How the Largest Medicaid Payer Leverages Digital Health to Bridge the Health Equity Divide

Welcome to Architect Health’s The Front Door Newsletter! In this newsletter, Architect Health’s Co-founder & CEO, Sohum Shah, interviews healthcare executives, founders, and experts on healthcare innovation, digital health, and preventative care. The goal is to identify pain points in these spaces and paint visions on how to address them, inspiring decision makers at traditional healthcare organizations.

Today’s interview features physician and health plan executive, Alice Hm Chen, MD, MPH. Dr. Chen is Centene’s Chief Health Officer and discusses digital health, health equity and the unique needs of the Medicaid population.

Interview Key Takeaways:

• Evolving Digital Health Integration: Transition from viewing digital health as a standalone solution to a critical component of a cohesive care strategy, integrating it seamlessly with traditional healthcare for transformative results.

• Leveraging Local Expertise: Centene utilizes local insights and community-specific knowledge to tailor digital health solutions effectively. Understanding local contexts enhances the relevance and impact of these solutions.

• Rigorous Vendor Evaluation: Centene implements a robust vetting process for digital health technologies. Focus on assessing the real-world impact, target populations, and evidence-based effectiveness to ensure value and reliability.

• Designing for Diverse Needs: When developing digital health products, prioritize understanding and addressing the unique challenges of underserved populations, including social determinants of health and integration with existing care structures.

• Advancing Health Equity: Address the digital divide by ensuring that technologies are accessible and culturally appropriate for all populations, particularly for underserved and non-English speaking communities, to promote inclusive health equity.

Listen to the Podcast:

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Alice Hm Chen, MD, MPH, serves as Chief Health Officer for Centene Corporation. Dr. Chen is responsible for Centene's strategies, policies and programs in support of improving population health for Centene's members.

Prior to joining Centene, Dr. Chen was Chief Medical Officer at Covered California, the state’s health insurance marketplace, where she was responsible for healthcare strategy focused on quality, equity and delivery system transformation. She previously served as Deputy Secretary for Policy and Planning and Chief of Clinical Affairs for the California Health and Human Services Agency, where she led signature health policy initiatives on affordability and access and played a leadership role in the state’s response to the COVID-19 pandemic. Dr. Chen was also a professor of medicine at the University of California San Francisco School of Medicine, based at the Zuckerberg San Francisco General Hospital, where she served as its Chief Integration Officer and founding director of the eConsult program.

Dr. Chen received a Bachelor of Science in environmental biology from Yale University and has a Doctor of Medicine from the Stanford University School of Medicine. She also has a Master of Public Health in health care management and policy from Harvard School of Public Health.

Digital Health: Pre vs. Post Pandemic

Sohum: How has your view of digital health changed pre-pandemic versus post-pandemic? And looking at a crystal ball, what does the future hold in store?

Alice: My career has focused on improving access, quality and care for underserved populations in the safety net. For the past two plus decades, I've been based in the Bay Area, home of Silicon Valley. So, I was actually involved in early telehealth initiatives. When you’re based in Silicon Valley, everyone thinks an app is going to save the world. And if you're in the guts of the healthcare system, trying to get real people real care, you realize that technology is an incredible enabler, but is only as good as the people and processes on either side of it – particularly in the safety net. It’s a lot more nuanced than people realize when they are drawn to the lure of a quick fix.

Looking forward, Bill Gates' quote often comes to mind: “We tend to overestimate the change in two years but underestimate the change in ten years.” The pandemic opened people's minds to the possibility of telehealth and now we have to figure out how to do it the right way. When we figure out how to seamlessly integrate technology with bricks and mortar health care, it's going to be really transformative.

Centene’s Unique Advantages

Sohum: Centene serves over 28.5 million members across all 50 states and is the single largest payer in Medicaid and Marketplace. What advantages does this footprint provide in member experience, as well as innovation? Are there any disadvantages?

Alice: There are pros and cons to everything. In size and structure, particularly for Medicaid, we are a uniquely local model. So many health plans talk about being local, but we grew by bringing in local plans with deep histories in their communities. The benefit of being local is a deeper understanding of your communities, your providers and your members.

