Latest / Becker’s Payer Issues Podcast / Leading Medicare Innovation and Supporting Dual Eligibles with Michael Carson

Transcript

Leading Medicare Innovation and Supporting Dual Eligibles with Michael Carson · Becker’s Payer Issues Podcast

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  Hello, everyone. This is Jacob Emerson with the
• 0:46
  Becker's Payer Issues podcast.
• 0:48
  Thrilled today to be joined by Michael Carson,
• 0:51
  who's the president and CEO of WellCare, which
• 0:53
  is part of Centene.
• 0:55
  Michael, thank you so much for taking the
• 0:56
  time to be with me on the podcast
• 0:58
  today. Thanks, Jacob.
• 1:00
  And, Michael, before we dive into everything we
• 1:01
  wanna talk with you about, can you tell
• 1:03
  us a little bit more about yourself, your
• 1:05
  background in health care, and what it is
• 1:07
  that you do today at WellCare?
• 1:09
  For sure. Pleasure to be here. Thanks for
• 1:11
  giving me the opportunity to connect.
• 1:14
  So time flies when you're having fun. I
• 1:15
  can't believe it's been thirty years in health
• 1:17
  care, but it's been a great ride and
• 1:20
  a great opportunity to work with some great
• 1:22
  organizations
• 1:23
  over those years. I've had privilege of working
• 1:25
  in in leading
• 1:27
  a few payer organizations,
• 1:29
  a few provider value based care type organizations,
• 1:32
  as well as some population health companies.
• 1:35
  So spectrum of administration and financing,
• 1:38
  care delivery
• 1:39
  mixed in with the care management aspect of
• 1:41
  things, which has been a great experience around
• 1:44
  those perspectives
• 1:46
  out. I've also had an opportunity to work
• 1:48
  across the types of benefits that we offer
• 1:51
  in our health care system, so fully in
• 1:53
  self insured commercial
• 1:54
  businesses,
• 1:56
  ACA business
• 1:57
  from a marketplace perspective,
• 1:59
  lots of Medicaid and lots of Medicare background.
• 2:03
  And then thinking across
• 2:05
  the types of companies that exist who've also
• 2:07
  had the opportunity to work in nonprofit,
• 2:09
  regional health plans, publicly traded companies,
• 2:13
  as well as some private equity start up
• 2:14
  organizations. So,
• 2:16
  again, I'd bring all that up just because
• 2:18
  of the breadth of experience and breadth of
• 2:20
  perspective that brings to what we're here to
• 2:22
  do for our members and constituents and communities.
• 2:25
  Before health care, I spent seven years in
• 2:27
  the air force. People ask me what kind
• 2:29
  of planes I flew. I say I flew
• 2:30
  a desk. So I did, like, quality assurance,
• 2:33
  standardization
• 2:34
  work for aircraft maintenance type work, and then
• 2:36
  I spent several years within as a bush
• 2:38
  after the military,
• 2:40
  something called total quality management. But it was
• 2:42
  really around performance improvement,
• 2:44
  helping businesses, helping companies do better.
• 2:48
  So that's sort of health care background and
• 2:50
  the things that led me into health care
• 2:52
  itself,
• 2:53
  which
• 2:54
  thinking about how to improve businesses
• 2:57
  and trying to be a change agent, those
• 2:59
  would are the kinds of things that have
• 3:01
  brought me throughout my career. And today at
• 3:04
  WellCare, where I serve, as you said, as
• 3:06
  the presidency of our of a WellCare Medicare
• 3:08
  business,
• 3:09
  It's,
• 3:10
  again, Centene's Medicare business. We're serving about 32
• 3:13
  states across the country
• 3:15
  with a very strong mission on on really
• 3:18
  serving our communities and improving the health of
• 3:20
  our communities one person at a time.
• 3:23
  Wow. I mean, so clearly, you've had a
• 3:25
  very
• 3:26
  diverse career background, Michael. And you mentioned you
• 3:29
  you served in the Air Force before
• 3:31
  really diving into the the health care industry.
• 3:35
  And for our audience who isn't aware, Michael
• 3:38
  served at organizations
• 3:39
  like Harvard Pilgrim Health Care, Bright Health Plan,
• 3:42
  and Care About.
