Latest / Becker’s Payer Issues Podcast / Improving Access to Preventive Care and Whole Person Health with Dr. Jennifer Nuovo

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Improving Access to Preventive Care and Whole Person Health with Dr. Jennifer Nuovo · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
0:02
Becker's Pay Your Issues podcast.
0:04
Thrilled today to be joined by doctor Jennifer
0:06
Nuovo, who's the chief medical officer at Blue
0:09
Shield of California's Promise Health Plan. Doctor Nuovo,
0:12
thank you so much for taking the time
0:13
to be with me on the podcast today.
0:15
Well, thank you for having me. Absolutely. And
0:18
before we dive into everything we wanna talk
0:19
with you about, can you tell us a
0:21
little bit more about yourself, your background in
0:23
health care, and what it is that you
0:25
do today at Blue Shield?
0:27
Sure.
0:28
I'm an internal medicine physician, and my, subspecialty
0:32
is endocrinology.
0:34
I practiced,
0:35
in Seattle and in Sacramento for about twenty
0:38
years,
0:39
and then I came to the health plan
0:41
side on,
0:43
in managed care,
0:45
particularly focused on low income populations and the
0:48
medical population here in California
0:51
as the phase of my career. And I've
0:54
done
0:55
medical director work with Health Net of Cal
0:57
of California Health
0:59
Net, with Sutter Health Plan in the Bay
1:02
Area and the Sacramento area,
1:05
with UnitedHealthcare.
1:07
And now I've landed with, Blue Shield of
1:09
California
1:10
on their Promise Health Plan, which is their,
1:13
medical medical only health plan here in California
1:17
for,
1:18
with lives in
1:21
Los Angeles and San Diego.
1:23
Fantastic. So a long career in the industry,
1:26
Jennifer.
1:27
And in that vein, we wanted to talk
1:29
with you today to start out about a
1:31
recent survey from Aflac that was showed that
1:34
nine out of ten Americans have missed health
1:37
checks or preventive screenings,
1:39
at some point in their life, which and
1:41
that's a lot of people, the majority of
1:43
people. So from your perspective,
1:46
how important is preventive health overall,
1:49
and and what's what is Blue Shield Promise
1:51
Health Plan doing to increase access to preventive
1:54
care?
1:55
Sure. Well, that's a long question. Two questions,
1:59
really.
2:00
Preventive health care is really the cornerstone
2:03
of
2:05
health
2:06
in
2:07
our culture, in our society, and really all
2:10
societies.
2:11
Our wealth as people is our health.
2:14
And
2:15
protecting health,
2:17
ensuring
2:18
people are healthy
2:19
is really done
2:22
a variety of ways, but primarily in the
2:24
health care world, it's done through prevention.
2:27
And, you know, I think the statistics sounds
2:30
shocking and is
2:32
is alarming,
2:33
but if you think of a lifetime
2:35
and all of the preventive services that are,
2:39
requested
2:40
and recommended for people, it's not surprising
2:43
that people miss an annual well visit at,
2:46
you know, at age of 53 and then
2:48
their next well visit is age of 55.
2:51
Right? So all everyone gets thrown into that
2:54
statistic.
2:56
Health insurance
2:57
and physicians
2:59
really partner together
3:01
to try to make sure our
3:03
members and the patients for the for our
3:06
doctors
3:08
know what the preventive
3:10
service
3:11
need is for that particular age and stage
3:14
of life. We all know that babies, for
3:17
example, have lots of visits their three years
3:20
of life, much of that for vaccination
3:23
and for developmental screenings,
3:26
and well child visits,
3:28
but then really annually thereafter
3:30
for all children. And then there's another
3:33
batch of vaccinations
3:34
that we highly recommend for kids going into,
3:38
junior high and then again going into college.
3:41
Adults
3:42
really also need preventive health care. How do
3:45
you know if you have hypertension?
3:47
It's a silent disease. Right? So you only
3:50
know by testing your blood pressure, and we
3:52
get that done through annual visits with your
3:55
physician.
3:56
How do you know you have diabetes?
3:58
Again,
3:58
very comes on slowly, very silent, quiet,
4:02
disorders, a disorder that we know we need
4:04
to identify early and treat early.
