Name: Brainstorm Health 2024: A Conversation With the Nation’s Largest Medicaid Insurer
Uploaded: 2024-05-21
Duration: 13 min 49 s
Description: Sarah London, Chief Executive Officer, Centene Moderator: Erika Fry, Senior Writer, Fortune; Co-chair, Fortune Brainstorm Health

Sarah London, Chief Executive Officer, Centene  Moderator: Erika Fry, Senior Writer, Fortune; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: A Conversation With the Nation’s Largest Medicaid Insurer

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Zarah. Thank you so much for being here. Thanks for having me. Uh So so much of what affects the health of the population you serve is outside the scope of the traditional health system, access to food housing. Uh Can people afford medications? Scenting takes an expansive approach to providing care? So I wanna ask you what works. Um How much do you know about the circumstances of your 28 million members? And how do you effectively address those needs to improve health outcomes? Yeah. Well, um you know, I think it's interesting this conversation around drivers of health or social determinants of health, I think has been emerging over the last couple of years, although the data has been very clear for a long time, um that you know, the vast majority, 80% ballpark and however, you want of health outcomes are really driven by factors outside of the traditional health care delivery system. Um But I feel like we're only just recently as an industry and from a policy standpoint at a place where this has become an active dialogue and for, from our perspective, that's incredibly exciting. Um But we need to do more than just talk about it. And so as you said, Centene, you know, one of the things that I found when I joined Centene 3.5 years ago was that, that intuitively, this was something that the organization understood because of its origins, right? So we have been in the Medicaid business for 40 years. Um And our focus for the unique platform of Centene is that we focus on government sponsored programs. So we serve 28 million Americans in Medicaid in marketplace and Medicare our customers, our members are among the poorest and the sickest and the most underserved in our communities. And so this question of what works really matters because we are also by virtue of being focused on government programs, essentially stewards of taxpayer dollars. And we are asked by states, we are asked by the federal government, we are asked by C MS through the subsidized population for marketplace to go out and figure out how best to support our members and essentially to deliver health outcomes. And so this question of what do you apply the dollars to that? Actually best deliver and best buy health outcomes is a question that again, it was sort of intuitively native to the organization. And, and it's interesting. So there's a, there's a health affairs article that uh came out in 2021 that I think has been um far too overlooked for, I think how insightful it is. There was a group that went out and did a bunch of polling and they went out and they asked black female democratic voters and white female Republican voters in North Carolina and swing voters. Latino, swing voters in Seattle and male Republican voters in Dallas Texas. The exact same question which was if you had $100 to spend, to buy health in your community, what would you spend it on? And every single one of those groups had the exact same answer, which was that they would put two thirds of that $100.66 dollars to housing food, child care jobs and only $33 to more health care. And so our members, you know, Americans know what makes a difference in terms of health outcomes and we just need to listen to them. And so that's really been how Sanin operates. We work directly in our communities and we of course, make sure that there is access to health care. But we also think about what are those things that are gonna actually drive health outcomes. And so when you're dealing with, for example, postpartum moms, yes, we wanna make sure that they have, you know, access during the pregnancy to good prenatal care, they have access to doulas and to midwives and to great hospitals. But afterwards, we want to make sure that they have access to healthy food and diapers and basics where if they can't, you know, they don't have access to transportation, how do we get them in for a postpartum visit? So those are all the things that Centene has really been focused on in addition to traditional health care access and how do you connect members to those things? Diapers or transportation, whatever it may be. Well, that's part of our local approach. We've always been local in how we approach health care and making sure that we have team members who live and work in the communities that we serve. And so our team in Nevada funded a van that goes out and literally delivers diapers to members, our team in Delaware. So Delaware just passed an 1115 waiver to focus on healthy nutrition and diapers for new moms. And our teams are already organized around that because we actually do that in multiple of our states already. Um healthy food drives, making sure that um we will fund internet access for um members and communities and community partners who allow for health visits. So it's just a lot of thoughtful community investment as part of the total calculus of getting health care outcomes for our members. Great. And I wanna come to the the audience for questions shortly. So think be thinking about them if you have questions for Sarah and you know, one barrier to health for the many in the Medicaid population is sort of the lack of affordable housing. I know this is uh something you're passionate about. We've seen other insurers invest in affordable housing, but you are trying something new and we're lucky enough to hear it here first. So I hope you could tell us about it and you know what, why you're doing it and what's different. Yeah, absolutely. So we're, we're very excited about this. We've talked a lot at Centene about partnership and having really strong local partners who believe investing in our communities with us. And to your 0.1 of the biggest barriers is um access to stable affordable housing. And one of the barriers to the the development of affordable housing units is actually the bottleneck of pre development dollars. And so one of the things we're announcing today, I'm really excited about is that the Centene Foundation is partnering with mccormick Baron Salazar M BS, which is um one of the nation's leaders in the development of affordable housing units and in urban revitalization and together addressing the pre development