Healthcare Rethink - Episode 67
In an era where healthcare is at the forefront of societal concerns, the need to transform Medicaid with technology...
BRIAN URBAN: Yes, this is the Healthcare Rethink podcast. I am your host, Brian Urban. And today we went big time. We're talking to one of the largest health plans across the United States. And we're fortunate to have staff vice president of Medicare products and Implementation Jennifer Brooks Kaluza joining us from Elevance Health. Jennifer, thanks for joining us.
JENNIFER KALUZA: Yeah, absolutely, Brian, super excited to be here today.
BRIAN URBAN: This is going to be a lot of fun, Jen. We've gotten to know each other a little bit here and there before the recording. But this is really where we kind of open you up to the audience. And we always like to start with getting to know our guests before they've come to a certain level of high visibility or high success, like yourself. So let's let's go back before the title here at Elevance. Who is who is Jen and how did you get in to this space? Not many people, I think, go directly into the Medicare Advantage space. They kind of find themselves in there and start to really help create a new models, create new plans. So how did you get here?
JENNIFER KALUZA: Sure. So I think anyone who works in healthcare innately has the feeling of serving others and having a passion for underserved or vulnerable populations, and really wanting to make a difference. So early in my career, I actually was not in health care. I my feeling and fulfilling my passion of serving others was actually in the international relations and diplomacy space. So early in my career, I worked in lobbying with the European Union, and I also worked with the housing crisis in South Africa, with Lawyers Without Borders. So that really was my initial feeling of how to serve others. When I returned home to Massachusetts, with all the hospital systems and providers and tech, it was, I think everyone works in some version of health care in Massachusetts, but got into medical device and the medical device industry was really opened the door to me of how I can make a difference in people's lives in an operator type role. I could never be a nurse or a doctor. Those people are amazing and they have skills that I don't. But it's still such a passion of mine, of how can I help patients? How can I help providers? How can I make health care better? So medical device I worked in the a onesie industry was really my my first view into that.
And then I took an interesting turn of food services and working with hospitals and nursing facilities on their food and dietary programs. So looking back, I really think that was my first experience. And interaction with food is medicine. So working with hospitals and working with nursing facilities to make sure that they have the nutritious food to make sure that they're meeting members needs in terms of if they need their food per pure period, that their food gets delivered to them that way. And then also the social impact of food, right? We go out to dinner and we love interacting with others. That's the same thing for folks in hospitals or nursing homes, you know, combating loneliness because they have a meal that, you know, makes them want to get out of bed and go to the dining room and interact with others. It was really, you know, looking back, it's interesting how I was preparing myself for a career in, in health care that I didn't really know was coming.
BRIAN URBAN: That's so interesting. So I didn't know any of those nuggets of your background. That's actually kind of hard to reach. I'm sure you could research and find that out somewhere on the ether, but that's so beautiful. Thank you for sharing that gem, because that speaks to your background not only like being in the dirt, being in the experience and being with people and actually working things through, but now coming into a leadership role as well. So it's interesting the way you described meals. I've actually not heard that before. And we've talked about a lot of nutrition scientists, chief medical officers as well, even though they're kind of a definitely a degree removed from food as medicine in terms of their training. But I've never heard someone say, like, the meals have this biological, of course, psychological and social play on patients and caregivers like that. I honestly have never really thought about food as medicine from that perspective. I've only thought about it from preventative recovery healing. I've never thought about it from that angle. So that's quite. And you found that through your your experience, your own experience coming through healthcare.
JENNIFER KALUZA: Yeah, absolutely. And it when you're in the when you're in the moment, I don't think I really appreciated it. And I was more focused of, you know, making sure they're getting the right meals. And now that being in the healthcare industry, you know, I've been at Elevance for almost 12 years now with a combination of both Medicaid and Medicare in my background, I've been able to sit back and look at how impactful that was and whether it was the meals or having an activity that members could join. And, you know, that was food based. We saw a tremendous impact in in the loneliness and self esteem and bonding with other people that a lot of times at that stage in their life, you know, that's not easy for them to do.
