Latest / Becker’s Payer Issues Podcast / Linda Hines, Virginia’s Medicaid Market President at Humana

Transcript

Linda Hines, Virginia’s Medicaid Market President at Humana · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400 payer and health plan executives
• 0:12
  and more than 100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George W.
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone. This is Elizabeth Caslow with the
• 0:36
  Becker's Payer Issues podcast.
• 0:38
  I'm thrilled today to be joined by Linda
• 0:40
  Hines, Virginia's Medicaid market president for Humana.
• 0:44
  Linda, thank you so much for chatting with
• 0:45
  us today.
• 0:46
  Good morning, Liz. Thank you so much for
• 0:48
  having me today.
• 0:49
  Of course.
• 0:50
  So before we dive in, can you tell
• 0:52
  us a bit more about yourself, your health
• 0:54
  care career backgrounds, and your current role at
• 0:57
  Humana?
• 0:58
  Absolutely.
• 1:00
  So I always like to start off by
• 1:02
  saying I am a nurse by background.
• 1:04
  I, I'm a registered nurse, and that's where
• 1:06
  I started my career, mostly on the provider
• 1:09
  side and, hospital space. I had an opportunity
• 1:12
  to join,
• 1:14
  Medicaid managed care specifically,
• 1:16
  oh my goodness, back in 1996, so it's
• 1:19
  been thirty years ago.
• 1:21
  Joined a very small health plan that was
• 1:23
  really just in the Central Virginia market at
• 1:26
  that time. We had only had about 3,000
• 1:28
  members.
• 1:29
  And, I actually joined them managing their medical
• 1:32
  management department,
• 1:34
  continued to stay with them, progressed,
• 1:37
  through the ranks to become the vice president
• 1:39
  of clinical services, which encompassed
• 1:43
  everything clinical,
• 1:44
  pharmacy, quality,
• 1:46
  care management, credentialing,
• 1:48
  and and stayed in that role for about
• 1:50
  sixteen years,
• 1:52
  then moved into a chief operating role, then
• 1:55
  to CEO of that health plan.
• 1:57
  When I left that health plan, we actually
• 1:59
  had grown from that 3,000 that we started
• 2:01
  with to well over 380,000
• 2:04
  members.
• 2:05
  Went to another health plan, was the president
• 2:08
  of, the Virginia Medicaid market,
• 2:10
  the dual special needs.
• 2:12
  And then now I am at Humana
• 2:15
  as the plan president specifically
• 2:17
  for the Health and Horizons, which is Medicaid
• 2:20
  and
• 2:21
  our integrated dual special needs plan.
• 2:24
  So,
• 2:25
  you know, that's quite a journey. I know
• 2:27
  I often get asked, how did you move
• 2:29
  from clinical, so to speak, into the more
• 2:32
  administrative? But I do think that it all
• 2:34
  fits together.
• 2:36
  That clinical experience really shaped,
• 2:39
  my experience to move more into the operations
• 2:42
  piece, and I think having that I'm more
• 2:44
  of an effective leader in this space at
• 2:46
  this time.
• 2:48
  Yeah. That makes a lot of sense. So
• 2:50
  today, we're gonna chat a bit about your
• 2:51
  market's youth behavioral health efforts.
• 2:54
  And schools are a cornerstone of those efforts
• 2:56
  from what I've been reading. Can you elaborate
• 2:58
  a bit on your partnerships and initiatives taking
• 3:01
  place in those settings?
• 3:02
  Sure.
• 3:03
  So we often see how distance and travel
• 3:07
  can truly impact,
• 3:09
  our members being able to specifically access those
• 3:12
  services.
• 3:13
  Many of our parents,
• 3:15
  you know, contrary to popular belief, they are
• 3:18
  working, and it is challenging for them to
• 3:20
  get off,
• 3:21
  during the day. And so we have formed
• 3:23
  a partnership
• 3:24
  with the Virginia Healthcare Foundation
• 3:27
  to focus really on meeting the critical needs
• 3:30
  of behavioral health services for our youth in
• 3:32
  our communities
• 3:33
  especially in those rural communities.
• 3:36
  So we invested
• 3:38
  $2,500,000
• 3:40
  in the nurture NAM program. And specifically, that
• 3:43
  program through the Virginia Healthcare Foundation
• 3:46
  supports,
• 3:48
  the delivery of school based therapy,
• 3:51
  and
• 3:52
  the pipeline to actually grow the behavioral health
• 3:55
  provider workforce.
