Covid-19 has highlighted for the American public what community health plan executives have known for a long time. The structural disadvantages and barriers that low-income or non-white families encounter lead to inequitable health outcomes—and Covid-19 rates are no different.
Amid the pandemic, plans like Community Health Choice (CHC) based in Houston, TX are targeting longstanding needs that are more urgent and more complex to address than ever before. We spoke with Lisa Wright, President and CEO of CHC, to hear how she’s leading her organization to focus on member needs—and keeping her own employees engaged and safe along the way.
Plans must address employee health and social needs to effectively care for their populations
Speaking to a group of community health plan executives at an Advisory Board-sponsored Association for Community Affiliated Plans (ACAP) fireside chat in October, Wright shared that one of her biggest priorities from the get-go was making sure her staff was safe and engaged.
“You have to take some time out,” Wright said, “not only to be healthy for yourself and for your family, but for our population. You can’t take care of someone else well until you’ve taken care of yourself.”
Covid-19 has made working from home part a new normal for many, but that comes with its own difficulties. CHC made a point to actively help its employees cope with their new reality. They hired a PhD-level educator to consult with employees about homeschooling. They offered flexible schedules and encouraged taking breaks. And they prioritized remote connection among employees.
Tackling the national conversation about racial inequity head-on
It was important to Wright and her employees to address the pain felt across the country in the aftermath of the deaths of George Floyd, Breonna Taylor, and other Black Americans killed by police in 2020. The national conversation led to internal conversations, and Wright saw that her employees needed to share their frustrations.
“The population that we serve is about 80% ethnic minority, and a lot of our employee base reflects those same percentages,” Wright said. “So, for some it was a continuing discussion, and for some it was a new discussion.”
“It was important for us to really have an intimate discussion with our leadership team and provide them with comfort around how to approach it, how to speak about it. And it was important not to just let this time go past and not acknowledge that the staff they're leading is dealing with it every day.”
Addressing member health inequities by focusing on underlying social needs
CHC has been at the forefront of addressing social determinants of health among their member populations. The insurer has been addressing health inequities since it was established by Harris Health System in 1997, said Wright.
“Community plans have traditionally served under-insured, uninsured, and higher-risk populations,” Wright said. “When we were looking at what we termed here in Texas as our ‘hot zones’ ZIP codes, a lot of our membership resided in those ZIP codes,” she said.
Wright told the group that CHC focuses heavily on paths to employment. CHC works with local employers and business groups to help members get job training, skills, and employment. Many of CHC’s own employees are former members.
Wright spoke of a new partnership with a local furniture store with whom they were working to connect members with opportunities, noting the importance of giving members real experiences to put on their resumes to help get future jobs. “If we can get more people off the books of Medicaid, then we’re really doing something to impact the community,” Wright said.
CHC mirrored efforts to help employees manage through the pandemic with members as well. The company has a licensed psychiatrist on staff, and they provided tools and guidance to their contracted physicians to help them ask mental health-related questions of CHC members. The company also worked with community agencies to help address food insecurity among their members, and to ensure that their own employees were able to put food on the table.
Fitting telehealth utilization into chronic care management goals
Contrary to popular belief, Wright shared that CHC data showed the pandemic didn’t keep members from seeking medical care. Utilization among marketplace plan members never dropped. And while they did see a small utilization drop among Medicaid members, utilization is generally back up to normal levels.
Like other payers, CHC also saw a tremendous increase in telehealth usage. But Wright said telehealth presented unique challenges for their health plan. “People are meeting with their doctor, talking with their doctor,” Wright said. “But for the folks that have some of these chronic conditions, our challenge is how do we still have that medical home connection?”
Accordingly, CHC focused on prevention. They worked with community organizations to supply immunizations, vaccinations and well child visits for their pediatric population. They deployed physicians and physician’s assistants to the homes of the chronically ill to ensure that they received needed care. And they encouraged all members to increase their usage of mail-order prescriptions.
Owning the community health plan mission
Wright is new to CHC, having taken the helm of the company in May 2020, at the height of pandemic uncertainty. But she is not new to the community health insurance market. And she encouraged her colleagues to own their mission.
“I feel like [community plans] bring to communities something others aren’t. And at the end, it’s really this membership base that has the most need. I truly believe that people who work for community plans are special people and they want to make certain that we’re taking care of this population.”