Latest / Becker’s Healthcare Podcast / Integrating Care and Accountability in Medicaid’s Next Chapter with Erin Henderson Moore

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Integrating Care and Accountability in Medicaid’s Next Chapter with Erin Henderson Moore · Becker’s Healthcare Podcast

0:02
This is where health insurance leadership comes together.
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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 and more than
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100 speakers to Chicago April.
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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,
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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.
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Hello, everyone. This is Jacob Emerson with the
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Becker's Pay Your Issues podcast. Thrilled today to
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be joined by Aaron Henderson Moore, who serves
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as the president and CEO of Fidelis Care
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of New Jersey.
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Erin, thank you so much for taking the
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time to be with me on the podcast
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today.
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Thank you so much for having me. Really
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excited to be here. Likewise, Erin. We're excited
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to dive into some important topics and hear
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a little bit about what's been going on,
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under your leadership at Fidelis of New Jersey.
1:01
But before we dive into that, just want
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to,
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have you fill in our audience on, who
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you are, what your healthcare career background has
1:10
looked like, and if you could give everybody
1:12
a quick overview of what your current role
1:14
entails.
1:16
Yeah. Absolutely.
1:17
So as you mentioned, I serve as the
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president and CEO of Fidelis Care of New
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Jersey.
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Fidelis Care is a Centene health plan,
1:25
supporting Medicaid,
1:27
Medicare, and marketplace. We also are really excited
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about our large
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long term services and supports population across the
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state. So you'll hear me refer to that
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that group as the LTSS
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population.
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So here in New Jersey, my role is
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really about aligning access, affordability, and accountability
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for our state, our members, our provider partners,
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and really building teams
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who can execute against that mission. So excited.
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I've been here at Fidelis Care of New
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Jersey almost three years, but not new to
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the health care space. So prior
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to Fidelis Care, I was at UnitedHealthcare
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for six years. I led their
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dual special needs plans in
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DC and in Maryland, and I was really
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excited to launch
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the dual choice program
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in DC, which is an integrated Medicare and
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Medicaid plan really
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aligned and designed to serve duals across the
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state, and that was a really innovative program.
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Prior to my time at UnitedHealthcare,
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I've been in consulting.
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I've worked,
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in government programs my entire career. So spent
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some time at DC Medicaid,
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spent some time in consulting, and spent some
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time in nonprofit management. But really excited,
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to continue to be in the government program
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space where I feel like
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innovation is really key, and you need people
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that are aligned to the mission,
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and to the goals of of those specific
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programs.
3:01
Wonderful. Well, Erin, like I said, we're we're
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excited to get to talk with you today.
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And let's stay on the topic of Medicaid.
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Like you mentioned, you've been in this space
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for a bit. You you've served,
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this population for a long time, and you've
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seen,
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trends come and go in this space.
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And so I I wanted to ask you
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and get us started by talking a little
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bit about,
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what we've been hearing from Medicaid managed care
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plans all over the country
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these last few years.
3:27
Of course, in the face of everything going
3:29
on federally with Medicaid,
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we're we're hearing from plans about rate adequacy
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concerns on the state level,
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increasing state scrutiny of how these dollars are
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being managed by companies like yours.
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So I wonder, you know, just given all
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the context of what's going on policy wise
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right now for Medicaid,
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what's an issue that's that's keeping you up
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at night in this space that isn't talked
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about enough right now in the industry that
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you don't think,
3:55
the the media is hitting on enough that
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your colleagues don't touch on enough? What do
4:00
you wanna hear more about in Medicaid managed
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care?
4:03
Yeah. Absolutely. I would say two,
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two things keep me up at night.
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The first is really integration. I think you're
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starting to see a lot of integration of
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programs that are not traditional clinical programs.
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Two that I'll I'll talk about here are
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behavioral health and housing.
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You really we're starting to see
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huge increases in spikes of behavioral health in
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particular, but there is a link between those
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two programs. And so you are seeing states
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really work with the federal government
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to move towards carbons of really making this
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such an integral part of the managed care
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experience.
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Because what we're starting to see is that
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we've so traditionally
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focused on
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physical health, but really where the the cost
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are spiking are in behavioral health and how
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do we make sure that people, especially if
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behavioral health needs, can remain housed and housed
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long term because that way we we know
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where people are located and how to then
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intervene with all the other parts of the
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managed care experience,
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to make sure that the people are receiving
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the care that you need.
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The second is really around
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support for older adults and individuals with disabilities.
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So you're seeing states do a lot,
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leveraging the flexibility between their Medicare and their
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Medicaid, but I you're gonna start to see
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and you're gonna continue to see a lot
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of focus on LTSS modernization
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and focus for care of those continuity of
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care and care for older adults and people
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with disabilities in their homes.
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You're gonna see that for a couple reasons.