BRIAN URBAN: It's amazing the glue that it is within our society and different cultures of health. I love how you describe that, Jen. That quite literally is very beautiful. And you have a food as medicine program at Elevance as well. I think Dr. Kofi is leading that work. So just amazing, amazing that that's integrated. And it's actually so fitting because of what you touch as well. And the supplemental benefit side that's really exploding for Medicare Advantage beneficiaries these days. It seems like it obviously it worked out well naturally. So I think it's safe to say you're definitely a expert when it comes to benefit design. Obviously, implementation in terms of the business side of IT and processes and procedures. But let's talk about innovation a little bit here with Elevance. So there's so many different services I see going to conferences across the US. There's so many rides and medically tailored meal services. How is Elevance thinking about the innovation and the the menu of offerings and maybe the personalization side for for your Medicare Advantage beneficiaries.
JENNIFER KALUZA: Yeah. So I say supplemental benefits is is really the fun stuff when it comes to Medicare Advantage. It's really where plans can get creative, really connect with our members. Because at the end of the day, supplemental benefits are only successful if you're addressing members needs and they are executed flawlessly. Right? So with MA continuing to rapidly grow and covering half of all Medicare individuals supplemental benefits is really where MA plans differentiate themselves. So when you're designing your supplemental benefits, it's important to acknowledge that. Multiple or a big inventory of supplemental benefits is not necessarily what members are looking for. What they're looking for are benefits that help them live a healthy life, right? That they can access it, that they understand them. And that's why at Elevance Health, we take a really targeted approach and understanding our members needs, making sure that the benefits that we are offering are executed flawlessly. So when you think about the grocery benefit, for example, that's a great example. It's groceries is incredibly popular supplemental benefit. But if you're a member and you're using your your car to go to the store, if you get that decline at the retailer, that's a really horrible experience. And that leads to embarrassment. And, you know, a lot of other factors that play in there. So we know that members want choice. We know they want flexibility. We know that they want it easy to use. So at Elevance Health, we believe being brilliant at the basics. So if we're offering a benefit, you know, that I think is a great benefit, which is a clothing allowance, for example. But my membership is telling me, yeah, you know, clothing is not really a big deal because I can get it from goodwill. I have donations, you know, my kids help me with clothes. You know, that's not going to resonate with them. But what they really do need is, hey, I need an extra $50 in groceries because what I'm getting is not enough. So being, you know, we talk about health care, being local, our members being local, really understanding their needs is what's going to make supplemental benefits successful.
BRIAN URBAN: That's amazing. And it speaks to the personalization of where things are going with this whole supplemental benefit space now. And it Jen, you said something interesting. I want to go into the supplemental benefits side here. The term obviously social determinants of health. Layered on top of this, we're talking about all different domains that are non-clinical non-medical needs that are impacting individuals households. CMS opened this up back in I believe 2019. You could keep me honest. You're far more obviously in touch with some of the regulations and proposals coming out of CMS than I am, so I think it was 2019 and it's been growing ever since. So I'm curious of how Elevance sees this space growing over the next several years. And from your perspective, you know, how can you get creative around in terms of supplemental benefits? It seems it just seems like where do you begin? There's so many things to try and tackle, like where do you start? So I'm curious of your take on how this is growing and you know, where the innovation and creativity comes into play.
JENNIFER KALUZA: Yeah, absolutely. So as you said, I think to truly appreciate and understand supplemental benefits, you have to look backwards a little bit and how they've evolved. So prior to 2019, only primarily health related benefits were allowed like dental vision and hearing. And when people think about supplemental benefits, those are typically the top three that you think about because they've been around the longest. The bipartisan act of 2018 is really what expanded the medical benefits to cover non-medical items. And shortly after that was the special supplemental benefits for the chronically ill that opened the door to benefits like groceries, utility assistance for this population. And when you see the growth of supplemental benefits among players has significantly grown, the plans are incredibly invested in offering supplemental benefits that address the whole person and the whole health of members. We all understand that health care and staying healthy doesn't happen only in the health care setting, right? It matters if they can, if they have transportation to get to the pharmacy, so they can only be made adherent, right? If they can get there, they can only, you know, we talk about aging at home or aging in place. You know, being able to pay your rent or your utilities are what enable things like that. So when the way that CMS has designed supplemental benefits is tying it to health outcomes. So when health plans are thinking about a supplemental benefit offering, it absolutely has to be tied to a health outcome. And that's where a lot of the scrutiny and the attention right now is, is with the the variety of supplemental benefits, ensuring that it is tying to health outcomes and go ahead. Sorry.