• 3:44
  So, Michael, talk to us about how all
• 3:46
  these past experiences
• 3:48
  brought you brought you to Wealthcare
• 3:50
  and how that's really shaped your approach of
• 3:52
  leading what what you just said, Centene's
• 3:55
  Medicare division, such a massive,
• 3:58
  organization.
• 4:00
  Yeah. And not to my colleagues at this
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  stage of our careers, the the list of
• 4:03
  companies becomes embarrassingly long to have to run
• 4:06
  through, But I actually started my health care
• 4:08
  career with a regional blues plan,
• 4:11
  Colorado, Nevada, New Mexico at the time. It
• 4:13
  was a non for profit plan
• 4:15
  just before,
• 4:16
  Anthem acquired it in the late nineties
• 4:19
  or so. So I've spent my time,
• 4:22
  as you said, with Harvard Pilgrim and Bright
• 4:24
  and care about sort of from a provider
• 4:26
  perspective,
• 4:27
  but also with, Amerigroup serving national Medicaid businesses,
• 4:33
  with Anthem quite a bit helping to build
• 4:35
  Medicare businesses as well,
• 4:37
  which again has been a great challenge and
• 4:39
  and opportunity.
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  As I think about, you know, how those
• 4:43
  things have led me here and how they
• 4:45
  helped shape my approach
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  to leading well care today,
• 4:49
  but really overall,
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  I kinda reflect on the combination of my
• 4:54
  work and health care experience with my uplink.
• 4:57
  And at the risk of sort
• 4:59
  of getting boring here, I think we all
• 5:01
  have a background and certain pillars
• 5:04
  to our foundation. And to me,
• 5:06
  I was born and raised in Germany, grew
• 5:09
  up in Europe.
• 5:10
  Mom was a factory worker.
• 5:12
  My dinner was the stuff that was left
• 5:14
  over from the cafeteria.
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  Dad wasn't in the picture, so no silver
• 5:18
  spoon, a healthy dose of reality of what
• 5:20
  we have to work very hard for.
• 5:22
  That coupled with that early military
• 5:25
  and business improvement experience
• 5:27
  being, you know, on the ready at any
• 5:30
  given time to go do what we have
• 5:31
  to do to fulfill a mission.
• 5:33
  So those pieces as a foundation combined with
• 5:36
  my health care experience
• 5:37
  have me focused on WellCare today in terms
• 5:41
  of what's our vision. Where do we need
• 5:43
  to go? What are opportunities?
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  What plan do we need to put in
• 5:46
  place? How do we execute on that plan
• 5:48
  in a diligent rigorous way? I love the
• 5:50
  eighty twenty rule. To what extent can we
• 5:53
  build an infrastructure that allows us to
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  manage what we have to manage
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  at the 80% levels that we can be
• 6:00
  ready to react
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  to the 20% of things that sort of
• 6:03
  punches in the mouth, and then we have
• 6:05
  to react to with the healthy dose of
• 6:08
  courage to make a difference.
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  Many of us pride ourselves on being disruptors
• 6:12
  or
• 6:13
  challenging the status quo, but I think all
• 6:16
  of us that are trying to make a
• 6:17
  difference and that are led by a mission
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  lean into that and try to find our
• 6:22
  own space
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  in creating improvement, creating difference.
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  Very few of us,
• 6:29
  sort of just view this as a job.
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  We view this as an opportunity
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  to make a difference.
• 6:34
  Sure. That makes a lot of sense, and
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  I appreciate you weaving in for us how
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  your your upbringing,
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  has really influenced how you,
• 6:41
  oversee,
• 6:42
  the current population that you serve as well.
• 6:45
  And in that vein, Michael, I wonder if
• 6:46
  you could talk with us about one segment
• 6:49
  of the Medicare population that that you serve
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  and and, of course, that we've seen,
• 6:54
  major growth in terms of enrollment in over
• 6:57
  these last few years. And I'm I'm referring
• 6:59
  to the dual eligible
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  population,
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  that, of course, Centene has, so many,
• 7:05
  enrollees in this segment as well.