And telehealth is not one size fits all. You have to understand local circumstances, not only of the members, but also of your provider community. If you want to actually create that connectivity, it is ultimately about your provider partners. We are on a journey to use the uniqueness of our local model and leverage our size to scale proven solutions.

Centene’s Digital Health Strategy

Sohum: How does digital health fit into Centene’s long term mission?

Alice: Insofar as our entire society has shifted, all health organizations, including payers, need to have digital health as a core strategy. Healthcare tends to lag, but this is where we need to meet our members where they are. Digital health plays a part in almost every clinical partnership we have, ranging from broad scale interventions to very granular partnerships. We're working with companies that are trying to tailor solutions, for example, to African American communities in order to make an impact on the Black maternal health crisis and use the right messengers and culturally appropriate messages to really engage our more vulnerable members.

Sourcing and Vetting Vendors

Sohum: How does Centene identify innovative technologies? How do you source, vet, and onboard external third-party platforms and vendors?

Alice: It’s a work in progress. When you have 31 plans, there are often 31 to 35 doors that companies are knocking on. We’re working to create a balance between rapid innovation and pausing to understand the value proposition and where we can scale.

We’re trying to do our due diligence up front, ask the questions, what problem are you trying to solve? Who is your target population? What demonstrable impact have you had on utilization, cost and quality outcomes? And frankly, do you have peer reviewed publications? Because a lot of different companies have different definitions of what member engagement means and everyone has a deck with their own analysis that always looks fantastic – until you start digging into it. So having a more objective arbiter, like a peer reviewed process, can be really beneficial.

Designing Products for Medicaid, Marketplace, and Medicare

Sohum: Addressing today’s digital health innovators, what are some unique concepts to keep in mind when designing healthcare products and services for Medicaid, Marketplace and Medicare - particularly Duals - members?

Alice: When talking to companies, we often want to know what their experience is with our members. Centene is the single largest Medicaid payer and single largest Marketplace player, where 50% of our members are at an income level that qualifies them for zero-dollar-premiums. And then in our Medicare Advantage business, members dually qualifying for Medicare and Medicaid are a significant portion of our membership. So our focus is low income, more vulnerable Americans.

When we talk to a company that was developed for employer-based insurance, and then wants to pivot to Medicaid, they may not understand our population. This means deeply understanding higher rates of health-related social needs, food insecurity, housing instability, lack of accessible transportation, higher rates of limited English proficiency and low health literacy. Another thing to consider is what is the coordination with the usual source of care, because ultimately, care happens in the provider's office, in the community and having a great solution out here that doesn't connect to the longitudinal system is only going to be a flash in the pan. To really have sustained value, you want to have that integration.

I think the thing about duals in particular, and Medicare Advantage more generally, is that your target may not be the member, it may be their caregiver, it may be a team of caregivers, and it may be a team of providers. So, it's actually a lot more complicated than engaging just one person.

Evaluating Health Equity in Digital Health

Sohum: Health equity is increasingly prioritized by industry leaders. Last December, the CMS released an updated framework to further advance health equity. How does Centene evaluate health equity in digital health and innovation efforts?

Alice: Health equity is about not just the members, but also their providers and physicians who are often part of the safety net. So, do you understand Community Health Centers? Do you understand public hospitals? Do you understand what it means to be a smaller, solo provider in a Medicaid space? One that’s serving its own community, whether that's an immigrant community, a rural community or the African American community?

The digital divide has definitely diminished, particularly in urban areas. In the past, people with higher incomes had much higher access to the Internet. More recent data shows that regardless of your socioeconomic status, as long as you're a certain age, you’re on the internet, and pretty much everyone has a smartphone. There’s still a group of older, poorer Americans who do not have access in the same way to digital resources. And there are still digital divide issues for rural communities.

The other thing that’s struck me is a lot of the companies that come to us to partner are not using multiple languages. For the most part the companies are just English and maybe Spanish. But this is where technological advances like simultaneous translation come in, which were clunky but are now pretty impressive. I’m not seeing that come forward in the way I had anticipated.

Digital Health and Value-based Care

Sohum: Digital health and value-based care are two of the most talked about advancements in modern healthcare. What’s the natural intersection between the two? Can value based care arrangements drive the adoption of digital health and vice versa?