BRIAN URBAN: Yeah. Keep going. You got me excited. Go keep going.
JENNIFER KALUZA: I could talk about this forever. Another important part is the flexibility of supplemental benefits. So at Alvin's house, we have something called Essential Extras, right? Where we know health care or the health of a person is not, does not happen in a silo, which is why SEO is so important to that. And your health is not linear. So by having flexible benefits, it allows members to say, I'm going to sign up for this plan. And transportation is important to me because I need to get to the grocery store or get my meds. But then in 2024, I got a car. So now transportation is not important to me, but I can now use an OTC benefit. So having that flexibility that complements the stages of lives that members are in makes it easy for them. They don't have to think about, well, do I have to change a plan now? Because now my needs have changed. So offering that flexibility is incredibly important.
BRIAN URBAN: I think that you said two really thing. Two things I really love, Jen. One, you said being brilliant at the basics. I think a lot of large corporate entities want to keep pushing new things, so much so that, you know, you're breaking the limits of why, you know, but being good at foundation, being brilliant at basics, I love that. And then health is not linear. That's just so nice. You took another very big step back and looking at the problem of just doing a lot of different options and menu of benefits and spraying them across the population, but not knowing that things can change. So the flexibility a very good example with that too. So I was wondering, you know, how how do we get you know, we're just really getting there right now. I think things are just exploding. But like, how do you see this space getting more precise over the next few years? I mean, are there different types of data that you're ingesting or different modeling that you're doing to fuel the innovation of offering the right thing to the right person at the right time? Like that's going to be very complicated. And I know it's still in the early stages here of design, maybe deployment of these new packages. But have you put thought to that have has Evelyn's and yourself kind of looked out to like, how do we get things really precise to what we offer people?
JENNIFER KALUZA: Yeah, I think the, the challenge with supplemental benefits is the data is not where we where we want it to be. Right. And that's not a fault of the program, but it's really that we simply have not had enough time to measure the interventions. And how have they really impacted the health outcomes. I think there is no disagreement that health plans believe data is critically important. We use data to inform so many of the actions that we take. But when we think about it, you know, a member who is using transportation to go to church addresses loneliness, but what would be the ICD ten code, right. To say that this member is now living happier, or they didn't have an admission because they are able to access this benefit that that combats loneliness, that maybe they participate in a church breakfast. And that's how they have some of their addresses, some of their food insecurities. So fundamentally, there are some challenges in in measuring those outcomes. But a big component of how we could potentially get there too is the zip codes. So the zip codes are not utilized as much as we would like them to, and they're not scaled.
But if we were to able to get more data on those zip codes through our providers, we would know more about our members. So when they're doing their annual well, visit a provider asking them, do you have food in the house? Do you have a home? Do you worry about finding your next meal? Do you have a caregiver? If we were able to get that information from providers, we would be able to really transform how we work with members and do some predictive work on things that they may need, right. The the goal is to be proactive with our members and getting ahead of the needs that they we anticipate that they would have in a way to get there. Right, is how can we get providers to send us those codes, whether it's incentives, requirements, you know, from the plans or CMS. We still haven't figured that quite out. But zip codes would be, you know, a great piece to that for us.
BRIAN URBAN: I Like where you're going, Jen, because I think it's it's something that's just overlooked is, you know, we all want to have movement progress and health equity personalization now. But there hasn't been enough time yet in specific to supplemental benefits, the use of them and then the connection into health outcomes. So that I mean there hasn't been yet. And we have to have the right measures in place to ensure we're seeing the right connection. So you're right, I think on top of the Z codes, kudos to them for really deploying their hiatus for the last decade, their measures, and now trying to weave in the social need screening and intervention to to have a social connection. So hopefully a lot comes out in the next several years there. The one thing that happened between the last time that we talked now I wanted to get your perspective on Jen. There is a proposal out from CMS, the Medicare Advantage plan, saying they want to have a health equity component put into a measure with supplemental benefits and having a lot of requirements. Underneath that, you got to have a health equity expert. Tied to utilization management committee. You have to be able to do an analysis of cohorts that are economically vulnerable to those that aren't, that you serve as members, and then compare the two and then make that public. That's a great suggestion. That is a ton of work to stand up. Very important. There's probably a leaner way to get it stood up and start to make progress. But this was several weeks ago. We're talking now into, I believe, early November or end of October of 23 here for our recording. But you know what? What's your thoughts on that? I mean, I think it's a great move forward, but just want to get your reaction to it.