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  Talk to us a little bit about this
• 7:09
  this specific segment. What are some of the
• 7:11
  unique challenges,
• 7:12
  that you are seeing dual eligible beneficiaries
• 7:15
  face right now? And how does WellCare specifically
• 7:18
  approach support for this vulnerable population?
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  As I think about mission, I I oftentimes
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  speak to
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  how
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  there are very few other populations for which
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  our mission comes to life the way it
• 7:32
  does for dual eligibles.
• 7:34
  Across the country, there are roughly 13,000,000,
• 7:37
  dual eligibles, so people that qualify for Medicaid
• 7:40
  and Medicare benefits and services.
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  Many of us know the demographics
• 7:44
  of this population,
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  but seventy percent have at least three, if
• 7:49
  not four,
• 7:50
  chronic conditions that they work that they're dealing
• 7:52
  with.
• 7:53
  Almost half are have at least one,
• 7:56
  a mental health condition that exasperates
• 7:59
  the chronic conditions
• 8:00
  that they're experiencing.
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  The food insecurity rate is roughly four times
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  higher
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  than,
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  for other populations.
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  And then,
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  there's so many sort of dynamics,
• 8:13
  to this population, but another one that's of
• 8:16
  interest and importance is that over 50% are
• 8:19
  people of color and cultural
• 8:21
  diversity. So so adding to all of those
• 8:25
  components, there are other barriers,
• 8:28
  to care. So oftentimes, it's
• 8:30
  urban communities
• 8:32
  that may be underserved from a clinical
• 8:35
  care access or rural
• 8:37
  areas that are that aren't served well and
• 8:39
  where we need to do better in finding
• 8:41
  penetrating
• 8:42
  opportunities to provide care. There are, as I
• 8:45
  said, cultural and generational diversity
• 8:48
  components that come into play in terms of
• 8:50
  how people have engaged with the health care
• 8:52
  system,
• 8:53
  over their lives. So all these things make
• 8:56
  it extremely challenging for members to navigate what's
• 8:59
  already
• 9:00
  a very complex fragmented health care system. I
• 9:03
  often
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  sort of joke that even as a health
• 9:06
  care CEO, it's hard for me to navigate
• 9:08
  the system at times.
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  So, unfortunately,
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  in a complex fragmented system
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  with all of those
• 9:16
  complexities and dynamics that pertain to a dual,
• 9:19
  it it means that it makes it extra
• 9:21
  challenging for them. So we have complex enrollment
• 9:24
  and eligibility processes,
• 9:27
  that combined with
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  high medical
• 9:30
  and social needs
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  really create one of the most challenging environments
• 9:35
  in health care for doulas. But, frankly, it's
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  also
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  where I think we can make the biggest
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  difference.
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  I'm always encouraged and,
• 9:44
  sort of motivated
• 9:45
  to lean into
• 9:47
  where
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  we have populations or communities
• 9:50
  that have particular opportunity in this, and I
• 9:52
  think the duals, certainly represent that. So, financially,
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  just another sort
• 9:55
  financially,
• 9:56
  just another sort of foundational component.
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  Duals is a growing population,
• 10:02
  but they also
• 10:04
  make up a significant portion of the overall
• 10:06
  spend in Medicare and Medicaid.
• 10:08
  Roughly,
• 10:10
  less than 20% of the Medicare population
• 10:12
  are dual eligible, but they drive over 35%
• 10:15
  of the cost. That's about $500,000,000,000
• 10:18
  in state and federal spending.
• 10:20
  So not only are we an opportunity to
• 10:22
  do good by helping
• 10:24
  members, communities navigate this health care system for
• 10:27
  better health care outcomes, it also addresses a
• 10:30
  significant driver of health care costs. So what's
• 10:33
  WellCare focused on specifically around this? Obviously, all
• 10:37
  the talk is integration and alignment.
• 10:40
  So we're very much focused on how do
• 10:42
  we connect the dots for our members in
• 10:43
  our communities to make it easier
• 10:46
  to navigate and optimize
• 10:48
  their access to benefits and to services.
