Chapter 1: What is the main topic discussed in this episode?
Welcome to a new instance of our McKinsey on Healthcare podcast. Today, I have the pleasure to speak with Errol Clare, the Senior Vice President of State Programs at Health First. The topic of today's podcast will be health equity. The COVID-19 pandemic exacerbated longstanding health and social inequities, and a broader social discourse on health equity is underway.
Chapter 2: How did the COVID-19 pandemic impact health equity?
One of the organizations that has made such an activation is Health First. Health First is New York's largest not-for-profit insurer and provides plans across Medicaid, Medicare Advantage, long-term care, qualified health plans, and individual and small group plans. HealthFirst currently serves 1.7 million members across its products.
Errol Pierre is the Senior Vice President of State Programs at HealthFirst, and in that role oversees HealthFirst Medicaid and commercial products. Errol, thank you for taking the time to share your experience with us today.
Absolutely.
Chapter 3: What challenges and opportunities arise from community diversity?
And Carlos, thanks for having me.
New York is arguably one of the most diverse cities in the world. with Health First members collectively speaking 70 different languages. How do you see that diversity creating challenges or opportunities in managing the health of the community?
Yes, absolutely. I look at it all as opportunities, honestly, because it allows us to bring together a diverse group of people and we share best practices. And I think that's the key to diversity, our ability to leverage everyone who has a different lens looking at the same problem.
and then coming up with ideas and strategies, and then being able to take the best practices from all the different ideas.
An example is, we have patient populations that are Chinese, we have huge populations that are Haitian descent, we have patient populations that are Dominican descent, and all these different populations have different issues, different health disparities, and we work with those doctors on how to tackle them. They all need different flavors of the same end goal,
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Chapter 4: How did Health First adapt its services during the pandemic?
through cultural competency. So if something worked with one population, sometimes we try it with another, but slightly change it based on the needs of that population. And we partner very closely with key stakeholders in those communities that say, I know the message you want to get across. This is the best way to do it.
And so working through them, we have credibility with those populations to be able to move the needle.
How did that bespoke model to each of your communities work while you were at the height of the pandemic?
We're serving, again, some of the most vulnerable, ethnically diverse patients in New York City. We quickly, because of our population, saw the disproportionate impact on black and brown communities. And that's from the South Bronx to Elmhurst, Queens. We also saw survival rates that depended more on your zip code than how healthy you were.
Chapter 5: What role do community partnerships play in health equity?
And from there, it enabled us to know where to focus. So there was a cross-functional team where everyone played their part. in terms of trying to figure out where to put our resources and where to sort of step in and try to help the members the most.
Our MedEcon team was able to work closely with our chief information officer and our chief analytics officer to create a dashboard that provided us the needed transparency into where the COVID admits were happening the most. And with that visibility, we're able to know where to put our resources into play. And with that, that was such a critical piece for us to understand those nuances.
Then we could partner with community physicians who were trusted in those communities to really put in interventions. An example is we partnered with a physician group called Somos. They're one of the largest physician groups in New York State. And that's just one example of our ability to curate very culturally competent solutions for the members we served.
Chapter 6: How does Health First utilize data to inform care management?
I think at the introduction you talked about an app that you deployed to be able to engage members during the time. Can you talk a little bit about that and more broadly how you've engaged members throughout these difficult years?
COVID hit around March of 2020 and utilization was dropping tremendously for our community physicians. And so we knew that the only way for access to care to continue to happen at the spike of COVID was through telehealth. So quickly, we made sure that all of our 1.7 million members, if they had a phone, were able to get telehealth services.
Our mobile app wasn't set to be released that early in the year. So we were able to move it up to around April, where we were able to deploy it, and they literally had to click a button to get access to telehealth services if they needed it. So that was one big push.
Another big push was, from our quality standpoint, our physicians were unable to get members to come to their doctor's offices, obviously, because of social distancing. So we modified the quality program where things could be mailed to the home, like a colorectal screening through Cologuard, versus things that had to be done in the doctor's office.
Chapter 7: What lessons were learned from the pandemic regarding health equity?
So we're consistently looking for ways to make it easier for the member. The second piece was, we worked with our pharmacy team. Through different partners that we have that were in our pharmacy network, members did not have to go to the pharmacy to get their scripts if they were on chronic meds. We actually had partners that could deliver it to their home.
And we had a directory where you could look for pharmacies that did delivery. And so these were all things that we brought to the table in the height of COVID to make sure that our patients were taken care of, even though they couldn't physically see a doctor. We tried to wrap things around them.
What other things did you do during the pandemic or before to support and collaborate with community organizations?
Great question. So during the pandemic, if you used a phone book to find a food pantry, you might have to call five or six places to find one that was actually open at the height of COVID.
Chapter 8: What future changes are necessary to improve health equity?
So we worked with an organization called NowPow that has a digital online directory for social services.
So whether it's food or rent or domestic violence, any need that has nothing to do with healthcare, it's more of the social determinants of health that impact health, any need that someone had, we were not only working with NowPow to update the list so that everything in their online directory was updated so we knew which
Social service entities were open during COVID, but we were also trying to find gaps. So, for example, if there was not enough food in a certain zip code based on our assessment, we found food deserts in communities that we were servicing, then we would find those gaps and then work with NowPow to find community-based organizations to add to NowPow.
How do you all think about ways of engaging members that might not be as digitally native or who might not have access to a stable broadband?
Our philosophy is we say digital first. Digital first doesn't mean digital only. We know many of our low-income members, our most vulnerable members on Medicaid, still have a smartphone. So while we're pursuing a digital approach, we always have an avenue for in-person partnership. But on the digital side, I'll give you an example.
Our marketing team was using text messages to tell members where vaccination sites were. to ask members if they wanted a vaccination, and we would actually schedule it on their behalf. We were doing that through the digital means. Now, the non-digital means was we were consistently in communities once COVID started to open up a little bit,
We were consistently in communities where their hurt was the most and where the need was the most, providing education with different partnerships and different providers. We were giving COVID education seminars. We were donating masks at food pantries. We were donating PPE. We were in these communities. Our digital approach is digital first. It's never digital only. Whether they wanted to
see us virtually or see us in person, we had an opportunity for them to see us. The one other thing I'll say too is some of it was hybrid, partially in person, partially digital. So even in the community office, if you were in person, we still had a paperless approach.
So using technology, someone could take a picture of the document with their phone and text it to our rep, and our rep could take it and upload it. So even in an in-person mode where we had social distancing, masks, plexiglass, there was still the ability to use digital tools, even when we're in person.
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