Latest / Becker’s Healthcare Podcast / Melanie Fernando on Expanding Women’s Health Access at Aetna Better Health of Illinois

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Melanie Fernando on Expanding Women’s Health Access at Aetna Better Health of Illinois · Becker’s Healthcare Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
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  together over 400
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  payer and health plan executives
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  and more than 100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hi, everyone. This is Elizabeth Cassello with the
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  Becker's Payer Issues podcast.
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  I'm so thrilled today to be joined by
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  Melanie Fernando, CEO of Aetna Better Health of
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  Illinois.
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  Melanie, thanks so much for joining us today.
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  Hi. Thank you for having me. Excited to
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  be here.
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  Of course.
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  So before we jump in and chat a
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  bit more about your collaboration with Electra Health,
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  can you tell us a bit more about
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  yourself
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  and your health care career background and what
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  you currently do, in your role now?
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  Sure. So I have been the CEO of
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  Aetna Better Health of Illinois
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  since October. So I'm nearly stepping into the
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  role, and it's truly an honor and privilege
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  to lead our Aetna plan in Medicaid.
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  I've been with Aetna Medicaid
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  since 2020, and prior to that was with
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  another Illinois Medicaid managed care organization. And really
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  my health
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  career has been focused on Medicaid. So
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  before joining industry, I was in government sponsored
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  program consulting,
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  working with both health care providers and payers
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  really to optimize
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  programs for the Medicaid population, whether that be
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  healthcare transformation,
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  cost optimization,
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  optimizing revenue, process improvement, etcetera. And really,
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  I wanted to focus my career on government
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  sponsored programs and particularly Medicaid
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  because growing up, I was a first generation
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  daughter of of immigrant parents and all of
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  our family, except for my immediate,
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  are still in a developing nation. So experience
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  a lot of
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  just material
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  challenges with access to care,
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  subsequent health care issues because of that, and
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  it really took a toll on just, you
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  know, the overall family and their ability to
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  to live healthy and fulfilling lives. So seeing
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  that growing up, but then also seeing that
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  happening, you know, in our own backyard in
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  the most developed nation
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  in the world, it it was shocking. So
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  that really was a call to action to
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  me. And, also, you know, my father and
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  my brother all work in the health care
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  industry as well. So I think we all
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  just felt called to
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  work in a an industry that could make
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  a difference
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  for those who need it most.
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  Thank you for giving us some background there.
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  So just for our listeners, today, we're gonna
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  be chatting a little bit more about your
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  organization's work with Electra Health, which is a
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  virtual menopause and midlife care provider.
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  So, Melanie, can you walk us through how
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  this collaboration came to be, who initiated it,
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  and what stakeholder needs it's meant to address?
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  Sure. So as a part of our normal
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  course of business process, we're always looking at
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  analyzing our data and trying to understand
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  our members and our populations better. So we
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  were taking a look at
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  what
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  areas or demographics
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  in our membership are largely unaddressed. Where are
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  we seeing health care needs popping up that
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  don't have a solution? And so through that
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  data analysis, we did identify that particularly in
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  women's health, there was an opportunity to build
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  out more robust programming.
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  And that's where a focus on the,
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  perimenopausal,
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  but then menopausal
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  kind of age range of women came up
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  as not having
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  a very robust pro programmatic solution. And about,
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  fifty one percent of the Illinois population is
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  women, and every at every stage of life.
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  And we found that only about eight percent
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  of women
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  in the,
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  menopausal
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  age range
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  seek any sort of treatment or seek to
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  understand their symptoms, which is just a a
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  very low percentage,
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  given that every woman, you know, eventually reaches
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  that age range. And menopause
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  and perimosal
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  perimenopausal
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  symptoms aren't widely talked about,
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  just in the
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  health care education space either. So it's kind
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  of like a silent suffering and and no
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  one talks about it. And that also was
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  a part of the conversation we had with
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  our our doctors was what opportunities can we
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  have to just create public awareness about a
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  condition, again, that every woman faces, but,
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  and oftentimes have very little support. So that's
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  when we started looking out into the the
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  landscape to see, what types of solutions are
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  available. We found Elektra,
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  talked to Janine, and there was a a
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  fantastic
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  solution that was available that kind of checked
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  all the boxes of what we're looking for,
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  something that,
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  offered clinician support.
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  So, you know, evidence based medicine,
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  we could actually have electronic office visits. So
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  accessible. There are, multiple languages offered, and there's
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  a lot of, high touch support. So coaching
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  that was available as well as education, which,
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  again, I think is important because,
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  just from our, surveys with members,
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  there's definitely an opportunity,
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  especially in the Medicaid population, for understanding
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  the symptoms and what they mean about women's
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  bodies.