• 10:52
  Simple things like one ID card so that
• 10:54
  we don't have to show up with two,
• 10:56
  three, four different
• 10:57
  cards for things. It's one customer service representative
• 11:01
  to be able to speak to. Take that
• 11:03
  to the provider side, a single point of
• 11:05
  contact for our providers
• 11:07
  to ensure that their Medicaid and Medicare benefits,
• 11:11
  and services are appropriately communicated so that the
• 11:13
  provider can be a best asset,
• 11:16
  to the member as well.
• 11:18
  But it also comes down to one of
• 11:20
  Centene's major strengths.
• 11:22
  Centene,
• 11:23
  for the record here, is the number one
• 11:26
  provider of Medicaid,
• 11:28
  coverage in the country.
• 11:29
  That includes being the number one provider of
• 11:32
  long term supports and services
• 11:34
  as well as age blind and disabled coverage,
• 11:37
  in the country. We collectively
• 11:39
  within Centene serve over a million duals today.
• 11:42
  What that means is
• 11:44
  Centene and WellCare are deeply embedded in the
• 11:47
  communities that we serve. We're deeply embedded in
• 11:50
  state as well as federal relationships
• 11:53
  that pertain to how programs and policies are
• 11:55
  designed
• 11:56
  to best serve,
• 11:57
  dual eligible members.
• 11:59
  We're embedded in provider relationships,
• 12:02
  I e,
• 12:03
  FQHCs
• 12:04
  and other sort of community health organizations
• 12:07
  as well as other community organizations that are
• 12:10
  there to serve
• 12:11
  and engage,
• 12:12
  dual members in our community. So we really
• 12:15
  try to lean in on the breadth and
• 12:17
  depth of our relationships at the community,
• 12:20
  at the state, and at the federal level,
• 12:23
  combined with that integrated approach from a member
• 12:26
  experience,
• 12:27
  consumerism perspective
• 12:29
  that needs to happen. Because of the complexities
• 12:31
  of the population
• 12:33
  and the complexities of the health care system,
• 12:35
  we feel like it's our responsibility to lean
• 12:37
  in and figure out ways to make it
• 12:39
  easier to do business work.
• 12:41
  Absolutely. And navigating these system complexities across so
• 12:45
  many different geographies and and systems. Like you
• 12:48
  mentioned, Centene operates in so many different states.
• 12:50
  What you're really touching on, Michael, is drilling
• 12:53
  down into it is is improving that member
• 12:56
  experience across
• 12:57
  the spectrum. And, you know, that's something that
• 12:59
  we hear about consistently
• 13:00
  right now from leaders like yourself here on
• 13:03
  the podcast, and and certainly what we've heard
• 13:05
  from the Centene leaders we've spoken to over
• 13:07
  these last few years is that the major
• 13:10
  focus is is improving that member experience. So
• 13:14
  how do you ensure that these investments you're
• 13:16
  making, this focus you are having on this
• 13:19
  experience for those that you serve,
• 13:21
  how does that also translate into better health
• 13:24
  outcomes at the end of the day?
• 13:26
  Yep.
• 13:27
  We have our metrics that we,
• 13:29
  hold ourselves accountable to and that certainly states
• 13:32
  and CMS and federal government holds accountable to.
• 13:35
  So things like
• 13:37
  voluntary disenrollment rates, member satisfaction scores, provider
• 13:41
  satisfaction scores. So there's a litany of sort
• 13:44
  of metrics that we evaluate there and work
• 13:46
  toward constant improvement.
• 13:49
  But as I think about this question about
• 13:51
  member experience and how to make it better,
• 13:54
  I think of some real hardcore blocking and
• 13:56
  tackling. Think of a member selecting a health
• 13:59
  plan.
