Latest / Becker’s Payer Issues Podcast / Strengthening Medicaid and Maternal Health in Florida with Fiona Fang

Transcript

Strengthening Medicaid and Maternal Health in Florida with Fiona Fang · Becker’s Payer Issues Podcast

• 0:02
  - GLP ones, Medicare Advantage Headwinds, a Medicaid landscape
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  - every quarter.
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  - Their leadership right now means making durable decisions
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  - Click events in the upper right.
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  - Hi, everyone. This is Elizabeth Cassello with the
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  - Becker's Payer Issues podcast.
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  - I'm thrilled today to be joined by Fiona
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  - Fong,
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  - CEO of Aetna Better Health of Florida. Fiona,
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  - thank you so much for joining us today.
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  - Thank you, Liz. I'm very happy to be
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  - here. We're so happy to have you. So
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  - before we jump in, can you fill us
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  - in a little bit about yourself, your health
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  - care career background,
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  - and your current role at Aetna Better Health
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  - of Florida and just what you're seeing there?
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  - Absolutely.
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  - I first started my career as an actuary.
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  - I have always thought of myself as a
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  - business minded actuary.
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  - I enjoy turning data into a few meaningful
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  - and relevant insights and use it to empower
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  - different teams to work together for actions.
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  - I have been with Aetna for almost ten
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  - years.
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  - During this time, I have led
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  - actuarial support across six different Medicaid markets, including
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  - Florida
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  - and oversaw
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  - pharmacy support for the entire Medicaid segment.
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  - And that multistate experience has taught me Medicaid
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  - is incredibly
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  - local.
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  - Every state has its own set of demographics,
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  - different sets of health conditions and priorities from
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  - different administrations
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  - and, of course,
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  - very unique budget realities.
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  - The first step for me is always,
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  - to listen and deep dive into the state
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  - we're in.
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  - From there, we can bring in our national
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  - expertise.
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  - Part of my role was to sit down
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  - with our state partners during budget season
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  - to show them potential ways we can lower
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  - program cost without really compromising outcomes
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  - and why, and also show them how other
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  - states are doing it and their savings.
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  - And we always approach it as a form
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  - of a partnership and offered it up as
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  - suggestions.
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  - Earlier this year, I had the honor,
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  - of stepping into the CEO role for Aetna
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  - Betterhouse of Florida,
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  - which is part of Aetna and CVS Health.
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  - We have been in Florida for more than
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  - thirty years, and today, we serve around 230,000
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  - Medicaid and CHIP members across the state,
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  - including children,
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  - families,
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  - older adults,
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  - individuals with complex needs.
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  - We are also very proud to be a
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  - NCQA
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  - four star health plan.
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  - For Medicaid populations,
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  - specifically,
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  - factors like healthy food,
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  - housing, transportation,
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  - and community support, they all play
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  - very important part, in our members' overall health.
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  - And as a health plan, we are committed
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  - to continue investing in community partnership
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  - and resource to address those specific needs.
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  - Our goal is very simple, to help people
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  - achieve better health. And our approach is very
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  - local.
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  - We work closely with providers, community partners, and
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  - our state agencies.
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  - Also, being part of a national organization,
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  - enables us to drive local solutions with broader
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  - capabilities.
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  - As a CEO, my focus has been,
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  - on making sure we operate effectively with discipline,
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  - strengthening partnership with providers and community organizations,
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  - and maintaining collaborations
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  - with our state agencies.
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  - At the end of day, it is all
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  - about, helping our members achieve better health.
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  - So I'd love to hear a little bit
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  - more about the transition into your CEO role
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  - earlier this year. I know you've already been
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  - at Aetna before, but,
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  - what has it been like integrating into this
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  - market?
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  - It has been a very good and exciting
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  - transition for me. I
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  - certainly didn't come to this role checking every
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  - single box.
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  - So it has been a tremendous learning experience
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  - for me as well.
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  - My actuarial background
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  - naturally gravitates me towards connecting the dots, and
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  - I love doing that. So I really value
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  - this role because it allows me to do
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  - that on a much bigger scale.
