Latest / Becker’s Payer Issues Podcast / Medicaid Readiness and Building Trust Through Engagement

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Medicaid Readiness and Building Trust Through Engagement · Becker’s Payer Issues Podcast

0:00
Hi, everyone. This is Lucas Voss with Becker's
0:02
Healthcare. Thanks so much for tuning in to
0:04
the Becker's Healthcare podcast series. It's great to
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have you. I'm excited to welcome Kendall Walcott
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and Steve Provence to the podcast. Kendall is
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the founder and CEO of Me plus You
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Care and former worldwide product head of interactive
0:16
media at a small shop you might have
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heard of, the Walt Disney Company. Kendall founded
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Me plus You Care in 2015 after a
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deeply personal experience supporting a loved one through
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cancer care where he saw firsthand
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the gaps, fragmentation, and challenges patients and families
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face. What started as a personal mission, however,
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to create a more human centered connected approach
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to care has since scaled to impact more
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than 30,000,000
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members
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and caregivers.
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Steve, on the other hand, brings decades of
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health care leadership experience with him with a
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background spanning hospital operations, large scale health system
0:49
management, including leadership roles at Kaiser Permanente, Providence
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Healthcare Network, and Amida Health. He has led
0:55
organizations through operational transformation, performance improvement, expanded access
0:59
to care. He's also the former CEO of
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Buckeye Health Plan and oversaw one of the
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state's largest Medicaid health plans focused on improving
1:07
outcomes for vulnerable populations and advancing innovative
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community based care models. I'm so very excited
1:13
to have you both on the podcast. Kendall
1:15
and Steve, welcome.
1:17
Thank you. We really appreciate it. That's exciting
1:20
times in health care these days, and we're
1:21
hoping to try and help help folks, learn
1:24
how to navigate through some of the biggest
1:25
challenges, that everyone's facing right now.
1:28
Yeah. Thanks as well. Excited to have the
1:30
conversation
1:31
today.
1:32
Yeah.
1:33
Kendall, as you've outlined, there's plenty to talk
1:36
about right now. HR one specifically
1:40
introduces some major shifts to Medicaid,
1:43
including work requirements and and more frequent eligibility
1:46
redeterminations.
1:48
While many plants don't have final guidance yet
1:51
from CMS and certainly their states as well
1:54
here,
1:55
what should plants be doing now
1:58
in order to prevent the most significant consequences
2:01
specifically
2:02
for vulnerable populations if the system just isn't
2:05
isn't prepared at all? Kendall, we'll we'll start
2:06
off with you. Yeah. I'll I'll say a
2:08
bit, but I I think getting Steve's perspective
2:11
as the CEO of of one of those
2:13
plans, you know, big time, I think,
2:16
is it really speaks to the heart of
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it. But I'll I'll just start it off
2:18
by saying
2:20
people plans think they can't do something right
2:22
now because they're saying, oh, we're waiting. And
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the answer is there is something to be
2:26
done right now, and it's actually critical that
2:28
you do it now. I think a lot
2:30
of folks saw with the Obamacare
2:32
issues, the ACA issues that happened Christmas to
2:35
January.
2:36
The drop off was huge. Right? People have
2:38
lost billions of dollars. Millions of people have
2:40
lost lost their care. We don't want that
2:42
to happen again, I think, is the is
2:44
the rallying cry for the industry right this
2:46
second. So we believe we have a way
2:48
to address that, but I think Steve ought
2:50
to set the table on on how an
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executive has to think about this today. Yeah.
2:54
Absolutely, Steve. Go ahead. Yeah. Kendall,
2:57
I would agree on that. In my opinion,
2:59
the biggest mistake, right now would be waiting
3:01
for the perfect guidance.
3:02
By the time you get it, it's gonna
3:04
be too late.
3:05
There's really probably a couple things plans,
3:08
should be doing or thinking about,
3:11
moving into this is first, be honest about
3:14
who's at risk. Not not medically, but administratively.
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And this is something Kendall was,
3:20
able to help,
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out in a big way.
3:24
Who's going to lose that coverage because they
3:27
missed the form? They didn't get a letter,
3:29
or they just didn't understand what was being
3:31
asked of them. And then probably the second
3:34
thing is fix your data. Do you have
3:36
the right, demographics?
3:38
Phone, text, email, language preferences.
3:41
I had terrible demographic information,
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and Kendall actually was able to come in
3:46
and help improve,
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the likelihood I would get a hold of
3:50
a member,
3:51
which is the starting point. Because if you
3:53
can't get a hold of him, everything else
3:55
breaks apart.