4:08
But without getting the preventive screenings, very hard
4:11
to know if you have those
4:12
conditions.
4:14
Absolutely.
4:15
It makes sense. So, really, your perspective here
4:17
is preventive health is wealth.
4:20
And it makes sense that so many people
4:21
have missed these these types of screens over
4:24
the span of their lifetimes.
4:25
I'm I'm wondering how you think the Blue
4:27
Shield's efforts in this space are helping to
4:30
address health disparities
4:31
in a place like California.
4:34
Sure. And I think I didn't even really
4:36
answer part two of your of your last
4:38
question, so I think I'll take a stab
4:40
at that and then talk about health disparities,
4:43
a little bit on top of that. But
4:45
whether you are just a middle class person
4:48
with employer based insurance or whether you have
4:51
Medi Cal or whether you are in the
4:54
one of the exchange products,
4:56
really, prevention is an area that that that
4:59
Blue Shield of California and Promise Health Plan
5:02
really focus on
5:04
making sure
5:05
that the
5:07
member or the patient
5:08
knows what prevention needs to be done for
5:11
that particular year. We do that with a
5:14
variety of touches and outreaches,
5:17
either telephonic
5:18
or mailed,
5:20
sometimes texting,
5:22
and sometimes through our, app that we make
5:25
available to our, membership so that you know
5:28
what you need to get done in this
5:30
particular year. We send very similar information
5:34
to the patient's doctor, to their primary care
5:37
doctor so that they know for the patients
5:40
and the members that are assigned to them
5:42
who needs a mammogram,
5:44
who needs a colonoscopy,
5:46
who's due for,
5:48
you know, a vaccination,
5:49
who's due for a well visit.
5:51
Those
5:52
notices,
5:53
hopefully,
5:54
align enough that the patient schedules a visit,
5:57
the doctor knows what to get done when
5:59
the patient comes in for that visit. So
6:01
there is a variety of messaging done by
6:04
the by the health plan by both Blue
6:06
Shield of California for their lives and by
6:08
promise for the Medi Cal lives. We also
6:12
have a variety of incentives
6:14
that we pay both to the provider
6:16
as well as some incentives that we can,
6:19
provide to the member for going in and
6:22
going to the inconvenience
6:24
and disruption of life of going into the
6:26
doctor
6:28
to get that done. And certainly on the
6:29
medical plan, we do offer transportation benefit
6:33
so that if transportation is an if issue,
6:36
if you don't have a car, you're not
6:38
on a bus line, you it's not easy
6:39
to get to the doctor,
6:41
we can arrange those
6:42
visits for you to try to remove that
6:44
barrier to access.
6:47
Sure. Sure. It may it makes complete sense.
6:49
So a lot of outreach, a lot of
6:50
incentives from from the health plans, towards providers
6:53
and towards the members to access this care.
6:56
Jennifer, coming back to the other question, how
6:58
do you think that these efforts are helping
6:59
to address,
7:01
health disparities among your members?
7:04
Yeah. So what we do notice is that,
7:07
in certain ZIP codes and certain,
7:11
of our membership,
7:12
there is lagging in getting the preventive services
7:16
done. Some of that is due to language
7:19
barriers, not understanding,
7:21
what it is that's available or what it
7:24
is you need to get done, just because
7:26
of not having, you know, English skills here.
7:30
Some of it is cultural.
7:32
Some of it is, you know, people are
7:34
new to this country and new to this
7:35
state, and they just, you know,
7:38
may not prioritize
7:39
getting into the doctor in their,
7:41
you know, in their
7:43
year or so here. So we do,
7:46
notice that there are a variety of populations
7:49
that really lag behind.
7:51
We also know that certainly in the African
7:53
American community, for example, there is often widespread
7:57
distrust of the medical establishment
8:00
not believing
8:02
that the primary care provider that you're assigned
8:05
to is really the right person for you,
8:09
and not knowing what their
8:11
recommendation
8:12
are their recommendations
8:13
truly,
8:15
you know, important for me? So there is
8:17
a fair amount of distrust among,
8:20
certain
8:21
people in this country, and then there's just
8:23
widespread,
8:24
I don't know what you're talking about. I
8:26
don't know I don't know what this is.