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  - And that really has empowered me this year
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  - to lead the team and drive forward initiatives
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  - on our top priorities.
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  - One of the main changes for me has
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  - been, spending more time in the field, boots
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  - on the ground, and getting closer to our
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  - communities we serve.
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  - I've met providers and community partners across the
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  - state.
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  - Every time I go out, I learn something
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  - new.
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  - Those conversations are incredibly valuable because we hear
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  - firsthand challenges and barriers
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  - that are impacting people's experience every day, and
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  - I always walk away with ideas for solutions
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  - and how we can better support our members
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  - and partners.
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  - The most,
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  - rewarding part of this job has been
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  - seeing the difference we can make in people's
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  - lives.
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  - Whether it's helping a child access the care
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  - they need at a critical moment,
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  - supporting a pregnant member in achieving her health
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  - goals,
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  - or connecting someone with safe and affordable housing
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  - in their community,
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  - those are the moments that really reminds me
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  - why we do what we do every day.
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  - So you said coming into this role, you
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  - may not have checked every single box. So,
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  - like, what has been, like, the top learning
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  - for you so far in these past few
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  - months?
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  - Really, it's,
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  - the experience and the time that I have
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  - gained,
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  - outside in the field,
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  - the ability to,
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  - connect with our communities and our providers,
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  - that experience,
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  - is new for me for this role.
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  - It's very exciting. It's a lot of great
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  - opportunities there.
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  - So I know one thing that
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  - you're... You were interested in chatting about was
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  - maternal and infant health initiatives across the state.
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  - So can you talk me through, like, are
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  - there innovative approaches that y'all are taking there,
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  - and do you have any data points or
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  - insights about what has been most effective?
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  - Yeah. Happy to, talk about our maternal health
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  - strategy.
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  - Maternal health is, definitely a top priority for
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  - us at Aetna Better House of Florida.
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  - It is also a top priority for the
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  - state of Florida.
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  - Actually, in Florida,
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  - around, four out of, ten babies are born
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  - under Medicaid coverage,
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  - which means that Medicaid plans like us, we
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  - have tremendous opportunity and responsibility
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  - to help improve outcomes for moms and babies.
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  - There isn't really a single program or intervention
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  - that is going to,
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  - solve maternal health challenges.
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  - We see great results,
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  - when providers, community partners, state agencies, and health
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  - plans all come together.
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  - It really takes a village and a coordinated
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  - approach to drive outcomes.
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  - At the health plan, we use data and
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  - analytics to identify pregnancies
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  - as early as possible,
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  - and we work very closely with providers and
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  - members to encourage early notification
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  - of pregnancy.
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  - The goal is really to engage moms early
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  - and connect them with the care and support
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  - they need.
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  - Really, the first trimester give us the best
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  - opportunity window to identify potential risk, develop a
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  - care plan, and provide the right support throughout
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  - the entire journey
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  - from the start of a pregnancy and twelve
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  - months postpartum.
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  - The earlier we engage, the more opportunities we
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  - have to improve outcomes for moms and babies.
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  - And we are very proud to share, according
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  - to the latest NCQA
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  - data, more than ninety percent of our members
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  - received timely prenatal and postpartum care.
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  - Fewer of our babies go to NICU compared
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  - to its national average.
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  - Those are very,
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  - encouraging statistic and signs,
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  - which means that our efforts are making a
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  - difference for our members.
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  - In addition to, medical care, we also offer
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  - wraparound services for the whole person care.
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  - So moms could have access to transportation,
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  - diapers,
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  - housing assistance,
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  - food as medicine, doula services, breast pumps, lactation
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  - supports. You can name it. All the resources
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  - based on their need.
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  - When we bring together
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  - providers, community support, and personalized engagement
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  - and the focus on the whole person care,
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  - that's when we see the... Would become the
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  - most effective.
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  - I was curious.
