Sarah London, Chief Executive Officer, Centene Moderator: Erika Fry, Senior Writer, Fortune; Co-chair, Fortune Brainstorm Health
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00:00 Sarah, thank you so much for being here.
00:01 Thanks for having me.
00:03 So so much of what affects the health of the population
00:06 you serve is outside the scope of the traditional health
00:09 system--
00:10 access to food, housing, can people afford medications.
00:15 CENTENE takes an expansive approach to providing care.
00:19 So I want to ask you, what works?
00:21 How much do you know about the circumstances of your 28
00:24 million members?
00:25 And how do you effectively address those needs
00:28 to improve health outcomes?
00:30 Yeah, well, I think it's interesting.
00:33 This conversation around drivers of health
00:37 or social determinants of health, I think,
00:39 has been emerging over the last couple of years,
00:44 although the data has been very clear for a long time.
00:48 That the vast majority, 80%, ballpark it however you want,
00:53 of health outcomes are really driven by factors
00:56 outside of the traditional health care delivery system.
01:01 But I feel like we're only just recently, as an industry
01:04 and from a policy standpoint, at a place where this
01:07 has become an active dialogue.
01:10 And from our perspective, that's incredibly exciting.
01:14 But we need to do more than just talk about it.
01:17 And so as you said, CENTENE--
01:19 one of the things that I found when I joined CENTENE 3
01:22 and 1/2 years ago was that intuitively,
01:27 this was something that the organization understood
01:31 because of its origins.
01:32 So we have been in the Medicaid business for 40 years.
01:36 And our focus, the unique platform of CENTENE,
01:40 is that we focus on government-sponsored programs.
01:43 So we serve 28 million Americans in Medicaid,
01:46 in Marketplace, and Medicare.
01:48 Our customers, our members, are among the poorest
01:53 and the sickest and the most underserved
01:55 in our communities.
01:57 And so this question of what works really
02:00 matters because we are also, by virtue of being focused
02:03 on government programs, essentially
02:05 stewards of taxpayer dollars.
02:08 And we are asked by states.
02:10 We are asked by the federal government.
02:12 We are asked by CMS through the subsidized population
02:15 for Marketplace to go out and figure out
02:19 how best to support our members and essentially
02:21 to deliver health outcomes.
02:24 And so this question of what do you
02:27 apply the dollars to that actually best deliver
02:30 and best buy health outcomes is a question that, again, it
02:34 was sort of intuitively native to the organization.
02:38 And it's interesting.
02:39 So there's a health affairs article
02:41 that came out in 2021 that I think has been far too
02:46 overlooked for, I think, how insightful it is.
02:49 There was a group that went out and did a bunch of polling.
02:52 And they went out and they asked black female Democratic voters
02:57 and white female Republican voters in North Carolina
03:01 and swing voters, Latino swing voters in Seattle,
03:05 and male Republican voters in Dallas, Texas
03:08 the exact same question, which was if you had $100 to spend
03:12 to buy health in your community, what would you spend it on?
03:17 And every single one of those groups
03:22 had the exact same answer, which was
03:25 that they would put 2/3 of that $100, $66 to housing, food,
03:33 child care, jobs, and only $33 to more health care.
03:37 And so our members, Americans know
03:41 what makes a difference in terms of health outcomes.
03:44 And we just need to listen to them.
03:46 And so that's really been how Centina operates.
03:48 We work directly in our communities.
03:51 And we, of course, make sure that there
03:53 is access to health care.
03:55 But we also think about what are those things that are going
03:58 to actually drive health outcomes.
03:59 And so when you're dealing with, for example, postpartum moms,
04:03 yes, we want to make sure that they have access
04:07 during the pregnancy to good prenatal care.
04:09 They have access to doulas and to midwives
04:11 and to great hospitals.
04:12 But afterwards, we want to make sure
04:14 that they have access to healthy food and diapers and basics,
04:19 where if they don't have access to transportation,
04:22 how do we get them in for a postpartum visit?