8:28
Why should I do this? So
8:29
a a lot of our focus really is
8:32
on
8:33
areas and populations
8:35
that really may not have good trust or
8:37
good understanding of what needs to be done.
8:40
So in addition to what we talked about
8:42
a few minutes ago of just sort of
8:44
a peanut butter spread, I call it, giving
8:47
messaging to everybody and giving messaging to every,
8:51
one of our providers,
8:53
we also do very targeted
8:55
outreach to certain populations that we know,
8:59
either from our own data or from just,
9:02
you know, historical data, no,
9:04
access
9:05
health care
9:06
reluctantly perhaps or or not frequently enough. And
9:11
in those particular populations,
9:13
at least on the Promise Health Plan side,
9:16
we have,
9:17
specific,
9:19
and targeted programs to reach into those communities.
9:23
You know, it it makes sense. There's it
9:25
has to be very targeted outreach to reach
9:27
different and diverse populations, but but please, continue.
9:31
Yeah. I mean, I think for a long
9:32
time, we didn't really think about that. Right?
9:35
We we just thought about, well, if we
9:36
just let people know, here's your doctor, here's
9:39
what you need to get done,
9:40
that folks would pick up the phone and
9:42
schedule.
9:43
And we have certainly found over time that
9:45
it it takes a little more effort with
9:47
certain populations,
9:49
and everyone
9:51
deserves preventive health care. Everyone
9:54
needs to be seen, and everyone needs to
9:56
be welcomed into the health care community
9:59
and become comfortable and familiar,
10:01
in those settings.
10:03
So particularly what we have,
10:06
launched and what we do, for,
10:09
certain communities is we offer,
10:12
appointment visits, well child visits, for example,
10:16
after hours and on weekends in,
10:19
specific,
10:21
targeted
10:22
ZIP codes and targeted areas where we know
10:24
it's very difficult
10:26
for families to get in for routine care
10:28
to their assigned PCP.
10:30
So we'll have these,
10:32
events,
10:33
in the evenings and on weekends. We also
10:35
know that our medical population
10:38
is often working, often very busy, and they're,
10:41
you know, working at jobs where they can't
10:44
really
10:45
take time off.
10:47
They if they take time off, they don't
10:49
get paid, or if they take time off,
10:51
they're told not to bother to come back.
10:53
So sometimes scheduling during routine doctor offices just
10:57
really doesn't work very well for a lot
10:59
of our population, and so those are areas
11:01
that we really target for our evening and
11:03
our weekend clinics.
11:05
And then we also know that there are
11:06
certain
11:08
services that people just don't wanna have. Right?
11:10
Either either culturally or they're just unpleasant services.
11:14
Mammograms
11:15
come to mind, right, as something that that
11:18
people will also often put up and be
11:20
reluctant about. So we have,
11:22
scheduled just, you know, just mammogram only visits
11:26
in provider offices or, you know, in certain
11:29
areas where we feel that people can get
11:31
into and schedule fairly fairly readily.
11:34
And we we make those events a little
11:37
festive, honestly,
11:39
Jacob. So, you know, balloons and a little
11:42
gift and, you know, a flower after you
11:44
get your mammogram done, a lot of counseling
11:46
and coaching.
11:48
There are,
11:49
a lot of women who are really reluctant
11:52
to get undressed in front of strangers
11:54
just either because of personal experience or cultural
11:58
beliefs. So,
12:00
you know, we have people like myself. I
12:01
tend to go to these events and and
12:04
do a little counseling and coaching as well.
12:06
My mother, for example, died of breast cancer.
12:09
So it's a it's a issue that's important
12:12
to me, and I know that a lot
12:14
of our members
12:16
get really caught up in,
12:19
their families' lives, making sure their kids are
12:22
doing well, making sure that everything is going
12:25
well, but often neglect themselves.
12:27
So we really try to work in those
12:30
particular
12:32
mammogram events on you're important to, your health
12:35
matters. It's really important for you to be
12:37
healthy because your family depends on you.
12:41
Absolutely. And if we're sticking to this to
12:44
this topic, Jennifer, of all the different ways
12:46
that Promise Health Plan is reaching your membership,
12:50
as as I understand that you have a
12:51
brick and mortar presence across the state through
12:53
your community resource centers. Can you talk to
12:56
us a little bit about about that and
12:57
and how these centers play a role in
12:59
in what we're talking about right now?
