna
• 14:46
  create, you know, a healthier flywheel here, and
• 14:49
  we're gonna do that by way of significant
• 14:51
  investments in network and social determinants of health.
• 14:54
  And so you take that ROI into account
• 14:56
  as well so that we're not just putting
• 14:58
  Band Aids on problems and spending money on
• 15:00
  administrative burden, but actually, again, making members healthier.
• 15:04
  Nobody wants to spend their life in a
• 15:06
  hospital or in a skilled nursing facility. They'd
• 15:09
  rather get their their care earlier and upfront,
• 15:12
  in a less expensive way. It's good for
• 15:15
  members. It's good for the plan.
• 15:16
  And when you can do that effectively
• 15:19
  by making the right investments, the right time,
• 15:22
  targeted to the right folks,
• 15:24
  you can actually
• 15:25
  significantly reduce costs
• 15:27
  on the administrative side as well as on
• 15:29
  the health care medical expense side.
• 15:31
  Fantastic. Well, I think that's a great place
• 15:33
  to leave things, Sameer. Some great bits of
• 15:36
  advice there for our audience,
• 15:39
  who are, you know, of course, facing similar,
• 15:42
  challenges as you and,
• 15:45
  a a lot
• 15:46
  of a lot of, I think tough conversations
• 15:48
  to come for plans all over the country.
• 15:50
  So I wanna thank you for,
• 15:52
  taking the time to chat with us about
• 15:53
  this and offering some some really good strategies
• 15:56
  on how to navigate,
• 15:58
  how to navigate this industry over the the
• 16:00
  coming year. Thank you very much. Appreciate it.
• 16:02
  It's been a great conversation. I really appreciate
• 16:05
  the time.
• 16:06
  Absolutely. And to our listeners, if you'd like
• 16:08
  to listen to more podcasts from Becker's Healthcare,
• 16:10
  you can visit beckershospitalreview.com.