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One, we're just having an aging population.
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Two,
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the infrastructure
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is not designed for people. We just don't
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have the capacity
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for people to be in facilities, and so
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you're going to see this move away from
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people meeting,
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different environments to age safely in place. And
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then thirdly, people just that's a better experience.
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So,
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I recently, you know, lost my parents, and
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it was really important that they were able
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to stay in their homes
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and,
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die with dignity and care in places that
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are comfortable for them. And a lot of
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times that means at home and putting services
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around them. And so,
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you're starting to see a lot of cost
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again
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at behavioral health services and nontraditional
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clinical services to allow people to age in
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place at home.
6:28
Well, I I'm very sorry to hear that
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about about your parents, Erin, but thank you
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for for sharing that with us, for connecting
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that back to why it's so important to
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continue to expand support for older adults, for
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people with disabilities,
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enrolled in these programs.
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And and if we're sticking on this topic
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in terms of,
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everything going on right now in terms of,
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Medicaid policy, of course, as you know,
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a lot coming down the pipeline,
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at the federal level, work requirements next year
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across the country.
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Nearby in New York, you've got the essential
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plan rollback,
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expired ACA enhanced subsidies at the end of
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last year and, you know, stalling of any
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kind of solution there in Congress. So just
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a lot going on for for individuals like
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yourself to be tracking. So I wonder, given
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all of that, how are you navigating
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member retention right now when when so many
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coverage pathways
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are shifting at once?
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That's an amazing question, and the the answer
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is we're using a multi pronged approach. We
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have not
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figured this out at, Fidelis Care, but we
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are working you know, we haven't figured out
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the bullet. Like, what what is the thing
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that that keeps people connected to care, especially
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with all the different things coming at them
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in the news and social media and other
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ways? But one of the things that I
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would say is really working with the state
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partners to make sure that the
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information that we have is correct.
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So, you know, one of the things is
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we've traditionally relied on mailing addresses and mailing
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things to people, but we're finding increasingly
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across the entire span is that people get
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their
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information differently. So one thing that generally doesn't
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change is email addresses, and so making sure
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that we have up to date email addresses
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for for people. Right? Like, stores have gotten
8:15
this,
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down packed, and so figuring out how can
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we leverage things that are that other part
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of,
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other retailers or other companies have really figured
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out, email addresses being one of them. How
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can we leverage text messages? It's one of
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the things that we found is across our
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population,
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regardless of income and regardless of ages, people
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have phones. And so how do we use
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text message? And then how do we then
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work with the data when we have the
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data that's better or more,
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more up to date than our state partners?
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How do we figure out a way to
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make sure that that data is being updated
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in their systems and not being replaced by
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daily eight thirty four eligibility files? So those
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are three things that are just really, really
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crucial
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to making sure people stay connected to care.
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The second is really making sure,
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and I say second, but another thing is
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really making sure that the state systems, because
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that's where we get or federal systems if
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we're talking about marketplace or,
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Medicare, is making sure
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our data has a redetermination
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date. So right now, one of the things
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that we don't have that date, right, so
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the state is kind of reengineering how do
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they give that date so that we're really
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always kind of keeping up to date with
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our members saying, don't forget to renew. Don't
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forget, here's how you do it. Here's how
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you can check the system. So really working
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with our state partners to figure out ways
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that we can
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also have that date and so that there's
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not this kind of I think it's around
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this time,
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and so that we can really,
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walk our members through the process.
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And finally, one of the things that we
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would say is we think it's probably a
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good idea for states to really be thinking
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much more creatively in how plans
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can,
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help members
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get connected to care. There's a lot of
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really interesting and innovative,
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partners,
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vendors
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that are doing really
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cool work and and to use
10:13
a, you know, more colloquial term of doing
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really innovative work, leveraging AI, leveraging all the
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data that we have on our members. And
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I think we need more flexibility in how
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we work with those members to keep them
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connected to care because what we're finding is
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when there's gaps in care, it's more
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expensive for the entire system
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and it doesn't serve people well to be
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disconnected. Right? So then now you're getting them
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back to the system. There's more expense And
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just that muscle,
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it takes a while to get that kind
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of muscle back of making sure people are,
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you know, taking their medicine and going to
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their doctor, and it causes a lot of
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downstream impacts to the system.
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Certainly. And I think that's such an interesting
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point that you make there, Aaron, in terms
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of we're hearing similar all over the country
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from leaders like yourself in in terms of
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get creative
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in a time of of uncertainty for the
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industry and and for some of your members.
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Think outside the box and meet them where
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they are, and really, I think, communicate differently
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is what we're hearing around the country with
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the members, with the state. And like you
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said, get innovative with with how you're interacting
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with them. And I think in that vein,
11:20
kinda going back to what you were saying
11:22
earlier about,
11:23
thinking outside the box outside the clinical box
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and,
11:27
really going,
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to address social determinants.