13:02
Yeah. Absolutely. We partner with,
13:05
LA Care Health Plan.
13:07
We are a a delegate to LA Care
13:10
Health plan, the local initiative health plan in
13:13
Los Angeles County.
13:14
And with,
13:16
LA Care, we have
13:18
13 or 14 community resource centers through, throughout
13:22
Los Angeles. We just opened, I think, our
13:25
center.
13:25
We have a couple of centers that are
13:28
our own as well.
13:30
But with the partnership with LA Care, we've
13:32
really been able to build these hubs within
13:35
low income communities
13:37
that are
13:38
places anyone in the community can walk in
13:41
and ask a health related question.
13:43
Classes are offered, wellness classes, fitness classes, Zumba
13:47
classes,
13:49
health education classes, diabetes, hypertension.
13:52
We have after school
13:54
places for kids to come and do homework.
13:56
Kids can get dropped off and play while
13:58
parents do a little bit of shopping. And
14:00
it's a place where you can,
14:03
learn about the Medi Cal program and get,
14:05
assistance with enrollment in the Medi Cal program.
14:09
So these community centers
14:11
not only,
14:13
really are hubs for the neighborhoods, but they're
14:15
really a way for
14:17
us as the health insurance company to reinforce
14:21
the importance of health care in your life.
14:25
Wow. So so more than a dozen of
14:27
these centers in the Los Angeles area, it's
14:30
amazing. And and I wonder you know, we
14:32
hear so much from insurers today, Jennifer, about
14:34
their their focus on whole person care, really
14:37
providing comprehensive
14:39
integrated services to their members. I wonder, you
14:42
know, based on everything we've talked about today
14:44
in terms of all the different ways,
14:46
that's the Blue Shield and the Promise Health
14:48
Plan is reaching its membership, How do all
14:50
these efforts really fit into Blue Shield's focus
14:53
on on whole person care?
14:56
Well, we understand
14:57
that
14:58
health doesn't exist in a silo,
15:01
and health care doesn't exist in a silo.
15:04
So the more we can understand,
15:07
the context
15:08
of someone's social and cultural and environment,
15:12
the better we can serve our population, whether
15:15
that means
15:16
that we really come up with,
15:18
specific outreach and bringing health care to people
15:21
who are perhaps unhoused.
15:24
You know, as you know, I think a
15:27
of all the unhoused people in the country
15:29
live in Los Angeles County.
15:31
So, you know, it and and just imagine
15:35
living in a tent under a freeway, and
15:37
then how are you gonna get your dental
15:39
care? How are you gonna get your your
15:41
annual flu shot? How are you gonna get
15:43
your annual well visit and find out about
15:46
your hypertension or get refills on your on
15:49
your diabetes medication
15:51
if we don't come to you?
15:52
So,
15:54
really understanding the context and that people are
15:56
not just,
15:58
you know, bodies for doctors to examine and
16:01
write prescriptions for. They really are living whole
16:04
lives. So how can we fit ourselves into
16:07
that life? And I think some of our
16:09
evening and weekend clinics really kind of speak
16:12
to that a little bit.
16:14
Our work with the,
16:16
street medicine,
16:18
providers,
16:19
you know, really fits with that.
16:21
And then really the state of California
16:24
or the Medi Cal population has really,
16:28
set up criteria and guidelines
16:30
and assistance for the health plans
16:33
for us to,
16:34
work with
16:36
very specific populations.
16:38
For example, if you are justice involved, if
16:41
you have if you are being released from
16:43
jail
16:44
and maybe while you were in jail or
16:46
in prison, you were getting
16:48
a treatment for substance abuse, and then all
16:50
of a sudden you're out on the street,
16:52
how do we make sure that insurance
16:55
is available to that person
16:57
at the time of release and that they
16:59
can continue on their medications, whether it's medications
17:02
for mental health, medications for diabetes, medications for
17:06
substance abuse
17:07
so that the health that has
17:09
been stabilized
17:11
in
17:12
the incarcerated setting
17:13
can be
17:14
seamlessly
17:15
continued. So there are certain populations
17:17
that the state has asked us to focus
17:20
on specifically.
