How Lived Experiences Creates a Servant Leader

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your Host, Brian Urban. And today joining our show, we have CEO of Highmark Wholecare, ns

. Ellen, thank you for joining our show.

Ellen Duffield:

Good morning, Brian. Happy to be here today.

Brian Urban:

This is going to be fun. We've gotten to know each other a good bit here and there before our episode here. So with every show, Ellen, we love to have our audience get to know our guests a little bit more. So you have a very big important job. You touch a lot of lives, make a lot of big decisions. But let's go back before the CEO title. Let's go back to what maybe led you into the healthcare ecosystem and who Ellen is. Take us through the journey.

Ellen Duffield:

Well, thanks Brian. Well, we'll go way back. I grew up in a multi-generational household, so my grandparents lived with us. My grandpa, who I was incredibly close to, was a diabetic, and he also took care of... I had two spinster aunts who lived in Philadelphia by themselves, and he was their primary caretaker. And growing up what I saw was really how important connecting all your healthcare pieces are. So my grandfather was a smoker and he became a laryngectomy. So he had his voice box removed and he went and started a club for other larynngectomies activities in the Philadelphia area. Speakeasy Club. Just kept going, bringing people together with similar issues and working through issues and challenges together. But then diabetes, he wound up being a double amputee, baloney amputee because of podiatry care and not getting good, consistent podiatry care.

My one aunt went in for a cataract surgery and the physician decided that he would take out an immature cataract from my other aunt and really set off a really bad healthcare spiral. So it really affected me in terms of seeing how people are resilient, it can work together to solution their challenges, but at the same time, huge opportunity to do better, right? To do better for people and making sure that you have a complete view of that individual and their circumstances. And so that really hit home for me. So soon after graduating from Temple University in Philly, I moved into the healthcare payer space and continued to work my way through.

And I go back far enough that when I heard about managed Medicare, I got really excited and I said, "Here is the opportunity to really bring together all the pieces of someone's-"

Brian Urban:

Wow.

Ellen Duffield:

... "Healthcare ecosystem together to make sure that they've got the right outcome, that they're getting the right care at the right time in the right way." So it really is very personal for me in terms of what led me here. And you really feel like you're doing the right thing for people. So you've got to remember that at the end of every day, at the end of every transaction, at the end of every claim or phone call, it's somebody's mom, brother, sister, aunt, whoever that person is. So that's how I wound up in managed care.

I had gone to school ideally to become a lawyer, didn't go down that path, wound up in healthcare and worked in multiple jobs across health plan operations. So really understood how the pieces fit together. And then having that opportunity to really get out there and work closely with the members and the community organizations, which I'm sure we're going to talk about quite a bit, really brings it home. And when you look at healthcare, the axiom, all healthcare is local, right? So whether you're in Pittsburgh or Harrisburg or Philadelphia or in Delaware or Wilmington, Delaware or New York or West Virginia, each environment, each locality has their own unique set of issues, activities, requirements that we really want to dial into and understand. So it really is a very rewarding, personally and professionally, to work directly with the communities, the states, and our members and inside Wholecare to bring about really great health outcomes for our members.

Brian Urban:

Thank you, Ellen, for taking us end-to-end there. And there's a lot in between we're going to get into, but I really appreciate you sharing your family connection into your career because there's a lot of great executives we talked to on our little show here, and that's a common theme and you went really deep on that. So I think our listeners will have a great appreciation for understanding how your experiences relate directly into the families that are being served by Medicaid managed care organizations like yourselves. And I think it's amazing too, what you just pulled out. I had a brilliant professor from Harvard, her name was Honor Passal. Dr. Passal said something very similar to what you said to me about a year ago or so, which is if you think about every data point you handle across healthcare, that is a finite piece of someone's life or experience in health or struggle.

And you just summed that up very similarly. So I wanted to share that brain connection I had with someone else. It was such a beautiful sentiment and we forget about that in healthcare. And in particular, your corner of the healthcare ecosystem, Medicaid, it's a particularly challenging place not only to keep members on the plan, keep them engaged in advanced health as well because they're dealing with so many different challenges. So with the population of Medicaid, Ellen, let's start from the top. How are you prioritizing engagement and advancing health for the lives that Highmark Wholecare serves?

