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

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

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