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  Yeah. And I wanna ask about some of
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  those, gaps with women's health you see in
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  the Medicaid population in a minute. But since
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  talking to Elektra CEO, Janine, who you mentioned
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  earlier, what was the timeline for rolling out
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  this initiative?
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  Sure. So, typically, what we do is
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  a
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  one month or so assessment process to just
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  really understand the vendors. That's kind of like
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  a meet and greet, getting to know the
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  solution. And then the the contracting process usually
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  takes anywhere from three to four months because
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  we really wanna do our due diligence on
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  identifying the right control population,
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  creating a program that's meaningful in terms of
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  guaranteeing
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  outcomes and
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  ensuring the proper coverage of services for our
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  members and ease of utilization.
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  So that part is probably the most time
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  intensive.
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  And then we actually get into implementation, which
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  might be anywhere from, you know,
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  sixty to ninety days depending on how much
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  technology has to be set up, data sharing,
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  and then ultimately,
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  setting up outreach modalities as well. So all
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  in all, I would say around a year
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  to go through the end to end process,
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  and then we launch the program.
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  So what early usage data and trends have
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  you been seeing with member engagement in terms
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  of adding these resources?
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  So far, our leading indicators have been just
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  click throughs into the ads. So we do
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  a a broader marketing campaign.
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  And so it's it's still a little early
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  because we just launched,
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  about a a month or two ago.
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  But we are looking at digital engagement. So
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  we are starting to see a ramp up
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  in the number of users who are opening
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  up on the text messages that are going
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  out, the emails that are going out, etcetera.
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  And my hope is we we typically
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  like to see
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  above a 30% engagement rate in a Medicaid
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  population.
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  Medicaid is, historically
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  and currently
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  the hardest
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  population to reach because of, you know, evolving,
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  contact information.
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  And some people are transient and they,
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  lose
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  phones, things like that. Their addresses change because
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  they're changing to live with family members.
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  So
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  30%
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  floor, I would say. But if we exceed
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  that, then it's a home run.
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  So how do you plan to address those
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  technological and logistical barriers? Also, just thinking about
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  the age range of people who may be
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  using these services,
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  and what are some long term indicators you're
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  going to look to as this program progresses?
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  So we always think an omnichannel approach to
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  any kind of communication
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  modality of a new solution. So to your
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  point about the age range,
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  anywhere from 40 to 64 is typically,
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  that perimenopausal
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  or menopausal age group. So we expect some
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  technological adoption. And so email,
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  tends to be the highest,
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  rate modality followed closely by text message.
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  And so we're constantly using skip tracing vendors,
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  data scrub and data integrity vendors to try
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  to get the latest contact information.
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  We're also just building in checkpoints
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  in every,
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  channel in which a member can interact with
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  us. So it could include whenever a member
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  calls in, we ask them for updated contact
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  information. Whenever they log in to the member
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  portal, there's a prompt that asks them for
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  updated information, so on and so forth. So
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  always trying to just have a pulse on
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  that directly with our members. But then, also,
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  again, trying to do different
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  outreaches is key. So in addition to digital,
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  we do have a lot of community events
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  and some that are
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  more geared towards women. We have, things like
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  baby showers where
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  whole families come and, typically, again, it's large
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  groups of women. So we add, our women's
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  health programs to those types of events as
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  well. So then we get that in person
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  component in the community. We have community based
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  partners where we can drop off flyers,
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  QR codes, things like that.
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  And then also we have our care management
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  staff. So our care managers are actually staff
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  that,
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  work closely with our higher acuity membership. And
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  so they have a higher touch program and
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  are able to,
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  actually interface with members on a more frequent
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  basis. So they too can share information,
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  more regularly because they're in more regular contact
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  with, our our members, and they're able to
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  tell them about new programs because that's another
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  thing. There are different programs for different types
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  of people. We don't wanna overwhelm our members.
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  We wanna make sure that they get the
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  right
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  fit for their condition in life. And so
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  that's why as a part of our,
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  communication strategy, we're also just always looking at
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  better understanding how we can make those communications
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  more tailored to the individual. And I think
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  that's just a movement
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  overall, right, in terms of,
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  communications and, all industries is how do we
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  use our data? How do we even look
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  at AI
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  to, tailor that messaging to make sure we're
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  fulfilling member interests and member needs?
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  How do you plan to translate those findings
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  with the marketing efforts, the early marketing efforts
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  you have going, and also eventually your care
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  insights
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  into broader quality improvement or care coordination programs
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  that y'all host?
