CareFirst BlueCross BlueShield Community Health Plan District of Columbia (CareFirst CHPDC, formerly Trusted Health Plan) has been a pioneer in serving Medicaid enrollees in the District of Columbia (DC) community since 2013. It has espoused what it truly means to be a community-based plan with its “high-touch” care management and engagement model. Over the past year, the plan has successfully renewed its Medicaid contract, onboarded thousands of new enrollees, and started serving high-acuity patients. In 2020, Trusted Health Plan was acquired by CareFirst BlueCross BlueShield (CareFirst).
Oliver Wyman's Parie Garg and Rahul Ekbote recently sat down with George Aloth, President and CEO, CareFirst BlueCross BlueShield Community Health Plan District of Columbia (CHPDC), and discussed their journey through the acquisition process, how they enhanced support of enrollees through the pandemic, and how it is growing, Here is what George had to say:
Rahul: This has been a very busy year for your plan with the contract award and acquisition. What have you learned as you’re balancing your operations with all the other changes across the organization amid the pandemic’s upheaval?
George: The key is to never forget what our number one priority is – our enrollees. It sounds sort of cliché, but it’s true. Over the course of the past year, I’ve realized that while acquisitions can present challenges (promoting an understanding of your organization with a new set of stakeholders, and the like), CareFirst has been deeply rooted in the community for decades and it was a natural fit to expand its offerings to include Medicaid. We are united in our goal of serving our enrollees at every stage and circumstance of life.
I’ve witnessed a deep understanding and appreciation across the enterprise that our Medicaid enrollees in the District often face challenges that impact their ability to access care and as a result, require a more personalized approach to care delivery. For example, an enrollee may simply need assistance scheduling an appointment, or they may be faced with clinical questions and decisions and look for the support of a trusted case manager or clinician. I've learned that whatever we're doing, we can't lose that focus. For us collectively, it is important to address enrollees’ needs above anything else. That’s one of the biggest lessons I’ve learned over the past 12 months in the face of the COVID-19 pandemic.
Parie: CareFirst CHPDC now has the opportunity to service 70,000 enrollees through its recent win of the Medicaid RFP. Congratulations! What are some of the more pressing challenges you encountered while onboarding these enrollees?
George: In preparation for this enrollment surge, we spent a good deal of time developing sophisticated staffing models and organizational designs, and then we got hit by a pandemic. All those charts and staffing models didn’t account for a global health crisis, but we knew there would be an influx of new enrollees that would require us to reassess our internal capabilities across the board, including everything from enrollee services to care management. Thankfully, our team has this start-up mentality and we quickly recalibrated our approach to focus on the evolving needs of our enrollees as a result of the pandemic. I would suggest that you can't do everything at once. Don't fix what's not broken.
Rahul: You made an interesting point: Don't fix what's not broken. It would be interesting to see where perfection is the enemy of good. Can you talk to us more about such a situation?
George: One example is that there's not always technology or software or analysis that’s going to say how to serve your enrollees. We know we could be a little bit slimmer in certain areas, but we need to beef up in others. And often, the data and benchmarks aren’t going to agree with that. So, sometimes you have to look at your own past experience to dictate what you need, versus always looking at outside sources. They’re helpful to an extent, but that cannot be the sole determinant for how to operate. The practical experience your team has is just as important.
Rahul: Yes, there are always improvements to be made across every area, but it’s about prioritizing and doing them at the right speed – not trying to squeeze them all in early. You don't want to just totally go uphill and make wholesale changes and then you can't keep up.
George: It's been challenging to prioritize, but I’m confident we’ve identified the right cadence for enhancements going forward and will continue to maintain flexibility and pivot based on the most emergent needs of our enrollees and the business.
Rahul: Related to that point, as you think about the position your plan has established in this marketplace as a high-touch community-based plan, how do you see that evolving?
George: Well, it’s not just one thing but a host of things we do to build our roots in this community. We’ve always operated within our communities, with many of our employees living in the communities we serve. As a result, we have a deep understanding of our enrollees and therefore the ability to create experiences, address needs and breakdown barriers in a way that is meaningful. We know what people need because we're in the community every day and will continue to leverage the first-hand knowledge and experience we have from living and operating within our communities to offer tools and services to help enrollees live their healthiest lives.
We know what people need because we're in the community every day and will continue to leverage the first-hand knowledge and experience we have from living and operating within our communities to offer tools and services to help enrollees live their healthiest lives.
We typically hire from the community. We've also had programs where we hire our enrollees to work at the plan. That allows us to develop a culture rooted in understanding what our enrollees’ needs are. We also have a high school internship program – a demonstration of our efforts to be responsive to the feedback we hear in the community.
Parie: It’s so true, right? It’s not only about access but also about respect and not having to have the enrollee explain to you what their experiences are. The best Medicaid plans understand that.
Rahul: Yes, great point. Switching gears a bit, the plan just opened a new physical resource center. So much is now influx with COVID-19, but in the long-term, do you see these brick and mortar facilities continuing to be central to your strategy? Or do you see things moving in a different direction?
George: We still see it as central to the strategy, but it's going to have to be nuanced. Everything will be a little different post-pandemic because we’re all wired a bit differently now. We plan to maintain the wellness centers but will be evaluating the services and resources we offer to ensure we continue to meet the needs of enrollees in the communities we serve. So is it going to be all be about wellness centers? No. Our focus might be primarily on continuing to build out the wellness centers and partially about a hub serving as a landing spot for different types of staff – for example, social workers, outreach workers, and case managers who are using it as a home base and then going out into the community and meeting people directly. That's something we always wanted to do more of.
One of the things that’s been highlighted over the past year, is our enrollees’ desire for connectivity and direct engagement. Pre-pandemic, we often saw enrollees come in, just to connect and grab a cup of coffee. We had an enrollee who came every single day for three years and he knew everybody and everybody knew him. So I don't think the model goes away. I think it will still be there, but you continuously iterate and improve upon it to retain relevancy.
Everything will be a little different post-pandemic because we’re all kind of wired differently now.
We had all these classes at our wellness centers – nutrition, exercise, and so on, which are now online. Once we go back to live classes after the pandemic, we'll continue to offer the online option to meet enrollees where they are and offer that same level of interaction and engagement many have come to know, expect and rely on during the pandemic.
Rahul: I want to talk now about social determinants of health – obviously a big topic!
George: Sure. Well, there will be different challenges for people in different markets, but one of the things that’s worked well for us is not to over-generalize what people need and want. For instance, we have three in-person centers and we tailor the services and programming at the centers to meet the needs of the diverse populations that live in those areas. Our wellness and resource centers allow us to provide a host of additional benefits and programs that promote health equity and address social determinants of health including our financial knowledge and credit counseling services, job training and workforce development program and our GED preparation and testing assistance programs, just to name a few. If you're going to put a center in a community, it’s important to be strategic and ensure the services offered can cater and provide value to the communities in which they are located. The cookie-cutter approach doesn't work.
If you're going to put a center in a community, it’s important to be strategic and ensure the services offered can cater and provide value to the communities in which they are located.