3:58
And as we're moving into this, you have
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to assume confusion,
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assume volume spikes, assume members are going to
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be overwhelmed.
4:06
Build and test for that now because at
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the end of the day, the biggest risk
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isn't going to be policy.
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It's eligible people losing coverage because the system's
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frankly just too hard to navigate.
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Now looking back, speaking of navigation or navigating,
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looking back at some of those post public
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health emergency redeterminations.
4:25
Right? Many health plans face to this unprecedented
4:28
operational and human challenge,
4:30
probably continue to face it. From a leadership
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standpoint, Steve, what did that moment reveal and
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show us about where Medicaid infrastructure is most
4:40
fragile and where it needs to evolve?
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Well, so it's probably a little bit of
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what I was just saying. The unwinding really
4:47
showed
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us that Medicaid isn't fragile clinically,
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it's fragile administratively.
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We still rely way too much on the
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ideal that someone gets a notice, understands it,
5:00
trust it, and responds correctly,
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usually within a very tight window or time
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frame. And it's just not how real life
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works,
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for a lot of our Medicaid members.
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It also exposed how disconnected
5:13
everything was between state systems, plans, providers, vendors.
5:19
They're not always getting
5:21
the same picture across all these entities, and
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it's just causing confusion.
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My opinion, we're still running a system that
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expects perfect behavior,
5:31
from people living very imperfect lives. And that's
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a
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we really have to have a big shift,
5:38
moving the system from a transactional
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model
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to a continuous engagement model,
5:44
where we build trust over time with our
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members. And, frankly, the partnership with MeYou
5:50
really helped Buckeye Health Plan achieve that consistent
5:54
engagement with our members and our providers and
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our community
5:58
members.
5:59
From a leadership standpoint,
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visibility is everything.
6:03
If you can't see where people are falling
6:05
off early, you can't fix it. Kendall,
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kinda like, maybe, where you could speak into
6:11
some of the things you were able to
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do to help me here. Yeah. No. I
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think it's really important
6:16
to to have a sort of a mind
6:18
change or shift, if you will,
6:20
to think that, well, I can't get to
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everybody perfectly today, whatever. That doesn't mean you
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still can't get to a heck of a
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lot of people. And and given digital technology,
6:30
led by the right minds, there's actually a
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tremendous amount that we've proven we can do,
6:34
but also, is just possible, frankly. SMS. Right?
6:38
You're talking about people. Everybody has a phone.
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I don't care what economic strata, what cultural
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strata, what, you know, whatever issue you're dealing
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with. You've got access to a mobile phone
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almost invariably across the country today. So so
6:49
that's number one. Number two is the ability,
6:53
to find those numbers. One thing we helped
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Steve with and we've helped other plans with
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is we actually have a an ability through
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partnerships
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to go and find a mobile phone number
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for someone that they don't have a connectivity
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with at all. And we literally turned out
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66%
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from zero. So we went and these were
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difficult, what are called, duals populations. Right? Both
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Medicare and Medicaid.
7:13
Very hard to find, very hard to manage.
7:15
And the other really important piece was we
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reached people in 80 languages.
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Right? And you're talk you I mean, I
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live in California.
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Southern California on a daily basis, over 26
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languages are used by the health plans are
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encountered by the health plans. This is by
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the way, it's also true in Ohio. It's
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also true we found it in Tennessee.
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I mean, it really is across the country
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now. You're dealing with enormous numbers of variability
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in terms of language. So the fundamental premise
7:40
that I took from both Disney, but also
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from my experience in Steve, you're talking about
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the complexity of the ecosystem,
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was to meet people where they are.
7:50
Don't expect them to come to you. Don't
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expect them to go log in to something,
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to come to your website. People have lots
7:56
of billions of dollars of websites. People don't
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use them. We're down to 7%
8:00
less access to websites. You gotta go meet
8:02
them where they are, and that's how we
8:04
built the company. So the ability to actually
8:06
put education,
8:07
put thinking, put just an awareness of this
8:11
thing's gonna happen
8:12
in the hands of members through SMS,
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through secure SMS, or PHI protected SMS.
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That's fundamental.
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The other real trick that everybody could do
8:22
right now is there are other things besides
8:25
employment
8:26
that count towards the HR one eighty hours
8:29
a month work eligibility.
8:32
Their training programs,
8:33
school,
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even there's some volunteer programs that count towards
8:38
those eighty hours. So what we're working with
8:40
health plans on is to literally send an
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SMS
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and take them through a little click through,
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just a simple click, directly to a local
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work training program, somebody who's vetted, somebody who's
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already gone through the system and being approved,
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where they literally can sign up and actually
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start to build that eighty hours. They can
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do that today. You wait till December
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way too late. So both the people need
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to know about this.