• 14:01
  Maybe they're with a company from Medicaid, and
• 14:03
  now they're joining a dual eligible SNP plan
• 14:05
  for their Medicare benefits, or they're just new
• 14:08
  to managed care to begin with. What is
• 14:11
  that onboarding experience? So to me, I'm looking
• 14:13
  for our teams
• 14:14
  and our capabilities
• 14:16
  to get ahead of that. How do we
• 14:18
  engage with the member
• 14:19
  where appropriate and where permitted even pre effective
• 14:22
  dates so that we can hit the ground
• 14:24
  running? We can know each other. We can
• 14:27
  develop an understanding of who our members are,
• 14:29
  what their most critical needs are right from
• 14:32
  day one,
• 14:33
  and begin to build that trusting,
• 14:35
  reliable relationship
• 14:37
  right up front. So we're looking for solutions
• 14:40
  to be
• 14:42
  early starters,
• 14:43
  proactive engagement,
• 14:45
  trusting relationship up front. Obviously, that requires us
• 14:48
  to be there for our folks to be
• 14:50
  trained, for
• 14:52
  our systems to work, for our,
• 14:55
  provider directors to be correct. So it's all
• 14:58
  it we need to be able to be
• 15:00
  a reliable source
• 15:02
  of appropriate access. And then couple that with
• 15:05
  making sure that our provider partnerships are strong
• 15:08
  so that our providers can be our eyes
• 15:11
  and ears on the ground, especially as members
• 15:13
  come to receive care so that we create
• 15:16
  a bit of a triangle,
• 15:18
  effect between us as a payer, our providers,
• 15:21
  and our members and really create an optimal
• 15:24
  solution there. But it really starts with us
• 15:26
  leaning in and saying, we have a responsibility
• 15:29
  from the get go to know,
• 15:32
  to connect with,
• 15:34
  and to help
• 15:35
  the member navigate into,
• 15:38
  managed care as well as through then the
• 15:40
  initial process so that there's familiarity and trust
• 15:43
  that's built.
• 15:44
  Understood. Your your passion for serving these members
• 15:47
  really comes through the the conversation,
• 15:50
  Michael. One thing I wanted to also ask
• 15:52
  you about is, again, when we've spoken to
• 15:54
  other leaders at Centene,
• 15:56
  we've heard so many about so many new
• 15:59
  innovations
• 16:00
  in terms of the clinical model across the
• 16:02
  different populations that the company serves. And I
• 16:05
  wonder if you could delve into that for
• 16:06
  us a bit in terms of your perspective
• 16:08
  at WellCare and and how you see the
• 16:10
  integration of behavioral, physical, and and social health
• 16:14
  evolving,
• 16:16
  within your part of the company?
• 16:18
  The beauty of
• 16:20
  dual eligibles,
• 16:22
  I find, you know, we can we have
• 16:24
  a whole list of things that can become
• 16:26
  challenging from a,
• 16:28
  regulatory requirement perspective at times. But the beauty
• 16:31
  of the dual eligible program,
• 16:33
  it introduces requirements such as an ICT, an
• 16:36
  integrated care team.
• 16:38
  And the intent and and objective here is
• 16:42
  to have multidisciplinary
• 16:44
  team working together
• 16:46
  with a single point of contact for that
• 16:48
  member.
• 16:49
  So this is where I love and I
• 16:51
  welcome
• 16:52
  the public private partnership coming together because that's
• 16:55
  really what we should be doing. So for
• 16:57
  WellCareforce and team,
• 16:59
  as our colleagues do across the industry,
• 17:03
  we lean in on building the most effective
• 17:07
  interdisciplinary
• 17:08
  care teams possible
• 17:09
  that bring together the medical
• 17:12
  or the physical,
• 17:13
  behavioral,
• 17:14
  and social components of things and try to
• 17:17
  bring solutions to them that are hands on.
• 17:20
  So just, you know,
• 17:21
  use your single point of contact care manager
• 17:25
  or,
• 17:26
  LTSS
• 17:27
  service coordinator
• 17:29
  that helps you navigate the system. But it's
• 17:31
  then also complementing that with the right data
• 17:35
  at the right time, perhaps
• 17:37
  an app
• 17:38
  to those that wanna use it. Access to
• 17:40
  data
• 17:41
  and access to digital strategies
• 17:43
  appropriately
• 17:44
  to complement sort of the blocking and tackling,
• 17:46
  just rolling up our sleeves
• 17:48
  and being there in person or being there
• 17:51
  live for a member as well. So the
• 17:53
  innovation
• 17:54
  here really is
• 17:56
  the the right
• 17:57
  interdisciplinary
• 17:58
  focus,
• 17:59
  where the member is. We can't wait for
• 18:01
  the member
• 18:02
  to
• 18:03
  come meet us at the doctor's office
• 18:06
  or wait for them to call us. We
• 18:07
  have to go to where the members are,
• 18:10
  and that's in the community. It's important for
• 18:12
  us to be in the community.