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  So we are able to take,
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  care insights. Meaning, we can, from the coaching
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  sessions that Elektra has,
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  take, and process,
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  qualitative and quantitative information
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  to be able to then,
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  create a a more or less a profile
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  for the member. So we already have a
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  profile based on just their health care,
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  setting utilization data. And so then we can
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  build upon it whether they cite that maybe
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  they have a health related social need. Maybe
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  they have,
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  symptoms,
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  outside of the realm of menopause that need
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  to be unaddressed that haven't been historically. Maybe
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  they have, an ask for a multilingual,
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  care manager, or they want to engage in
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  care management and don't know how. So it
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  depends on the type of feedback, but, really,
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  this is the, the benefit of having different
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  types of partners that are connecting with our
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  different member demographics is they can take different
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  approaches and their own unique engagement strategies
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  to obtain information that can just, again, better
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  help us tailor our programming for membership. So,
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  when it comes to, for instance, trying to,
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  close HEDIS care gaps, which ultimately translate into
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  improved quality scores and health plan ratings,
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  again, another a key barrier to being able
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  to do that is effectively communicating with our
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  members, help them appreciate the importance
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  of, you know, going to get certain screenings
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  or going to certain health care visits. So
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  when we have partners who are able to
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  build trust through care navigation,
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  through coaching,
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  It just improves the overall member experience and
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  engagement in all of our programs.
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  And how are you expecting to see ROI
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  on this initiative?
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  Some of through which I I already mentioned,
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  just the improved member engagement. Improved member engagement
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  leads to,
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  health plan, member retention.
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  It leads to, again, higher engagement in all
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  required activities, whether that be contractual with the
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  state or,
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  quality improvement initiatives. It improves likelihood
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  of our members going to PCP visits.
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  There's a very clear link between,
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  our members going to their PCP and and
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  regular scheduled health appointments and their ultimate health
• 12:55
  outcomes,
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  just regular
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  engagement in programming, whether it be virtual visits,
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  virtual coaching, or even digesting and reading through
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  and engaging in kind of gamified
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  health education
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  is all linked back to better engagement
• 13:13
  in the health care system and better understanding
• 13:15
  of how to manage health. And so
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  we see and track ROI
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  on just the for the members that are
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  actually using the platform and, you know, engaging
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  with Electra,
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  what how do we see,
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  their usage of the health care system change?
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  Do we find that previously,
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  they were not seeking care at all or
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  only seeking care once a year in the
• 13:38
  emergency room for non acute conditions. And now
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  they're actually feeling empowered through Electra and through
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  being able to trust the clinician
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  to start to see others
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  and, go to their PCP visit, for instance.
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  So we do have some criteria, you know,
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  in our contracts that speak to what we
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  would expect to see for,
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  members who engage in the platform.
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  Absolutely. That makes a lot of sense. So
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  what other opportunities are you seeing in women's
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  health for Medicaid right now,
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  but also other life stage conditions?
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  And where else are you looking to next?
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  That is a great question.
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  The sky is the limit in terms of
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  of opportunity.
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  I think, one thing that we're continuing to
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  dive in and focus on
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  is not to
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  reiterate or reemphasize the same thing over and
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  over again, but just that unable to reach
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  population. That has always been kind of the
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  Achilles' heel
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  of, Medicaid payer organizations
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  and that they tend to have
• 14:38
  the,
• 14:40
  lowest performing health outcomes. But because of life
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  condition and circumstances,
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  they're the harder or hardest to reach and
• 14:49
  hardest to engage. So,
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  that continues to be a focus where, you
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  know,
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  they might only be receiving care in inpatient
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  or emergency room and have never seen a
• 15:01
  primary care physician or a specialist.
• 15:04
  So we're continuing to explore and test and
• 15:06
  experiment different, again, modalities
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  of how to,
• 15:10
  reach and engage,
• 15:12
  this type of person.
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  Additionally, we're in terms of women's health,
• 15:17
  Chicago is one of the most disproportionately
• 15:20
  impacted areas in terms of,
• 15:22
  maternal child, and infant morbidity morbidity and mortality.
• 15:27
  And so women's health in terms of the
• 15:29
  maternal population
• 15:31
  continues to be a focus.
• 15:33
  The TANF or, in Illinois, it's called NDCA
• 15:36
  population, which is moms and babies, tends to
• 15:39
  make up a significant portion of Medicaid
• 15:41
  in any state.
• 15:43
  And so it's a continued focus in an
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  area where, again, we're continuing to try to
• 15:47
  learn and test different types of solutions. And
• 15:49
  Illinois has been extremely progressive in expanding access
• 15:52
  to care for moms. So they've, recently covered
• 15:56
  doulas under Medicaid, lactation consultants, midwives,
• 16:00
  which is fantastic, and we're really excited about
• 16:02
  that. So we've been looking at solutions that
• 16:04
  can you continue to expand,
• 16:07
  those types of nontraditional
• 16:08
  services
• 16:09
  and really see if that helps build trust
• 16:11
  and engagement.