9:04
Consumers need to know about this, but also
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plans need to know about this and take
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action today,
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not in July.
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Steve, how do we then actually do this?
9:15
Right? This requires a lot more than just
9:17
implementing,
9:18
certain measures. It it requires a lot of
9:20
trust. It requires communication. It requires engagement. There's
9:22
a lot of levers that need to be
9:24
pulled for this to work. Right? So what
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does it then truly
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take to build that trust, to be able
9:30
to say, okay, we are doing the best
9:32
we can to reach you specifically when it
9:33
comes to we don't have the data. We
9:35
we need better data, etcetera.
9:37
How do we do this?
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Yeah. Well, to Kendall's point, trust does not
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occur with a single campaign.
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It's the result of consistent member experiences.
9:47
A promise made, a promise kept.
9:50
It's when the message is clear, it's in
9:52
your language, it matches
9:54
what your doctor's office told you. And when
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you ask for help, you actually get help.
10:00
If you reach out, you need to get
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a response.
10:03
And Medicaid trust often sits in the community,
10:06
not just with the plan. So you have
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to work through the people, through the organizations
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that members already trust.
10:14
Like Ken Kendall was talking about with some
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of the work programs out there. This becomes
10:20
even more important with
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work requirements that people trust the system,
10:25
they're more likely to respond, report, or stay
10:28
engaged with you. When trust goes up, compliance
10:31
goes up. When trust breaks down, coverage breaks
10:34
down.
10:35
And one of the fundamental things, again, this
10:37
comes out of the Disney experience is
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you have to deliver something of value
10:42
each time.
10:44
I used to argue with folks who said,
10:46
well, I just wanna send out a message
10:47
from the chief medical officer. I said, because
10:49
listening to a rich white doctor in his
10:52
fifties who went to Harvard is gonna work
10:54
in Columbus, Ohio.
10:57
You know? Have we have we really thought
10:59
this through? You know? And instead,
11:01
you work through the no. No. Small messages
11:04
of value. You know, do you need to
11:05
know how to deal with diabetic foot pain
11:08
because your mom's got it? That's all the
11:10
member wants to know is what can I
11:11
do now to help mom not hurt so
11:13
much? You do that with me a couple
11:15
of times, I'll listen to the next communication.
11:17
I'll I'll trust you on the next one.
11:19
So we have to get out of the
11:21
marketing message world,
11:22
and into the actual value added world. And
11:25
I think that is a large part of
11:27
why Steve had success. We reached a 98%
11:30
redetermination
11:30
rate,
11:32
at Ohio. It's because they built up a
11:34
series of trusted communications
11:37
where they said, okay. Well, they gave me
11:38
good information about that. They gave me a
11:40
reward. It actually gave gave me 10% off
11:42
something I wanted. You know, you build a
11:44
you build a relationship.
11:45
Yeah. And so to Kendall's point there, people
11:48
don't want
11:49
macro messaging that are just to the the
11:51
masses. They want micro messaging
11:54
that is to their specific needs and their
11:56
specific moment.
11:58
Example, back in COVID,
12:00
we literally had geo fence through, Kendall system
12:04
that could geo fence the populations within an
12:07
area
12:08
around the pharmacy, their trusted community partner,
12:12
to help connect with and get them,
12:14
engaged in the care we needed, with a
12:16
lot of unknowns at the time with COVID.
12:18
And so,
12:20
having a partner that can do that is
12:22
a game changer.
12:24
And part of that was to what we
12:25
call mass personalized.
12:27
And that was,
12:28
how do you have,
12:30
care managers
12:31
or pharmacies or assistants to them start to
12:34
own a population, start to own a group
12:36
of folks and say, I'm Kendall. I'm here
12:39
for you. You're gonna consistently see my image
12:41
on the SMS message. You're gonna hear my
12:44
voice on something. And even we get around
12:46
using the other part of me plus you,
12:48
which is chat. Right? No app. Remember? Meet
12:50
where meet people where they are. No apps,
12:52
folks. No no portals. No apps. But you
12:55
can start to have actual conversations. Well, with
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who? We'd like to have with the same
12:59
person.
13:00
You know, we all know what customer experience
13:02
looks like today. It's an AI bot thing
13:04
that you you have no relationship with. We
13:07
go the other way. We believe that including
13:09
a human,
13:11
in every piece, every comes changes the dynamic.
13:14
It changes the entire conversation, and we've proven
13:16
that. We continue to prove that. And that
13:18
matters a lot to your core point about
13:21
trust.