JENNIFER KALUZA: Yeah. And I think this ties to as well in lieu of data, how can we, you know, measure. Right. So you know working with our members obviously gives us some insight there. But also the screening tool, you know, implementing a screening tool through, you know, the health risk assessment or with brokers when they're working with members on sales, you know, that is really beneficial. And also, you know, your own claim data can tell can give you a lot of information. Right? We've seen members who utilize their supplemental benefits have lower disenrollments. They have lower MLMs. So when we're looking at these new requirements coming from CMS, they're critical components. When we look at our benefit design, benefit design is not simply just the numbers and the math of of making the benefits work. It's an all inclusive view. So you ask yourself, what need is this meeting the member? How does this contribute to health equity? How does this contribute to Caps? The members experience grievances, right? It's really a full picture, a full portfolio that you need to evaluate your benefits on. So you're hitting all the marks and you don't have any blind spots of, you know, this was a great idea, but it is a huge member experience issue, or it's going to be a call driver or we're not quite yet there. So now it's going to lead to grievances. So it's really that full picture that now CMS is you know we were doing or a lot of plans have been doing that for a while. But now it really forces it because we have to answer now while we design this benefit. And these are the, you know, the boxes that it checks.
BRIAN URBAN: Yeah. For the reasons I like that. It's kind of interesting. I'm hearing two things. One, this has always been there. Now we just have to highlight it and measure it and report it out in a very meaningful, digestible way publicly and to CMS. And then the other side I heard was, um, I guess that there's there's more sophistication required in doing this. There's such a thoughtful process in putting together a benefit design that it's not just a big kind of strategy. It's a pretty tactical in nature as well. So there's a lot to think through in terms of what you do with your benefit designs. I think that's overlooked as well in a lot of folks that aren't inside an Ma plan or aren't inside a large health insurance carrier seen from the outside view. So that I think is very helpful. You know, Jen, as you're describing this stuff, I was I was thinking and even coming to our conversation, I was thinking about all these different supplemental benefit designs. And one thing that I can't stop seeing everywhere is pickleball. And it's, it's it's Rose now to a professional pickleball league I believe I saw on ESPN plus or something like that. And the crazy thing is, I believe the majority trend is around 65 and older folks.
And I'm wondering, you know, it's fun. It's also a great social activity biologically. It's also a great preventative health activity as well. There's a lot of risk that does come with it. I'm curious, is there ever a fun design for a plan that involves pickleball in the future for Elevance? Is it something that you would all consider kind of integrating that into the experience of being a member of Elevance? Just the fun thought. I was curious of what your take is on that.
JENNIFER KALUZA: Yes, the thriving fitness benefit that we see in the market today. So the short answer is yes, absolutely. Elevance Health has a fitness benefit, right? Where all of the benefits always have to tie back to right is how is this improving health outcomes. So a pickleball membership in this example right is keeping our members active. We know all the downstream positive impacts of our members being active and getting out there. But where as an industry and this is kind of where we are very new and we have to evolve is we're combining fintech with health care right now. And I bring that up because we have to be able to say pickleball membership is okay, but the sweatbands that you want to buy because you like to wear them during pickleball is not okay. And that's where the marriage of. Yeah, that because sweatpants don't contribute to health outcomes. But the pickleball is so having again that a broad enough category like fitness. So we don't have to have a specific pickleball benefit. But if you have a generic benefit like fitness, if you like to go to tennis, play tennis, I'm sorry if you like. So go swimming at a swim club. Like those are the categories of the fitness benefit that we have to help members understand. But also at the same time, you can't buy your golf balls or you can't buy your sweatpants, your sweatbands for your sports.