Ellen Duffield:

That's so fundamental to everything we do. And with our membership, we have to be creative in terms of how we engage with our members. We learned so much through the pandemic and COVID in how we needed to engage with our members. That traditional health plan mechanisms, care manager picks up the phone calls the member, didn't work, it just didn't work. And so it became going out to where our members are, going into the communities and engaging with them directly, engaging with the organizations who serve them and supporting those organizations who serve them. And we all have gotten a masterclass, if you will, around the importance of addressing social determinants of health and health equity issues. Because quite frankly, if you don't have a safe place to sleep at night, you're not thinking about your vaccines. You're not. And it's really incredible what can happen when you address those fundamental issues.

So that's at the very core of what Highmark Wholecare and for that matter, Highmark does. It's woven into the fabric of what we do every day. So when you think about the different areas that we're focused on, whether a member is in a food desert or a maternity desert or has transportation issues, because again, these issues are highly local. So you really want to understand the community in which you're serving. Because if you look across the areas that we serve, Pennsylvania, Delaware, New York, soon to be West Virginia, there are urban hubs, suburban hubs, and more rural communities. And all of those areas have different needs and issues. So you really got to get in there and understand what the local issues are to address that. So in one area it could be food is medicine and food is medicine is just basic and something sound that we can dress, but in other areas it may be transportation or safe housing.

So our approach is to really understand what is unique about a community, work with the organizations in that community to develop solutions and then deliver them to the members. And that's how you drive engagement, right? You get out there, you understand what their issues are, you address them, and I'm sure we'll get into health equity at some point in our conversation, but part of that is really an understanding of the cultures and the communities with whom you're working. It's much easier to address health equity issues when you're talking to somebody who is from your community, who speaks the same language, who understands your culture and how healthcare intersects with culture because there are significant differences, culturally, in how people approach healthcare. So being able to get to that level with our members and our community really allows us to better engage with them in a more wholesome way.

Brian Urban:

I like where you took this, Ellen, almost cultural health precision you have to have. So you can't be behind a screen or doing it just through a digital modality. You have to be with other people that you're trying to help physically in their communities and engaging in the ways that they are most appreciative of or they most care about. That's extremely helpful in terms of a philosophy. And speaking of health equity, I would like to get into your philosophy on addressing health inequities. Feel free to give us a blend of personal or professional views on how you do this because it's not turnkey. You're just mentioning it's intervention by intervention. So what's your philosophy that you take into approaching health inequities?

Ellen Duffield:

So when I think about it, I'll take a funnel approach, more broadly within Highmark and Highmark Health, our living health strategy really embodies health equity and social determinants. We're simplified, we're personalized, we're proactive. We blend all the components of the health ecosystem together to make it simple. And in order to be successful at that, you really do need to address those equity issues. To give you some specific examples, we have a program in central Pennsylvania with Centura Hispano along with Tower Health. So we're convening a community organization, a managed care organization, and a provider working together.

And what we've done is we have bilingual community health workers who live in the [inaudible 00:11:39] area, who work directly with what we call the program [foreign language 00:11:44], and they work with different members of the community to... They get referred there either through Wholecare, through another community-based organization or Towers, and they refer them to this community health worker who learns to understand their needs and then looks to connect them with the community organization that can best address their needs. Because there are so many organizations out there that sometimes it's difficult to know where to go first. So that's a person by person. It's a community by community approach that has been very successful for us.

On a personal basis... We all know the golden rule, right? Treat people how you would like to be treated. So I don't at this point recall where I read it, but I think there's a platinum rule out there, which is, treat people how they want to be treated. And that really resonated with me because, yes, not everybody has my life experience. Not everybody is living where I live or has the same background I do. So to me, it really drove home the point of seek to understand when you engage with somebody.

I have no idea what happened to you this morning, Brian. I don't know how your day is going. I'm not going to make assumptions about what's on your mind, but I'm going to listen as we engage to understand where you're at and how I can work with you. And taking that philosophy, I think allows me to come to a discussion or an organization with a very open mind and approach to how I would engage. That being said, I think it's really important that we really listen to get to what the fundamental issues are that could be masked by something else. And I think that's another important point that I've learned over the years that I bring to interactions with me on a daily basis.

