This interview has been edited for length and clarity.

Q1: Looking back on the last 90 days, what issues have you been focused on the most? Do you think your peers (leaders in other MCOs) have been focused on similar issues?

Hepatitis C Elimination Efforts

2019 has certainly been a year of transformation in the state of Louisiana’s Medicaid program, known as “Healthy Louisiana”. One of the most notable changes this year was the launch of the Louisiana Department of Health’s (LDH) Hepatitis C Elimination program. Using a “Netflix style” subscription agreement with Asegua Therapeutics, LDH will be able provide an unrestricted supply of Asegua’s generic version of EPCLUSA^® to the Medicaid and corrections program in an effort to cure this deadly disease and prevent long-term illness and disability.

As a Medicaid managed care organization participating in the Healthy Louisiana program, Healthy Blue is fully supportive and committed to LDH’s hepatitis C elimination efforts. Over the last 90 days, most of our work has been in aligning ourselves to best support this effort by partnering with health care providers to expand screening of high-risk populations and expedite the hepatitis C treatment process.

Healthy Blue’s Red Ribbon Provider Program will ensure our network of PCPs who treat HIV and hepatitis C have access to the tools and training they need to be successful in managing and treating these patients.  After providers complete a comprehensive educational curriculum that covers all aspects of hepatitis C screening and treatment, provided by Access Health AIDS Education and Training Center, providers can earn a special recognition as experts in these fields.  They receive an incentive for their participation and Healthy Blue will provide them with a special designation in our provider directory.  Even after their training, these providers will continue to get support from this program, such as access to an infectious disease specialist for consultation if needed.  Our goal is to increase the number of PCPs and other providers who will open up their practices to treat patients with hepatitis C, thus improving access to treatment that is much needed across the state and supporting LDH’s hepatitis C elimination efforts

Value-Based Care Focused on SDoH

Value-based care is an important part of our strategy in Louisiana. We are thrilled that nearly 52% of our total medical spend is to provider groups who are under contract with Healthy Blue to participate in a value-based payment (VBP) incentive program. We recognize that we must continue to evolve our VBP programs to meet the needs of our providers and ensure there is continued alignment to our quality and member outcome goals.

Over the last 90 days, closing out 2019 and gearing up for the new year, Healthy Blue developed and designed a new provider incentive program that aims to increase screening for social determinates of health (SDOH) factors. Launching in 2020, Healthy Blue now offers a Social Determinants of Health Provider Incentive Program (SDOHPIP)

SDOHPIP will offer incentives to Providers who: (1) screen members for SDOH needs, (2) submit appropriate SDOH-related diagnosis codes on their claims, (3) refer members to relevant community-based organizations (CBOs) and (4) update the status of those referrals to indicate that a member attended that appointment. We are excited about adding SDOHPIP to our portfolio of value-based incentive arrangements and look forward to our efforts to identify and address the social needs of our members.

Q2: Looking ahead for the next 90 days, what do you think the most pressing issues will be?

Non-Emergent Medical Transportation

It goes without saying that access to care for our Medicaid population is paramount to improving outcomes and quality. A large driver (no pun intended) in creating access to care is the role non-emergent medical transportation (NEMT) plays in our state Medicaid program. With NEMT being such a lynch pin to access to care for this population, much of our work over the next 90 days will focus on the NEMT ecosystem. This ecosystem includes NEMT providers and brokers, along with legislation and policy that can potentially confine or constrain a high-performing NEMT system.

I feel the optimal NEMT ecosystem must include the following: (1) NEMT brokers that not only have a robust network of NEMT drivers, but deploy the use of technology and innovation to optimize ride-routes and monitor the patient safety delivery aspect of NEMT transport from pickup to delivery and then back to the originating pickup site; (2) insurance and policy requirements that find the balance of ensuring drivers are appropriately licensed, credentialed, and insured but does not place an undue financial burden on drivers to the extent that they cannot afford to participate in the NEMT program; and (3) forward-thinking policy and legislation that supports the use of ride-share to augment and compliment the NEMT systems. I think states such as Tennessee and Arizona are leading the way in this space and can provide the playbook for us in Louisiana.

Administrative Simplication

Over the next 90 days, we will be working with legislators and policy makers to either modify or introduce legislation that allows our managed care programs to be more flexible and innovative with our reimbursement strategies, medical policies and clinical criteria so that we can fully uphold our value proposition to the state. At the same time, we must find common and unified approaches for payors and providers to advance administrative simplification efforts in areas where we can improve efficiency, eliminate waste, and alleviate undue administrative burden.

I’ve spent my career on the payor side working with providers to help reduce and/or eliminate administrative burden and increase administrative simplification. I’ve been part of and observed the mutual benefits of moving toward centralized credentialing verification organizations, common and shared pre-authorization request portals, and single preferred drug lists among payors, all of which have greatly contributed to higher levels of efficiency and administrative simplication. However, there is always more work we can do.

I fundamentally believe that managed care organizations (payors) and hospital and health systems (providers) have far more in common and are more greatly aligned than what industry norms lead us to believe. We are both in the business of creating and delivering access to affordable health care and we must work together, alongside one another, to achieve our organizational missions and value-propositions. Collectively, we can find mutually beneficial and agreed upon policy and administrative standards within our Medicaid program that aim to address administrative simplification and allow us to focus more on patient care, access to care, and quality.

Q3: What advice would you give to your peers about managing vendor partner relationships?

Just like any relationship, it’s about give and take. It’s about holding each other accountable. It’s about finding common ground and aligning the interests of the two parties to mutually achieve shared outcome goals and objectives. Additionally, relationships that are not cultivated or invested in eventually fall apart. So, it’s incredibly important to work at managing your vendor partner relationships – just as you would with your state or provider partnerships.

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