BRIAN URBAN: Yeah, it's so funny because you have to draw that line. I think the consumerism, at least in the Western culture, obviously is it's taken over the way that we behave on a daily basis. So you think that you can immediately get access to things immediately buy things. Everything comes with everything. But when we're talking about health care coverage and improving health outcomes, there has to be lines and it has to make sense fiscally, but also for the experience of the member as well. So I'm glad you said that, because sometimes these worlds that we're in are blending so fast, it's tough to disseminate the what what is an experience versus what's a benefit and kind of what those two things are delineating those two things. But well, Jen, I love where we've gone today. There's so much more to discuss. I think in all of the work that you're going to be doing over the next several years, but I want to look at where you are now with relevance in terms of your Medicare Advantage supplemental benefits, and then where you're going maybe in the next several years. So take us down this kind of road or look into your crystal ball here. What are some of the biggest, you know, moves or contributions that you think your particular products are going to be having for the member experience in the future here?
JENNIFER KALUZA: Sure. Absolutely. You know, when looking at supplemental benefits, we have seen the majority of the plans are really investing in them again. This shows that plans truly believe in this. And with CMS, you know, the the changes to policies in 2018 shows that they believe in it as well. Right? We work in this direction of closing care gaps, health equity and addressing SDOH and supplemental benefits is just so critical to that. I will say, I think we're all anxiously waiting on how supplemental benefits and regulation unfold at this point. There's a lot of attention from CMS in Congress on the benefit offerings, so that plans, to your earlier point are offering truly health enabling benefits and not offering benefits that now almost become commercialized. So members, instead of thinking about a health plan that can help them pay, you know, or cover medical costs and address their needs, the last thing we want is is members chasing. You know, I'm going to pick this plan because it has higher dollars for a fitness benefit, and I like to go to a really expensive gym that negates the intent of these supplemental benefits in the policy to really drive health outcomes. And like I shared, you know, the flexibility and making sure the benefits resonate with members are are critical. You know, we go back and we think about DBH, right. That was the initial kind of foundation of supplemental benefits. You know, I think it's it's a possibility that CMS could say, we're going to go back to you only being able plans, only able to offering medical benefits or not being able to advertise. So there's a lot of questions out there in the direction that supplemental benefits are going to go.
But I don't see plans slowing down on those offerings until there's more information about them or more direction from CMS. I think, you know, supplemental benefits have just been a tremendous a tremendous success. And like I shared, there's been some some growing pains and I don't I'm not sure if the industry truly appreciated combining health care with fintech right now. We have to take into account a network of grocery stores being able to have restricted spend. So members in a store can buy milk, but they can't buy fireworks, right? Those are things that, as an industry, we're really catching up on. I'll tell you, in this role, I did not expect to be an expert in financial technology processors and merchant acquirers, but it is a new knowledge set that I have, and it's given me such an appreciation for the complexity of supplemental benefits. And back to the point of being brilliant at the basics. These are things that we really need to understand as we continue to grow and innovate on supplemental benefits, how are they actually executed? Do we have the foundation to execute them in a way that the benefit is truly intended to design? So I think a lot's up in the air. I don't see plans slowing down, pushing, you know, or looking at benefits differently, especially with our population. Right. It's important to acknowledge that our non snip and our Snip members have very different needs, and tailoring those benefits to those different populations and evolving them is going to be very important.
BRIAN URBAN: I'm glad you brought that up, Jen, because there's a lot of subpopulations under what a lot of people think is a very generic 65 and older population. There's a lot of individuals that have physical cognitive disabilities that are able to have Medicare Advantage as a health care coverage and as a plan. And there's there's so many different needs at the individual level in general. So I love where this is all going. It's not slowing down. It's getting better. It's good to hear that your work and leadership is being reflected into being brilliant at the basics. That is a theme to this conversation, for sure. Not about the bells and whistles, but about doing the right things, foundationally supporting individuals in their health, and getting access to things they need to help their health. So I've truly loved this conversation. I feel a follow up coming on. Hopefully, if you're up for joining one of our executive roundtables, we'd love to have your perspective on one of those gems. But but thank you so much for joining our show today.
JENNIFER KALUZA: Yeah. Thank you Brian. This has been so much fun talking about supplemental benefits. It's a passion of mine and this is just a great time to connect.
BRIAN URBAN: And it's not often that we say that a passion to talk about supplemental benefits. But you've made it exciting and I appreciate that. And your background is so well rounded. You're not just a one track thinker. You've done so many things. So I just I'm excited for your continued success, Jen. And for more exciting excerpts and insights, please visit us at finthrive.com.