17:21
We've talked for a minute about the unhoused
17:23
population,
17:24
the justice involved population,
17:26
also foster youth.
17:29
You know, how how can the health plans
17:31
really,
17:32
lift up and work effectively
17:34
with the foster families and the foster youth
17:37
to make sure that those health care for
17:39
those kids and teens is also happening.
17:42
And, you know, in that way, I think
17:44
we really have been asked to not just
17:47
think about the social environment people are living
17:50
in and how to deliver health
17:53
effectively in that environment, but also what can
17:56
health care provide
17:58
that
17:59
stabilizes
18:00
your health? Housing,
18:01
for example,
18:03
sober centers,
18:06
recuperative
18:06
shelters. So if you're discharged from a hospital,
18:09
but you still have some lingering,
18:12
health needs,
18:13
you know, you don't have to go right
18:15
into the regular shelter system. You can go
18:18
to a recuperative shelter and continue to get
18:21
those health needs.
18:23
Home modifications,
18:24
you know, people often have to leave their
18:26
home and go into nursing care, nursing home
18:29
care because they don't have a ramp. So
18:32
now we can provide ramps to people so
18:34
they can stay in their own housing.
18:36
That's the sort of activities that we're really
18:39
incorporating
18:40
into the provision of health. It's not doctors
18:44
exactly and it's not medicines exactly,
18:47
but it is
18:48
it is sometimes more powerful
18:50
than than the medication to have a secure
18:53
place to live.
18:55
Certainly. And it's wonderful to hear how much
18:58
of a focus Blue Shield is placing on
19:00
serving
19:01
such vulnerable populations across the state, Jennifer.
19:05
Before we go, anything else that we're missing?
19:07
You have the ears of a lot of
19:08
other health plan leaders from around the country.
19:11
Is there any final thoughts or final bits
19:13
of advice you wanna share with them?
19:15
We wanna highlight one more program that I
19:18
think other health plans could, you know, perhaps
19:20
pick up on. We offer a program called
19:23
GED Works. So we really,
19:26
encourage
19:27
our members
19:28
to get their high school equivalency,
19:31
degree accomplished
19:32
so that they can go out into the
19:34
workforce
19:35
and be a more attractive,
19:38
employee for people. So, you know, again, it's
19:41
not
19:42
it's not a medicine,
19:44
but it's a lifetime and it's a lifetime
19:46
investment
19:47
in a person,
19:49
so that they can have a successful
19:52
life,
19:53
you know, in America.
19:54
And, so things like that. How do you
19:57
help people with high school equivalency?
19:59
How do you help them,
20:01
enroll and and persist in a in a
20:04
college,
20:05
program or in a training program? Those are
20:07
the kind of things I think that, health
20:10
insurance companies should think deeply about and figure
20:13
out how do we really get everyone
20:16
on
20:17
close enough to a level playing field that
20:19
they can have a successful adult life.
20:22
My final thoughts or my recommendations
20:24
is we have to do
20:26
we have to continue to figure out ways
20:29
to reach people
20:30
and to encourage access to care and encourage
20:34
preventive,
20:35
health care and make sure that we are
20:38
following the recommendations
20:40
of the
20:41
United States preventive task force
20:44
on that. And then we also have to
20:46
think creatively about how do we make lives
20:49
more,
20:51
healthy
20:51
in
20:52
ways that aren't just doctors and pills. Right?
20:55
How do we encourage
20:57
healthy lifestyles,
20:59
exercise,
21:00
healthy eating, healthy neighborhoods,
21:03
you know, all safety, safe neighborhoods so that
21:06
you can, you know, take a walk every
21:08
evening and not be frightened.
21:10
Those are areas I think that health insurance
21:12
can be involved in and can really think
21:14
creatively and deeply about.
21:17
Wonderful. Well, doctor Nuovo, thank you so much
21:19
for taking the time to sit down with
21:21
us on the podcast and for sharing your
21:23
insights with our listeners. We really appreciate it.
21:26
You are welcome, and thank you for having
21:28
me. Absolutely.
21:29
To our listeners, if you'd like to listen
21:31
to more podcasts or Becker's Healthcare, you can
21:33
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