Latest / Becker’s Payer Issues Podcast / Gary Rosenfield, Director, Medicaid Product & Strategy, United Concordia Dental

Transcript

Gary Rosenfield, Director, Medicaid Product & Strategy, United Concordia Dental · Becker’s Payer Issues Podcast

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  Hello, and welcome to the Becker's Healthcare podcast.
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  I'm joined today by Gary Rosenfield, director of
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  Medicaid product and strategy at United Concordia Dental.
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  Gary, can you start off by telling us
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  a little bit about yourself and your background?
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  Sure. I am, as you said, the director
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  of Medicaid product and strategy at United Concordia
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  Dental.
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  We are the wholly owned subsidiary dental plan
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  under the umbrella of Highmark Health.
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  I joined in
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  January of this year after spending a lot
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  of my career on the Medicaid managed care
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  side
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  of the of the business.
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  So I ran the Medicaid line of business
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  in a couple health plans in New York,
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  ran
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  Medicaid strategy for a number of years at
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  a large health plan on the West Coast.
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  And I was excited to join United Concordia
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  because in my
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  experience on the managed care side,
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  dental is a
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  a huge
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  challenge
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  for the Medicaid population,
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  and I believe United Concordia Dental is positioned
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  well to, address those challenges. So I'm tasked
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  with,
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  really growing our
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  Medicaid footprint beyond our, you know, beyond Highmark
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  Health, which is where we currently serve Medicaid
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  in 3 states.
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  From improving member experience and expanding value based
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  care to controlling costs, You know, payer executives
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  have ambitious growth goals for the rest of
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  the year and into next year. In your
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  role, what would you say is your top
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  priority right now, and how are you planning
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  to get there?
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  So
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  the top priority I mean, there there's there
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  are several top
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  priorities. I would say
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  2 of them that are are
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  probably equal is 1.
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  Access to care is a is a challenge,
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  especially for the Medicaid population.
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  So what yeah. One of the things that
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  we're looking at is
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  we have the
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  largest provider network. United Concordia, which I didn't
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  mention before,
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  has the TRICARE
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  contract. So we have the military contract. So
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  we have a network provider. If there's a
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  post office, we have a network provider.
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  So
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  how do we
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  leverage
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  that network
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  in a way that
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  expands
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  access.
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  But with the challenges,
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  within the current providers who take Medicaid,
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  one of the, like, kind of priorities is
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  how do we expand the capacity for those
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  existing
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  providers? So that's one. The other is
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  more you know, this this is like a
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  team effort.
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  The head has,
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  for an inexplicable
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  reason, been separated from the body when it
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  comes to regulations
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  and funding.
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  We need to really work on advocating
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  to get the
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  proper attention to make oral health
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  really part of the conversation so that there's
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  the appropriate funding to to really
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  make that connection between the oral and systemic
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  health link.
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  At an industry level, what would you say
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  are the biggest barriers to effectively serving and
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  engaging members?
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  You know, what opportunities do you see for
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  large scale improvements in this area, and how
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  are you currently applying these strategies?
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  Yeah. So, you know, great question. You know,
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  in the in the dental space and, again,
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  with Medicaid,
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  I I could cite, you know,
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  some statistics,
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  like 93%
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  of
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  people in poverty
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  have not used dental services.
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  People of color are 3 times more likely
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  to have never seen a dentist, and they're
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  also 3 times more likely to go to
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  the emergency department when they have an oral
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  health care issue.
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  So one of the biggest
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  barriers
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  to engaging members is
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  we need to
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  really figure out or really
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  get to the community level. You know, much
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  like community health workers, we at United Concordia
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  have a team of government relations liaisons who
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  actually go out in the communities,
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  where the military bases are, and they educate
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  the active duty military members and their families,
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  help get them connected to providers that are
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  in their neighborhood or area
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  with with the intent to make sure that
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  the active duty military member is fit for
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  deployment.
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  We could take that same model and have
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  the the boots on the ground that kind
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  of address
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  the
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  kind of trust barriers that we find with
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  those populations,
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  help get them connected to social
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  services that may be impediments,
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  help get them connected to to providers,
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  really put some programs in there that drives
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  not only engagement, but actually
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  access,
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  adaptability,
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  or adoption
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  of of the care.
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  And so so we're looking at that as
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  far as like large scale improvements.
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  It's it it is a team
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  effort and Medicaid
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  as as the saying goes, you've seen one
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  Medicaid member, you've seen one Medicaid member. It
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  is really community driven. So how can we
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  leverage
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  some of the, you know, the technology
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  tools that we have
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  to remove some of the,
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  barriers
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  of getting providers in the network. Right? So
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  administrative
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  kind of burdens that are placed on them.
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  How can we
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  get creative with value based contracting
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  with the providers who are in our network
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  so that they're more open to enrolling in
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  Medicaid and taking those those members? Mhmm. Things
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  like that.
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  So keeping up with, today's rapidly evolving health
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  care landscape is is challenging.
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  What's one piece of advice you'd like to
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  share with other leaders in your space to
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  help grow their businesses while keeping members top
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  of mind?
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  That that is a really good question. I
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  I would say the the first piece of
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  advice is
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  patience. This is it's not a sprint. It's
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  a marathon. It's a complicated
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  population like Medicaid. So really kind of understanding
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  that it is