13:22
And I just wanted to come back to
13:24
Steve's point that he made earlier. This can
13:26
only happen if the data is good. Right?
13:27
You know, Steve mentioned the data just wasn't
13:29
there at the point in time. We we
13:30
need data to be able to feed this
13:32
beast, so to speak, to be able to
13:33
say, okay. We can reach out. We have
13:35
meaningful interaction with you because we know exactly
13:38
who you are and what you need, which
13:40
is so crucial.
13:42
As we look towards the future then now.
13:45
Right? And and, Kendall, I love that you
13:47
mentioned, like, you need to be doing this
13:49
now. This is don't don't start six months
13:51
from now. This is something that needs to
13:53
start now. Right?
13:54
How should organizations
13:56
define success
13:58
when they're doing this heading into the rest
13:59
of the year and beyond? And and and,
14:01
again, as they prepare for policy changes, what
14:04
does all of this mean when we're looking
14:05
in preparedness?
14:07
I think one of the easy so I
14:09
I believe you know, as an English major,
14:11
I believe strongly in analytics.
14:13
Why? Because I'm a mission based company. I
14:15
want to prove to myself as a owner,
14:18
but also to our customers that something actually
14:21
happened, that action was actually taken. I don't
14:23
care about just, oh, they touched, they clicked,
14:25
they this. That's nice. I wanna know they
14:27
actually did something that matters to their future.
14:29
Right? Otherwise, I haven't met my mission,
14:31
and our clients aren't as happy as so
14:33
what we really look for is what I
14:35
call response campaigns. Did you we we send
14:38
bidirectional,
14:39
multidirectional communications where we can prove that something
14:42
transpired.
14:43
So I would say an early win to
14:45
your question is, did they get something in
14:48
whatever language? Did they respond back that they
14:50
understood,
14:51
had these three questions? And then to Steve's
14:53
point, you can't leave them dangling. You gotta
14:55
go back around again as many times you
14:58
follow-up
14:59
to see if in fact you answered their
15:01
questions. Do they know what they're supposed to
15:03
do next? Are they gonna try and go
15:04
to that third party and get training or
15:06
whatever it is? So I think early thing
15:08
is, can we check our response rates?
15:11
What the questions are? Are we improving the
15:14
education, the information
15:16
dynamic, if you will? That can be done
15:18
instantly.
15:19
You know? That we're a SaaS company. We
15:21
can have you up and running in less
15:22
than thirty days. That's that's the easy part.
15:24
Technology is the easy part. It's about did
15:26
you build the messages
15:28
to get the right response so you can
15:29
continue to refine
15:31
what's going on next. Then you say, I'm
15:33
gonna send you an esign form, or I'm
15:35
gonna have you take a photo of your
15:37
driver's license or whatever it is you need
15:39
next. We can support that entire
15:41
virtual transaction period. Again, no apps
15:44
all the way. But there's
15:46
easy early success right now that we can
15:48
demonstrate. It comes back to the trust piece.
15:50
Right? Building that trust, being able to do
15:52
that. Steve, same question for you. Again, how
15:55
should organizations
15:56
define success in all of this? Yeah. Well,
16:00
honestly, preparedness,
16:02
isn't just about compliance. It's whether your system
16:05
actually works under stress,
16:08
under that member stress.
16:10
And so to me,
16:11
you really gotta have a couple test points.
16:14
Are your operations ready for the volume, the
16:16
complexity that's gonna come? Are your communications
16:19
easy to understand in a way that they
16:21
know how to act on it?
16:23
Your providers and community partners know, and are
16:26
you working with them in a way that
16:29
brings them into the mix that that really
16:32
help there? Because it really comes down to
16:34
simply this with me. Success
16:37
is not how many notices you send out.
16:40
Success is whether or not eligible people stay
16:43
covered. The organizations that are able to lead
16:46
through this next phase
16:47
won't just manage policy, they're gonna reduce the
16:50
friction caused by the confusion.
16:54
Yeah. The root cause. We come back to
16:55
the root cause being able to attack it
16:57
from there and not just sort of hitting
16:59
little points here and there as as as
17:01
Kendall mentioned earlier in our conversation.
17:03
Steve and Kendall, it's so great to have
17:04
you both. Thank you so much for spending,
17:06
some time with us and providing you, us
17:08
with these great insights. It's great to have
17:10
you. Thank you. Thank you. Really appreciate the
17:12
opportunity. It was a pleasure.
17:14
We also want to thank our podcast sponsor,
17:16
Repulse You Care. You can tune into more
17:17
podcasts from Becker's Health Care by visiting our
17:19
podcast page at beckershospitalreview.com.