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I know that Fidelis last year announced half
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$1,000,000
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in health equity grants
11:36
through this year for things like food security,
11:39
maternal health access,
11:41
expanding rural care access.
11:44
So, you know, those things are amazing. Talk
11:47
to us about the the business case here
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for investing in social determinants work during what
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we just talked about, during this period of
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coverage instability for so many.
11:57
Yeah. Absolutely.
11:59
I think what it's really about getting upstream.
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You know, what we are seeing
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is that
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a lot of the factors
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driving
12:10
cost
12:11
in the system
12:12
is not the clinical cost. Clinical is a
12:15
is a reactionary.
12:18
It's a lagging indicator of of how people
12:21
are doing. And so one of the things
12:23
that we're really trying to do is really
12:24
get upstream
12:26
and really address social,
12:29
social determinants of health, housing instability,
12:31
behavioral health fragmentation,
12:33
and all the caregiving burden on families. So
12:35
if we don't up address those upstream levers,
12:38
the system will continue paying downstream
12:41
in the emergency department and long term care
12:44
institutional settings. So a lot of the grants
12:46
that we put up there, both at Centene
12:49
nationally and at Fidelis Care, is really
12:51
shifting spend upstream and not just lowering rates.
12:54
Right? Getting really creative,
12:56
you know, and really getting creative and paying
12:59
differently
13:00
to drive affordability in the system.
13:03
Well, it's great to hear. And I know
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from our perspective, Centene has certainly been one
13:07
of the more innovative companies in terms of
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how and where you decide to,
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use social determinants,
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grants,
13:15
equity grants. So wonderful to hear about that
13:18
at the New Jersey level as well, Aaron.
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Before we go,
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what else are we missing today? You've got
13:24
the ears of a lot of other Medicaid,
13:27
Medicare,
13:28
insurance leaders overall all over the country facing
13:31
similar dynamics as you. So,
13:34
final bits of advice that you'd share with
13:36
them.
13:38
Yeah. I would say two things. I think
13:41
we really need to focus
13:44
on integration.
13:45
I would you're you're seeing it in in
13:47
large
13:48
fragmentations
13:49
of the integration of
13:51
systems,
13:53
you know, large systems, Medicare and Medicaid, but
13:55
also medical, behavioral, social services, how that we
13:59
operationalize
14:00
those together.
14:02
And the second thing I would say,
14:04
is states are being asked
14:07
states are being asked for measurable outcomes, not
14:10
just access metrics or metrics. And so what
14:13
you're going to be seeing is that what
14:16
what states are asking what the federal government
14:18
is asking of states, what this federal government
14:20
is asking for providers, what the federal and
14:23
state governments are asking for their MCO partners.
14:26
That is changing. And so,
14:28
to me, you're gonna start to see
14:31
more data share sharing, more out come based
14:35
contracting both with our with the health plan
14:37
partners but also with our downstream partners. And
14:40
so I think you're going to see a
14:42
confluence or a mix of integration plus accountability
14:46
that will really define the next decade of
14:48
Medicaid or and and much larger government sponsored
14:51
programs. And I think you're starting to see
14:53
that really in the signals
14:55
at the federal level, but we're seeing it
14:57
local across the country how states are asking
15:00
more
15:02
integration,
15:03
person centered care, and how we think
15:05
about how we think about that to be
15:07
really differently. And that's not just how we
15:09
pay providers, but really how we drive accountability
15:12
in the system. So that's really what I
15:14
would think about. And then the last thing
15:16
I would just say, is really about this
15:18
population aging.
15:19
I think you're starting to see that across
15:22
the book of business, nonclinical
15:24
services
15:25
are driving the cost to Medicaid.
15:28
And so you'll really start to see that
15:30
demand continue to outpace
15:33
traditional physical health demands,
15:35
and we're gonna see people continue and we're
15:38
gonna need to continue to enable aging at
15:41
home. So lot of focus on that in
15:43
the next decade, and I'm really excited,
15:47
to kind of be at the table to
15:48
see how we continue to change,
15:51
Medicaid and and what we expect of the
15:53
program.
15:55
Wonderful. Well, it's some really great advice for
15:58
our audience, before we go. So, Erin, I
16:00
wanna thank you for taking the time to
16:03
sit down with me today and for sharing
16:05
your insights,
16:06
and everything about what's going on under your
16:08
leadership at Fidelis Care of New Jersey.
16:10
We really appreciate you taking the time. So
16:12
thank you. Thanks so much for having me.
16:15
Look forward to the next one. Absolutely. And
16:17
and to our listeners, if you'd like to
16:18
listen to more podcasts from Becker's Healthcare, you
16:21
can visit beckershospitalreview.com.