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  - You talked about the the timely,
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  - you know, care and some of the recognition
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  - that y'all have gotten there. What does timely
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  - mean in this context?
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  - Timely means,
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  - to be able to, get moms in for
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  - a visit as soon as possible
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  - upon pregnancy.
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  - Again, the first trimester is the best opportunity
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  - window for us to identify any potential risk
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  - such as diabetes or high blood pressure.
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  - So this way we can manage those conditions
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  - along the way
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  - and, you know, have the most opportunity to
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  - help us to improve the outcomes for both
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  - moms and babies.
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  - Okay. Yeah. That makes sense. I'm also curious
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  - just with the Medicaid landscape right now. I
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  - know Florida is kind of an exception because
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  - it's not an expansion state. You know? Who
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  - knows if it's gonna be an item on
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  - the ballot in 2028?
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  - But I would love to hear what are
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  - your top concerns with the Medicaid population in
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  - your market right now?
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  - Yes. You're right. Florida is not a Medicaid
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  - expansion state, so we're less impacted by some
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  - of the challenges other states are facing.
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  - With that being said, we're still seeing Medicaid
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  - membership decline statewide in Florida.
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  - Actually,
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  - this week,
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  - we felt the impact of the CMS non
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  - citizen Medicaid eligibility change that took effective
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  - October 1.
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  - Thousands of our members were at risk of
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  - losing coverage. In some cases, people lose coverage
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  - because they're not knowing or didn't complete the
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  - paperwork in time.
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  - It's not because they should they should lose
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  - coverage.
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  - Notice were mailed to members, but how many
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  - people would actually read their mails in time
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  - or if at all?
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  - And that is concerning because maintaining coverage matters,
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  - and people rely on Medicaid to access medications,
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  - ongoing treatment, preventive care,
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  - and coverage and care gaps in some cases
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  - could lead to ER and inpatient admissions.
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  - So
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  - as soon as we receive the member list
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  - from the state, we acted very quickly. Within
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  - the days, we were able to,
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  - text and email thousands of the members, from
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  - the list in multiple languages and let them
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  - know what they need to do to stay
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  - covered.
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  - I actually just saw our October membership this
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  - week. We're definitely seeing a big... Bigger drop,
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  - but they are not as significant as we
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  - initially feared.
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  - So that is also encouraging because it may
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  - suggest our outreach efforts help the member with
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  - the information they needed.
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  - Another thing I wanna point out, that's especially
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  - important right now is protecting the integrity of
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  - the Medicaid program.
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  - So when we talk about fraud, waste, and
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  - abuse,
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  - we talk about a very small number of
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  - bad actors.
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  - The majority of providers are dedicated professionals delivering
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  - very high quality care to our members.
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  - At Aetna, we take this responsibility
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  - very seriously.
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  - In 2025,
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  - as a company, we investigated
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  - more than 15,000
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  - instance of potential fraud, waste, and abuse nationwide.
• 12:21
  - We have a comprehensive program in place that
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  - combines
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  - technology,
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  - predict,
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  - predictive analytics,
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  - clinical expertise, and,
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  - we also have a dedicated investigation team on
• 12:33
  - the ground.
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  - So the goal isn't just to identify issues
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  - after they occur, but to detect,
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  - those
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  - patterns early so we can prevent the problem
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  - before before they become too big.
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  - We also... On the network side, we have
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  - gut reels and oversights to make sure those
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  - bad actors do not enter our network in
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  - the first place.
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  - We know Medicaid resource are finite and as
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  - a health plan, we are responsible to make
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  - sure those resource are invested in improving access,
• 13:04
  - quality, and outcomes for our members.
• 13:07
  - Well, Fiona, thank you so much for chatting
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  - with us today, and I really appreciate you
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  - taking the time.
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  - And thank you very much. I really appreciate
• 13:14
  - it.
• 13:15
  - Of course. And to our listeners, if you'd
• 13:17
  - like to hear more podcasts from Becker's Healthcare,
• 13:19
  - you can visit beckershospitalreview.com.
• 13:21
  - Thank you.