Brian Urban:

That's very helpful, and thank you for the examples, Ellen. Because the community by community approach, I think from a business perspective for maybe a very large healthcare payer, it's slow. It's maybe agonizing. They might shove it in the civic affairs corner, but this as a model to improve trust, I would think for sure, foundationally, and then to help improve engagement and then start to address some of those social health barriers and fill in some of those needs. It makes total sense. And I think health equity is pulling more toward the center of the being of Highmark Health overall like you've shared. So it's just great to see that that's where now the Medicaid arm is really positioned well. So that's extremely helpful, Ellen.

I want to get into something that hopefully this doesn't give you a headache, me saying the word Medicaid redetermination, but it hasn't happened in three years, and it happened in the second quarter of this year and just wrapped up at the end of July. So we haven't seen much disruption for those that are Medicaid beneficiaries going through the pandemic, COVID-19, and now we have, and it's a bit different. So from my background, I'm not a Medicaid policy sophisticated in any way, but it seems like there's been a challenge with communication in terms of reducing churn or closing the gaps on some sort of lapse in insurance over the past several years. So how has Highmark been addressing some of the individual needs that came through this last big redetermination from the unwinding of the public health emergency?

Ellen Duffield:

So this is a process that's going to be with us for a while yet. Absolutely. When you think of the sheer volume of participants who need to go through this process, it is really staggering the number of folks that need to go through this renewal process. And remember, many of the folks have never done this before. This is completely foreign to them, and they are completely unaware of it. So the Highmark is, again, taking a very holistic approach, taking some of our learnings from COVID and how we got out into the communities to make folks and educate folks around the vaccine. We're taking a similar approach to the redetermination process, and again, it's getting out into the community, meeting people where they are, whether it's a back to school night, whether we have mobile dental clinics that we ran over the course of the summer.

So use that as an opportunity to address healthcare needs, but at the same time, educate folks around what they need to do to maintain their coverage. We work very closely with the state, obviously, in understanding how we can reach out. We partner extensively with our provider community in making sure that as a member is walking into a physician's office that they understand that, "Hey, Mr. Smith, you're up for renewal. You can call these numbers." They can help you with your process, educating all the stakeholders, the state legislators, district offices, making sure that they have the material handy and they know who they can call for assistance. And then again, the community-based organization. So whether we're at a Juneteenth event or a pride event, and this month is Hispanic Awareness Month, all of these events, we're leveraging those engagements, those opportunities to get out into the field. So that's field facing.

And then there's a continuous effort in terms of telephonic outreach to our members, leveraging text, mail. So every communication vehicle that is at our disposal, we are leveraging. On average, we're touching our members eight to 10 times through this process. And that's just us, the payer. So the state is also conducting, it's a robust set of outreaches too. So it really is a full court press. But remember, many of these folks obtained Medicaid as a result of the pandemic. So again, here we are with social determinants, they may be housing insecure. I have members who have the county office as a home address-

Brian Urban:

Wow.

Ellen Duffield:

... As a mailing address. So they could have moved a few times, they could be out of state, they could be employed. Any number of factors could be affecting that. So it really is just a number of different avenues and approaches that we're looking to engage. So right now, for example, back to school nights are an important lever for us. So we're there seeking to educate people, helping them do it. The process can take 20 minutes to an hour depending on where somebody is in the process. So it's not about clicking a few buttons here. There's information that needs to be obtained and processed in order to do it. So there are barriers too.

Again, health equity comes into play. Do people understand what they're needing to do when you look at these forms? Do they understand what they need to incorporate into the form? So multilevel, multifaceted approach, and we're always looking for new and different ways to do this. And many of the health plans are working together to identify best practices because it's in everybody's best interest to make sure people obtain coverage and maintain coverage. So to that end, if someone that we're working with we find has lost coverage because of eligibility, let's see how we can facilitate them obtaining coverage, whether it's through an Affordable Care Act plan, an ACA plan, or through CHIP. Also making sure that people are understanding that if this no longer works for you, here are some of the options that are available to you as well. So it's taking about, if you look at one month's cohort, upwards of 120 days to complete.

Brian Urban:

Wow. [inaudible 00:20:33].

Ellen Duffield:

Significant efforts.