• 3:56
  We truly believe if we can provide that
• 3:59
  care in the schools while we have that
• 4:01
  captured audience,
• 4:02
  it's more effective. They don't have to worry
• 4:04
  about transportation. Many times the parents do not
• 4:07
  have to worry about taking off from work.
• 4:09
  We are able to be more effective.
• 4:12
  So in 2023,
• 4:13
  Humana,
• 4:14
  actually invested 500,000
• 4:17
  in that, and we will continue to invest
• 4:19
  each year as the program grows.
• 4:22
  I can also imagine having these resources in
• 4:25
  schools, you know, even parents aside and transportation
• 4:28
  access there. It's also easier to keep kids
• 4:31
  in schools and not have them physically leave
• 4:33
  that space too.
• 4:35
  You did mention growing the behavioral health workforce.
• 4:38
  So those challenges are prevalent across the country.
• 4:41
  Can you elaborate a bit more about what
• 4:44
  Humana Healthy Horizons in Virginia is doing to
• 4:46
  address this,
• 4:47
  especially when it comes to specialists for the
• 4:49
  population?
• 4:51
  So yes. So this particular grant, actually, the
• 4:54
  nurture now grant that we're working with, the
• 4:57
  Virginia Healthcare
• 4:58
  Foundation, not only is it providing the therapy
• 5:01
  in the schools,
• 5:02
  but then we are helping more practitioners to
• 5:05
  become licensed
• 5:07
  and
• 5:08
  then be able to get their practicum done
• 5:10
  while they are
• 5:12
  providing the therapy in the school. So they're
• 5:14
  working with,
• 5:15
  people who are already licensed,
• 5:18
  shadowing them, as well as starting to provide
• 5:21
  some of the therapies so that they can
• 5:22
  become licensed.
• 5:24
  And to date,
• 5:26
  they have been successful
• 5:28
  in really treating a total of over 1,200
• 5:31
  students at six schools
• 5:33
  and, providing 2,900
• 5:36
  behavioral health visits
• 5:37
  as well as medical visits. So that that
• 5:40
  has increased
• 5:41
  our ability
• 5:42
  to really reach more students with increasing the
• 5:45
  number of practitioners in schools.
• 5:48
  As a follow-up to that, I'm curious. What
• 5:51
  are you seeing in the long term
• 5:54
  with
• 5:55
  working with these providers and being able to
• 5:57
  build out a more robust base of providers?
• 6:00
  How are you seeing that interplay with other
• 6:02
  aspects of
• 6:04
  health care outcomes for youth?
• 6:06
  Is it changing utilization,
• 6:09
  cost? What are you seeing there?
• 6:12
  So, I mean, Liz, I think all of
• 6:13
  the above. I think that, you know, the
• 6:15
  metrics that we look at, yes, of course,
• 6:18
  is utilization. And when we say utilization, I
• 6:20
  know a lot of people think for managed
• 6:21
  care that's keeping people from utilizing the services.
• 6:25
  Quite the opposite. We really want people to
• 6:27
  utilize these services because when they do,
• 6:30
  we see the opportunity to identify other areas.
• 6:33
  It's not just behavior health. It's also their
• 6:36
  medical concerns, primary care concerns.
• 6:39
  And so we're able to do that. Then
• 6:42
  that has increased preventive care as well. We're
• 6:45
  seeing children receive more of their immunizations,
• 6:47
  their well child visits.
• 6:49
  It decreases anxiety. We are able to get
• 6:51
  people
• 6:52
  really
• 6:53
  off of medications if they don't need them
• 6:56
  or to improve compliance
• 6:59
  with their medication, which is also very important.
• 7:01
  We also measure things like days absent from
• 7:04
  school.
• 7:05
  We've seen a decrease in that for our
• 7:07
  children.
• 7:09
  More compliant with their schoolwork,
• 7:11
  being able to sit and listen and participate
• 7:14
  in the classroom.
• 7:15
  So it really has a very far reaching
• 7:18
  effect that, you know, when we think about
• 7:21
  sometimes
• 7:22
  just the health care, you're thinking only about,
• 7:25
  well, has it improved their mental status? Well,
• 7:26
  mental status really, you know, touches a lot
• 7:29
  of different points, improves the quality of life
• 7:32
  for not only the student,
• 7:34
  but the parents as well as the community.