• 16:13
  Outside of that, we're just continuing to look
• 16:15
  at where are there, again, gaps
• 16:18
  in, health care
• 16:20
  engagement and or
• 16:22
  outcomes performance. So if we're seeing that, you
• 16:24
  know, a certain age group, for instance, children
• 16:27
  ages
• 16:28
  18 to 30 aren't going to their well
• 16:31
  child visits and we're seeing that, again, more
• 16:34
  care is being sought in acute settings.
• 16:36
  That's an area where we're looking to fill
• 16:38
  the gap and and create a program. So,
• 16:41
  I'd say, again, it's really based on what
• 16:44
  we're seeing in the current state and our
• 16:46
  populations are continuing to change. Right? We we
• 16:49
  just went through
• 16:50
  the post, public health emergency redetermination
• 16:53
  where,
• 16:54
  a lot of people lost coverage and,
• 16:57
  we're seeing the membership
• 16:59
  and the, health care trends shift a little.
• 17:01
  And, I anticipate that's gonna continue as we
• 17:04
  see some of the other changes that have
• 17:05
  come through federal policy as well. So just
• 17:08
  keeping a pulse on that.
• 17:11
  But really our intent and objective is to
• 17:13
  have true population health programming
• 17:16
  for every age and every stage. I actually,
• 17:19
  one of my
• 17:20
  friends from, a health care
• 17:23
  provider said from
• 17:25
  twinkle to wrinkle, which I absolutely loved. I
• 17:27
  hadn't heard that that terminology before. But, surely,
• 17:31
  every age in life, every,
• 17:33
  acuity stage across the continuum,
• 17:36
  whether you're walking well or whether you have
• 17:39
  a chronic condition,
• 17:40
  we're looking to have a tailored solution for
• 17:43
  every kind of subgroup that we can identify.
• 17:46
  So
• 17:47
  that's the aim. That's what we're continuing to
• 17:48
  focus on and, of course, all tied
• 17:51
  to value and tied to improving health outcomes.
• 17:54
  I've also never heard that terminology
• 17:56
  either, but, that's a really interesting way to
• 17:59
  put it.
• 18:00
  I would love to hear if you have
• 18:02
  any final thoughts,
• 18:03
  or advice for other industry leaders, you know,
• 18:06
  in Medicaid or even beyond as they navigate
• 18:08
  these types of solutions.
• 18:11
  Yeah. Yeah. Definitely. I mean, I would say
• 18:13
  and I think many of us or most
• 18:14
  of us know this. There really is no
• 18:16
  one size fits all. Medicaid is such a
• 18:18
  unique population, and there are so many exacerbated
• 18:21
  social needs layered throughout that,
• 18:24
  many approaches that work for other lines of
• 18:27
  business and insurance don't work for the Medicaid
• 18:29
  population. And so we all just need to
• 18:31
  be cognizant of that and continue to tailor
• 18:33
  our solutions to include
• 18:35
  cultural competence, building trust,
• 18:38
  meeting members where they are in the modalities
• 18:40
  that they prefer, and not assuming that we
• 18:43
  know them, but truly having,
• 18:46
  responsive bidirectional feedback channels that allow us to
• 18:50
  understand
• 18:51
  the current state of our members and how
• 18:53
  they wanna engage. And then offering
• 18:55
  nimble platforms that are self-service,
• 18:58
  but also high touch where needed. So again,
• 19:01
  it's really all all centered on simplifying the
• 19:04
  member experience,
• 19:05
  enabling our members to feel empowered and taking
• 19:08
  control of their health care.
• 19:10
  And that really just leads to success all
• 19:13
  around.
• 19:14
  So that would be
• 19:15
  my
• 19:16
  advice for industry leaders is,
• 19:19
  even if something has existed for thirty years,
• 19:23
  if it hasn't worked the way you wanted
• 19:25
  it to, sometimes you just have to dismantle
• 19:27
  it and rebuild it.
• 19:29
  Well, thank you so much, Melanie, for joining
• 19:31
  us today. This was such a great conversation.
• 19:33
  Thank you for having me. It was fun
• 19:36
  to participate,
• 19:37
  and I hope everyone derives some value from
• 19:40
  from a part of it.
• 19:42
  Oh, absolutely.
• 19:43
  And to our listeners, if you'd like to
• 19:45
  listen to more podcasts from Becker's Healthcare, you
• 19:47
  can visit beckershospitalreview.com.
• 19:49
  Thank you.