• 18:13
  And then to the extent that people want
• 18:15
  to use it, bring
• 18:17
  digital
• 18:18
  data solutions,
• 18:20
  that help them navigate the system in a
• 18:23
  more efficient and effective manner.
• 18:25
  Wonderful. Well, Michael, before we go today, what
• 18:28
  else are we missing? What other final thoughts
• 18:31
  or final bits of advice do you wanna
• 18:33
  share with our listeners? We've got so many
• 18:35
  others from across the industry listening in, within
• 18:38
  the dual eligible, the Medicare, and the Medicaid
• 18:41
  spaces.
• 18:41
  What else do you wanna share with them
• 18:43
  today? Listen. I appreciate you, Jacob. I appreciate
• 18:45
  you calling out that the passion is coming
• 18:48
  through. It's one of these things where we're
• 18:50
  dealing
• 18:51
  with
• 18:52
  complex,
• 18:54
  high financial matters in these
• 18:57
  managed care organization roles.
• 18:59
  But at the end of the day, what
• 19:00
  I find,
• 19:01
  uniformly across my colleagues
• 19:03
  is that most of us love what we
• 19:05
  do, and
• 19:07
  we have this passion
• 19:08
  and that aligns to a mission.
• 19:11
  And
• 19:12
  everybody I know, I think, we we love
• 19:15
  that we're able to do something good for
• 19:17
  the communities
• 19:19
  that we serve and our neighbors
• 19:21
  that you know, what I encourage us all
• 19:23
  to do is continue to double down on
• 19:25
  that passion,
• 19:26
  keep leaning into it, and,
• 19:29
  sort of allow our industry to reinvent itself,
• 19:33
  become more consumer focused, more agile,
• 19:36
  more digitally and data enabled.
• 19:38
  The consumer focused thing is interesting. I I
• 19:41
  sometimes quote, it's probably a few years dated
• 19:44
  now, but there was net promoter score,
• 19:47
  results by industry,
• 19:49
  and it had cable companies
• 19:52
  as the worst ranking at the time. I
• 19:54
  have no idea if that's today, by the
• 19:55
  way. So I hope cable company
• 19:58
  leaders don't reach out to me at the
• 19:59
  time some years ago.
• 20:01
  Next to last,
• 20:03
  guess what?
• 20:04
  Health insurance.
• 20:05
  So we need to do better from a
• 20:07
  consumer
• 20:08
  perspective
• 20:09
  and need to make sure it's a priority.
• 20:12
  It's understandable that the time that somebody has
• 20:15
  to engage with the health insurance
• 20:17
  is a time of need and a time
• 20:19
  of stress, either for themselves or for
• 20:22
  a family member
• 20:23
  or somebody else close to them. So it's
• 20:26
  a stressful situation, and it makes it really
• 20:28
  hard.
• 20:29
  But we have to take on the responsibility,
• 20:31
  put that passion to work that we all
• 20:33
  have,
• 20:33
  and move the ball down the field in
• 20:35
  terms of doing better on consumerism
• 20:38
  and reinventing the business.
• 20:40
  Absolutely. I mean, it's a great and and
• 20:42
  timely call to action for all those listening
• 20:45
  in. So, Michael, I wanna thank you for
• 20:47
  taking the time to sit down with us
• 20:49
  and for sharing your insights with us and
• 20:51
  with our listeners. We really appreciate it.
• 20:54
  Thank you very much, Jacob. And to our
• 20:56
  listeners, if you'd like to listen to more
• 20:58
  podcasts from Becker's Health Care, you can visit
• 21:00
  beckershospitalreview.com.
• 21:05
  At athena Health, we know your ambulatory practice
• 21:08
  wants healthier,
• 21:09
  A healthier business, healthier care teams, and healthier
• 21:12
  patients.
• 21:13
  But the complexities of modern healthcare tech make
• 21:15
  it hard for you and your care teams
• 21:17
  to focus on what matters most.
• 21:19
  That's where athena Health can help. Our AI
• 21:22
  native all in one solutions reduce administrative burdens,
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  health. See how simpler is healthier at athenahealth.com.