Brian Urban:

It is. And I like your full court press terminology in this scenario here and probably going forward as well. There's so many different engagement touchpoints that you're trying to put in your playbook to ensure that you're getting to folks at the right time at the right place, and you're walking through it with them. That I think is the biggest gap for a lot of other health plans across the country, is not being able to have advocates with someone, physically, when they're going through the process. And then there's of course the literacy gaps as well, and just knowing the process and-

Ellen Duffield:

[Inaudible 00:21:11].

Brian Urban:

... Fear trust components as well. And you know what? You shed really good light on the fact that a lot of people, this huge influx of Medicaid beneficiaries happened as a result of the economic downturn and other impacts in our society in the US. So when I say this statistic that a lot of people are probably aware of, this little stat here, you've got to take that consideration and you know where I'm going. So Kaiser Family Foundation has a member enrollment ticker for their Medicaid population analysis-

Ellen Duffield:

[inaudible 00:21:46].

Brian Urban:

You definitely pay attention to that. And I found their small article, in June they released, pretty intriguing in terms of procedural reasonings, why there was about 73% of the total US Medicaid beneficiary population dis-enrolled. And that's a huge number. You think about the tens of millions of people. And for again, an outsider perspective, for me, it seems like it's a contact information thing. Maybe you weren't having the right mailing address, phone number, the right modality, but it can't be that simple. And I know that. But I just don't know all of the things in between here, and it's different by state too. So what has made this so complex for Unity and then even for your own Medicaid managed care organization to try and slow the churn or address it really well? There's probably so much we don't know, the public outside of the headlines, that I'd like to be educated on here, Ellen.

Ellen Duffield:

So you hit it on the head. If you've seen one state in Medicaid, you've seen one state in Medicaid. There are nuances to eligibility and the different programs within states and how you go about obtaining and maintaining eligibility. That being said, just the application process, the renewal process. So in Pennsylvania, for example, if an individual does their renewal paperwork within a 90-day window, it's a streamlined application. If they don't get to it in that 90 days and they get turned and then they need to start over and they have to do the full eligibility application. So now the challenge has become that much more daunting.

So again, multifaceted approach, getting to the members where they are, so we can, if you will, beat the clock and help them get through a more streamlined process. Other states have something called ex parte renewals, which is essentially taking available financial data and doing an auto-renewal. Different states have different capabilities relative to their information technology and what they can and cannot do with the information technology. So something that may be very simple in one state is a challenge or not possible in another. So we're dealing with that and then it's the paperwork and understanding the application and the information that they need to have available to them. Again, I go back to health equity.

Do people understand the forms and the information that they need to bring to the table to do that? So again, it's really about getting into at a member level, at a community level and finding those opportunities and channels that will allow us to best connect with participants, help them understand what they need to do, make sure they understand what they need to do, the implications of it and how they can get help. It's street by street, neighborhood by neighborhood, and that's how we're looking at our data to understand, are there large pockets in the north side of Pittsburgh where we want to make sure we tap into an event and what community organizations can we partner with in bringing members together? So it is something that is very broad in scope, but then also very, very micro at the participant level in order to get these renewals completed.

Brian Urban:

I love the perspective because no one knows the day-to-day work, let alone the strategic vision that you have to have for this population to ensure they're not only insured, but they're advancing their health. And then on top of that, you're trying to address other social needs that aren't easily gathered. So it's so much, and I was not aware of the two separate applications, the renewal and then starting over. That sounds daunting unto itself. So I think that gives our audience a much better understanding of the world of Medicaid in terms of enrollment and renewals. So let's shift gears a little bit here off the administrative side and into the health side. You stood up a free clinic this past year near the state capital of Pennsylvania, Harrisburg, Pennsylvania. I want to know how that's been received by the community. That seems like a great mission, heart led initiative. Tell us what that's been like and what it's meant to yourself and maybe what's ahead, if there's some more really creative projects coming down the pike.

Ellen Duffield:

So we opened two, we have one in the Pittsburgh and we also have one near the state capitol. And we opened these, I'll never forget, in December of 2020. So we were in the teeth of the pandemic. And so foot traffic, candidly, Brian, was very, very, very slow to pick up. So we've seen in 2023 really feels like the year that people are kind of getting back to the new normal. So we have seen some uptick in traffic, but we want to touch more members. We want to get out into the community and do different things. So we're looking to leverage the broader Highmark footprint in terms of how we're reaching out. We're partnering in some areas with our partners, our provider, health system partners, and looking at strategic locations where we think we can be more impactful. We're looking to be more mobile, and then we're looking to partner with new and different organizations.