funds, we are going to unlock $900 million worth of development projects across the country focused particularly on the communities that we serve. And importantly not just create thousands of affordable housing units as a result of this, but it also it's a platform where we can deliver community services that are again critical to those other drivers of health. So think about grocery stores in food deserts, um community health clinics, community activity centers, um early childhood education, and some of those other critical services that really surround the affordable housing and sort of the health journey of our members. So we're really excited about this partnership um over the next couple of years. And I think it's a, it's a slightly different approach, you know, for Centene, it's about doing a lot with a little, which is something that our members are uniquely amazing at. Um And I think, speaks to our mission of transforming, not just health care but transforming the health of the communities that we serve. Great. Um And you know, raise your hand. If you have a question, I'm gonna ask uh Sarah about uh you know, a big, we worry about people falling through the cracks, especially over the past year with what's been dubbed the Great unwinding or the red terminations, 94 million Americans having to go through the process of re enrolling for Medicaid or lose their coverage. Meanwhile, a recent study found millions of Medicare aid beneficiaries weren't even aware they had insurance. Um You know, can you tell us how do you engage with your members? One to make sure they understand uh the benefits they have and then to make sure they understood the re enrollment process, you know, what were the challenges and how has that gone? Yeah, that was, has been a major focus of ours over the last year and actually, for almost 18 months leading up to when the red determinations process started, um We did a huge outreach campaign, we bef you know, within the first month, we had already done 9 million calls out to our members. And that rate and pace just continues through the process. Um whether it was, you know, phone calls, um mailings, we actually got to tech. So I wanna come back to that because that was a pretty important thing. We did 15,000 community events again just in the first couple of months, partnering with those institutions and those community partners that are really good conveyors of information, education, whether that's um churches, uh you know, uh pharmacy partners, clinical partners, really making sure that our members understood what was coming, they understood the process and to the extent that we could partnered with the Medicaid agencies to help our members through that process. And we were certainly not alone in that. I think the industry stepped up broadly um in a big way, but it is a, a consistent challenge in making sure that we can communicate with our members the way frankly they wanna be communicated with. So, one of the challenges coming into redetermining was the um T CPA and the fact that it actually precludes us from directly texting members. And so congress sort of waived that through this process. Um And the chairwoman of the FCC did some awesome work to make that possible. But I think it speaks to the fact that um in many ways Medicaid is due for a modernization, not just from an infrastructure standpoint or a process standpoint, but frankly, from a consumer standpoint, right. Our to think that our Medicaid moms are not attached to their phones. I think they're not juggling 8000 things is completely naive and we need to be in a position to be able to be in a position to serve them and to support them the way that they wanna be supported as consumers. So I think we saw some great strides but, um, it's an opportunity to push that forward. Uh Great. And we have a question over here. Hi, my name is Tim Leen. Excuse me, I work for the Association of Schools and Programs of public health. And you're, you're describing is a very public health approach which is fantastic. Um Can you talk a little bit about how we can scale this model in order to have even a broader impact um across the whole country or the world potentially? Yeah, I think so. So two things, one is um to me scale is kind of the the power of the fabric understanding that health care and public health is local in delivery and in sort of nuance. But then how do you extract and extrapolate best practices? Right. And so um the the first thing is making sure that we have an integrated approach and that we embrace this idea that the drivers of health are not just some buzzy progressive way of talking about health care, they actually work the math works. Um And we should be investing from a public dollar standpoint in health outcomes in this way. And then I think the other bigger answer longer answer um but I'll make it pithy is data because if we have broad access to data and we do the work to make that data liquid and to really look at it, not just around local be best practices, but then where there is there connectivity, where do you get scale and proof about what should be sort of standard of practice that that's how we're gonna start taking some of these great local innovations and pushing them out across the country and across the world. And that is really sort of the core of cent's thesis, which is our platform of 28 million Americans in 50 states. We see where the innovation is and we have that data and being able to pull that up and integrate that into the conversation, whether that's policy operations service, that's really how we innovate. Um And quickly before we're out of time, we got to. Uh Hi, so sorry. OK. Question the back very quickly. You mentioned scaling, I wonder how you are working across states because your 50 states only a few of them have those 1115 waivers. Like you just mentioned, how do you work across so many states that aren't even expand, hadn't expanded Medicaid at all? Um And how do you get the social determinants into those places? Well, so part of, it's a great question. Part of why I, I am so enamored with this polling that was done is that, to me, it is proof that while 1115 waivers certainly are increasing in their um adoption uh that sitting in 32 states for Medicaid, very different politics. But when you get on the ground, there is not actually a difference in terms of what people know, makes a difference and being in a managed care spot, we can actually direct those dollars and, and create the proof points and then move the conversation regardless of the politics. Great. Um Thank you, Sarah, good note to end on. Um And thanks again for being here.