• 7:37
  That's great to hear. And thinking more broadly,
• 7:40
  at least in the communities that you're serving,
• 7:42
  so I know you mentioned rural Virginia,
• 7:44
  what sorts of supports are most lacking for
• 7:47
  youth in Medicaid,
• 7:48
  and how is your team working to address
• 7:50
  those gaps?
• 7:52
  So, really, it is about the partnerships. You
• 7:54
  know, we we don't deliver direct care.
• 7:57
  It is through the support
• 7:59
  that we can provide to our providers,
• 8:02
  to our community partners that also touch the
• 8:05
  social determinants
• 8:06
  of health and social factors.
• 8:08
  So, yes, we need to grow the behavioral
• 8:10
  health pipeline of providers as well as our
• 8:13
  medical pipeline providers.
• 8:15
  But we also look at housing needs,
• 8:17
  food and nutrition needs.
• 8:19
  The transportation, again, is is very important.
• 8:22
  And so
• 8:24
  our initiatives focus,
• 8:26
  yes, on all of the health care needs,
• 8:28
  the benefits that we provide. We want to
• 8:30
  make sure that people understand those benefits,
• 8:33
  that they are availing themselves of those benefits.
• 8:36
  But we also look what are the barriers
• 8:39
  that are keeping people from utilizing those, from
• 8:42
  getting the services, and we try to fill
• 8:44
  in that gap. We have housing specialists
• 8:46
  that are not only looking for the particular
• 8:49
  partnerships,
• 8:50
  but then if someone has an immediate need.
• 8:52
  We work closely with the food pantries.
• 8:55
  We we've worked with our, food banks to
• 8:58
  look at the food as medicine initiatives.
• 9:00
  We have lots of baby care programs, and
• 9:02
  those baby care programs go beyond
• 9:05
  making sure that, our members are getting
• 9:08
  great prenatal care because that's really where it
• 9:11
  starts. We need to make sure that they're
• 9:12
  getting that care. But what's keeping them from
• 9:16
  receiving that care so that they can have
• 9:18
  a healthy birth outcome
• 9:19
  and also get connected to those services so
• 9:22
  that the children will continue to receive services
• 9:25
  throughout,
• 9:26
  their span of time?
• 9:28
  So as we wrap up, I would love
• 9:30
  to hear what advice you have for other
• 9:32
  industry leaders, particularly those
• 9:34
  in the Medicaid space,
• 9:36
  when it comes to
• 9:38
  handling
• 9:39
  issues with youth behavioral health and establishing those
• 9:42
  partnerships.
• 9:43
  One, I would say, really listen to your
• 9:45
  partners. Listen to the community,
• 9:48
  and your members. And, you know, when I
• 9:50
  say members,
• 9:51
  yes, it's important that we talk to the
• 9:53
  parents, but it's also important to talk to
• 9:55
  our youth and to understand
• 9:57
  what are the challenges. I mean, going to
• 9:59
  school today is a lot different. You know?
• 10:01
  I will say when we were in school,
• 10:03
  just even, you know, all the AI challenges,
• 10:05
  the social media, all the other things that
• 10:07
  will impact it. So we like to listen
• 10:10
  to, you know, what are they facing and
• 10:12
  how can we help? Where are the gaps?
• 10:15
  Start there, you know, whether you do focus
• 10:17
  groups or it's just a listening session. And,
• 10:19
  of course, our providers, what are they seeing
• 10:22
  in in the community? How can we decrease
• 10:24
  provider operation for them so that they can
• 10:27
  treat and see more of our members?
• 10:30
  So I would just say be really good
• 10:32
  stewards
• 10:33
  of what we've been entrusted, especially in the
• 10:35
  Commonwealth of Virginia,
• 10:36
  but also to be good partners,
• 10:39
  with all of our stakeholders.
• 10:42
  I absolutely love that point about making sure
• 10:44
  the youth voice is included and heard.
• 10:47
  Well, thank you so much, Linda, for chatting
• 10:49
  with us today. We really appreciate having you
• 10:51
  on. Thank you so much again for having
• 10:53
  me.
• 10:54
  And to our listeners, if you'd like to
• 10:56
  listen to more podcasts from Becker's Healthcare, you
• 10:58
  can visit beckershospitalreview.com.
• 11:01
  Thank you.