Alice: Value is quality over cost. How do you maximize quality at an affordable price point while bending the cost curve? Technology can help us achieve the goal of right care, right time, right place. And that place could be digital. Receiving care in person will never go away. The question is, where do you most efficiently leverage digital health? Digital health has the potential to drive value if it links to the healthcare ecosystem and isn't just this thing on the side. It needs to be integrated so that when you need in person care all the data is at your fingertips.

Addressing Point-solution Fatigue

Sohum: In telehealth, one of the challenges constantly discussed is point solution fatigue. What approach has Centene taken to address that?

Alice: Being new to the health plan world, I came in and was immediately inundated with requests to meet with companies that had the silver bullet for X, Y and Z. There's so much urgency to address the deficits that we have in population health. There are disparities, and there's been a tendency to throw spaghetti at the wall to see what will work.

But more is not better. And activity isn’t necessarily progress. We are trying to step back and use data analytics to figure out, who is our population? Where does it make sense to have a point solution for intractable problems like renal disease or cancer? What situations require a more holistic solution for our complex members?

Ideally, we would have primary care partners who would be robust enough that they would be the ones deciding which capabilities they needed. Not everyone needs a traditional patient-centered medical home, but almost everyone is going to need a longitudinal touch point. In my ideal world, companies would figure out how to have a value-based relationship with the primary care provider, who then decides what partners are needed. That would be my ideal state. But right now, we're patching in between.

Secrets of Member Engagement

Sohum: Providing a plethora of care options and health benefits is only beneficial and effective when members can actually access them. What is Centene’s secret sauce in engaging members?

Alice: I don't think any plan has a secret sauce for engaging members, frankly. But if we have one, it's our uniquely local footprint. Many of our plans have significant relationships with community organizations, with community health centers and provider groups. Showing up at community events, at health fairs and partnering with your provider network enables better engagement.

Another thing is humility and knowing that health plans are not always the most trusted entity in a member's life. The truth is, members often turn to their providers. So, it’s really important for us to partner with our provider network to provide data and determine aligned incentives to make sure that the member is taken care of.

What’s Next in 2024?

Sohum: What are you most looking forward to for the rest of 2024? What are some changes or trends in healthcare that you are most excited to witness?

Alice: Three things – First, Centene is about to embark on a multi-year initiative around maternal child health. Medicaid covers 42% of births in the United States and as the single largest payer in Medicaid, we have an outsized responsibility to lean in here. We're going to figure out where we can put our size and scale behind moving the dial on maternal child health and health disparities.

Another theme is multi payer alignment. Coming from the provider space, I've seen firsthand the challenges of being a provider. If you have multiple payers coming at you with slightly different things, frankly, the more that is asked of a provider, the less likely anything is going to happen that's substantive. If we agree that maternal child health is important; if we agree that improving diabetes and hypertension will drive population health improvement; if we really want to make sure cancer screenings happen; if we can all come together and land on a set of quality measures that matter and put our heft behind that, we could move the dial on population health outcomes. I see that happening in certain geographic areas, particularly through the state transformation collaboratives that the Center for Medicare and Medicaid Innovation (CMMI) has been sponsoring.

Lastly, we can’t talk about digital health without mentioning AI. Health plans are one of the few entities in the country positioned to drive population health. There’s exciting work in the field looking at both overutilization and underutilization of healthcare services. If you could get rid non-value add utilization and use those resources to target underutilization, we would still save resources, but have much better outcomes across the board.

Architect Health is a digital health aggregator, navigator, and vendor manager that makes it easy for health plans and their members to access virtual-first care solutions. Architect optimizes health plan RFP processes in a consolidated and comprehensive platform, reducing admin burden and costs. This helps health plans realize digital health cost savings opportunities - up to a 7x ROI. Architect's Digital Health Quality Index has vetted and scored thousands of telehealth solutions on efficacy, company reliability, and health equity. Co-founders Sohum Shah and Sidd Hariharan have deep expertise working with health plans and have built care management programs and aligned technology for Humana and BlueCross BlueShield. Architect Health is backed by Drive Capital, Entrepreneurs Roundtable Accelerator (ERA), Cherrystone Angel Group, Plug and Play Ventures, Service Provider Capital, and strategic advisors.

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