So for example, very excited about this, here in Pittsburgh, we are partnering with Inglis House, which is a well-established organization out of Philadelphia. And we had visited their innovation center over a year ago, where they had a simulation lab for individuals to learn how to use assistive technology. They had a 3D printing lab where they could repair wheelchair parts or eating utensils. We were just so excited by what we saw there. So we provided a grant to Inglis to come open an innovation center here in Pittsburgh. So that's opening at the end of October. We've placed it inside suburban hospital, a former age N facility that has an incubation lab for healthcare technology that surrounds the Inglis House Innovation Center. So we're very excited to do that and we're continuing to look for new and different ways to engage, to bring solutions and capabilities into the community. So the connection centers were a great first step, but we're looking to do more and we're looking to engage with more members and more community groups along the way.

Brian Urban:

I love that example of Inglis Health. And Inglis, from what I understand, serving a lot of long-term care, special needs individuals, but so much more to their approach, very creative, innovative, and having a partner like yourselves will just only accelerate that impact that they're wanting to have. So I love that. I think it's so interesting. So many different organizations look for tech software, maybe leading research firms, but you all drop it so local and keep it so precise that the impact, it's not just like a year one, year two impact. It's a long range impact. So that's what it comes off to me as. And I just think that is just so thoughtful and it takes time to be able to develop those relationships, not only across a state or market, but across the actual delivery side of servicing somebody. So I love that example, Ellen. That's fantastic.

Ellen Duffield:

We're very excited about it.

Brian Urban:

And you gave a good shout out to Dr. Jeff Cohen as well, subtly there, it's hard to mention his work without saying his name, but now he's going to sneak his way on this podcast in some way, somehow.

Ellen Duffield:

I would highly encourage that, doing fabulous work over there and just putting the organizations together in such close proximity. Can't wait to see what evolves from it.

Brian Urban:

Just so creative. I would love to get deep into that because there's very few places that revamp a community hospital, put incubators in there for innovation startups, and just really make an impact across the ecosystem, not just locally, but the US and I think globally as well. So we'll definitely have to get into that at some point.

Ellen Duffield:

But at the same time, serving a member who has a need that we can address right there, that to me is incredibly exciting.

Brian Urban:

In the community. That's the-

Ellen Duffield:

In the community.

Brian Urban:

... Best part.

Ellen Duffield:

[inaudible 00:31:33].

Brian Urban:

Deeply rooted, speaks to the history of Highmark and what Highmark Health is now. So Ellen, we've gotten into a bunch of great things here today. Your background all the way through the vision and repairing enrollments, if you will, through Medicaid, redetermination, the path forward as well. And then your new partnerships. I want to take a look into the future here, maybe five years or so down the road. Who will Highmark Wholecare be? What maybe could you list as the top three contributions to the members you serve?

Ellen Duffield:

I would put it under the umbrella of Highmark Health's Living Health vision and continuing to focus on simplifying the healthcare ecosystem for our members. Developing personalized solutions, making sure that we're getting out in front of things, being proactive, making sure people have their preventive services along the way, and then really being a convener, bringing health systems, MCO partners, bringing those together to really create a tremendous health experience for somebody. And really that means that we are going to be the leaders in addressing health equity challenges, social determinants at the community level. That ultimately allows us to bring our services and capabilities to a broader participant set, whether it's in Pennsylvania, New York, West Virginia, or in Delaware or other states. But really continuing to grow our capabilities and service to our members, our state and regulatory partners, and really being a leader in that space. Ultimately I think is where we want to be in five years.

Brian Urban:

Well, I know I'm going to follow along and I know a lot of the broader region in the US is going to as well with Highmark Health and the strategy that you all are on rolling. So what a wonderful conversation. CEO of Highmark Wholecare, Ellen Duffield, thank you for joining our little show here today.

Ellen Duffield:

Brian, thanks for having me. Really enjoyed our conversation today.

Brian Urban:

And for more exciting excerpts and insights, please visit us at finthrive.com