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  local, you know, community driven.
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  Also,
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  don't get caught in the trap of trying
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  to boil the ocean, which is often a
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  lot of leaders wanna just fix everything.
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  Really start on a
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  a kind
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  of a a deliberate
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  kind of more focused approach
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  to solving
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  or addressing
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  challenges that that they're facing. All that being
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  said, that does keep the members in mind
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  It because
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  if you're understanding
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  the challenges of the local communities
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  and then putting programs in place to address
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  those challenges, you will start seeing
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  outcomes, drive delivering a better member experience,
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  and all the things that are related to
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  that.
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  So we we talked about the rapidly changing
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  health care landscape.
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  It's also ever evolving from a regulatory environment
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  as well. What are some of the tools
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  and strategies that have helped your organization improve
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  quality and clinical outcomes
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  while staying,
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  compliant?
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  So very good question. So we we are
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  a heavily regulated industry. It especially with Medicaid,
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  you you have to be in compliance. Right?
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  So the contract is scrutinized,
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  the reporting,
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  everything that we do for the members, how
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  we engage them, you know, the marketing,
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  the messaging, all has to be approved.
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  And and to your point, it is an
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  evolving
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  regulatory environment and, you know, given
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  what happened
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  with the election, not to bring that in,
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  but
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  Medicaid is going to be in the crosshairs
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  of massive changes at the federal level, most
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  likely. So we have to start thinking about
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  that. But in terms of of, you know,
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  being able to improve the quality and clinical
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  outcomes
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  while staying compliant,
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  we at United Concordia Dental, and and and
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  this this kind of is one of the
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  advantages of having Highmark Health, which is an
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  MCO as our parent company,
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  have are you know, we take a total
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  health approach.
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  So we are, yeah, like, really
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  deliberate
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  about driving better health overall health outcomes. So
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  we do that by
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  making that, like, medical, dental integration. So kind
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  of connecting the oral systemic health link.
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  You know,
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  60 chronic conditions, including, like, diabetes
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  and and heart disease.
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  Those are all things that could actually be
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  diagnosed
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  or or mitigated if you get your oral
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  health care. There's a link between oral health
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  and and those chronic conditions.
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  There are other like like, with prenatal
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  care,
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  there are connections to if you get the
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  moms in for
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  a teeth cleaning
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  during pregnancy,
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  it actually
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  reduces
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  the risk
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  of
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  preterm births and low birth weight. Those are
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  all things that that we're doing. So we've
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  we've created, like, a dental medical insights platform
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  Mhmm. That allows us to kind of take
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  the data and and
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  gain some
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  actionable insights
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  that allow us to take action to improve
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  quality
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  in terms of, you know, managing diabetes
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  or
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  improving
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  quality for maternal health.
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  So a little bit ago, you talked about
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  some of the
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  disparities in the dental space in your communities.
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  What are some of the things your organization
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  is doing to address these? And, you know,
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  do you have any measurable examples of success?
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  So that that is a great question. You
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  know, measurable, you know, we're, you know, still
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  kinda sifting through that. Mhmm. But some of
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  the things that that we're doing, like I
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  mentioned, kind of, using our kind of government
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  relations liaisons or GRL model,
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  you know, we could call them community dental
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  advocates, like, use that model
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  or the Medicaid population
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  to really get into the communities
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  to
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  address the diverse needs, you know, one community
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  at a time. So we could, you know,
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  look at rural areas or certain ZIP codes
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  where there are some challenges and kind of
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  develop a framework or a model where we
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  actually have
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  boots on the ground, people from the community
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  who could build that trust and address some
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  of those inequities and disparities that are out
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  there.
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  We also
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  have
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  kind of recognized or identified, you know, some
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  of the, you know, prior auth
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  challenges, like prior authorizations.
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  So, you know, for example, like with diabetes,
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  like,
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  removing the
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  prior auth need so that someone with diabetes
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  could get, like, an extra cleaning, get an
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  extra exam.
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  You know? So kind of working with with
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  those populations
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  on a on a disease level. We also
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  are you know, use benefit limits exceptions. So
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  a lot of states with Medicaid, they have
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  for the adult population, they have, you know,
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  strict limits on
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  how much is paid in dental.
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  There are certain kind of
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  procedures, again, with the chronic conditions
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  that we make exceptions
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  and and because it's the right thing to
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  do from a health standpoint.
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  So those things
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  are delivering,
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  you know, better outcomes.
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  And, again, it's like one community at a
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  time. Mhmm. Mhmm.
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  Well, Gary, I really appreciate you sharing your
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  insights today. But before I let you go,
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  do you have any final thoughts you'd like
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  to leave with our listeners?
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  So final thought is and I I say
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  this to everyone. I said at the beginning.
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  It's real we we need to make
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  the head part of the body, and we
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  need everyone out there,
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  especially on the payer side,
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  recognizing
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  that oral health is part of physical health.
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  It is part of the body. Mhmm. And
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  and really
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  get, you know, take take some focus and
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  and really, you know, lean into
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  addressing
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  oral health care needs as part of total
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  health. Well, Gary, thank you again for joining
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  us today on the Beckers Health Care Podcast,
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  and I hope you have a lovely rest
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  of your day. Alright. Thank you so much.
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  Bye bye.