04:24 So those are all the things that Centina has really
04:26 been focused on in addition to traditional health care access.
04:30 And how do you connect members to those things, diapers
04:33 or transportation, whatever it may be?
04:35 Well, that's part of our local approach.
04:37 We've always been local in how we approach health care
04:39 and making sure that we have team members who
04:41 live and work in the communities that we serve.
04:44 And so our team in Nevada funded a diaper van
04:47 that goes out and literally delivers diapers to members.
04:50 Our team in Delaware-- so Delaware just
04:52 passed an 1115 waiver to focus on healthy nutrition
04:55 and diapers for new moms.
04:57 And our teams are already organized around that
04:59 because we actually do that in multiple of our states already.
05:03 Healthy food drives, making sure that we
05:06 will fund internet access for members and communities
05:10 and community partners to allow for telehealth visits.
05:13 So it's just a lot of thoughtful community investment
05:17 as part of the total calculus of getting health care
05:20 outcomes for our members.
05:22 Great.
05:22 And I want to come to the audience for questions shortly.
05:25 So be thinking about them if you have questions for Sarah.
05:29 And one barrier to health for many in the Medicaid population
05:35 is the lack of affordable housing.
05:38 I know this is something you're passionate about.
05:40 We've seen other insurers invest in affordable housing.
05:44 But you are trying something new.
05:47 And we're lucky enough to hear it here first.
05:50 So I hoped you could tell us about it
05:51 and why you're doing it and what's different.
05:54 Yeah, absolutely.
05:55 So we're very excited about this.
05:57 We've talked a lot at Centene about partnership
05:59 and having really strong local partners who
06:03 believe investing in our communities with us.
06:05 And to your point, one of the biggest barriers
06:07 is access to stable, affordable housing.
06:12 And one of the barriers to the development of affordable
06:15 housing units is actually the bottleneck
06:18 of pre-development dollars.
06:19 And so one of things we're announcing today
06:22 and really excited about is that the Centene Foundation is
06:25 partnering with McCormick Baron Salazar, MBS, which
06:28 is one of the nation's leaders in the development
06:31 of affordable housing units and in urban revitalization.
06:35 And together, addressing the pre-development funds,
06:38 we are going to unlock $900 million
06:41 worth of development projects across the country,
06:44 focused particularly on the communities that we serve.
06:47 And importantly, not just create thousands
06:51 of affordable housing units as a result of this,
06:53 but it also creates a platform where
06:55 we can deliver community services that are, again,
06:58 critical to those other drivers of health.
07:00 So think about grocery stores in food deserts,
07:04 community health clinics, community activity centers,
07:08 early childhood education, and some
07:10 of those other critical services that really
07:12 surround the affordable housing and the health
07:15 journey of our members.
07:17 So we're really excited about this partnership
07:20 over the next couple of years.
07:21 And I think it's a slightly different approach.
07:24 For Centene, it's about doing a lot with a little,
07:27 which is something that our members are uniquely amazing at
07:31 and I think speaks to our mission of transforming
07:34 not just health care, but transforming the health
07:36 of the communities that we serve.
07:38 [APPLAUSE]
07:42 And raise your hand if you have a question.
07:45 I'm going to ask Sarah about a big--
07:49 we worry about people falling through the cracks,
07:51 especially over the past year with what's
07:53 been dubbed the Great Unwinding or the redeterminations,
07:57 94 million Americans having to go
07:59 through the process of re-enrolling for Medicaid
08:01 or lose their coverage.
08:03 Meanwhile, a recent study found millions
08:05 of Medicaid aid beneficiaries weren't even
08:07 aware they had insurance.
08:11 You know, can you tell us, how do you
08:12 engage with your members, one, to make sure they understand
08:17 the benefits they have, and then to make sure they understood
08:21 the re-enrollment process?
08:23 What were the challenges and how has that gone?
08:25 Yeah, that has been a major focus of ours
08:28 over the last year and actually for almost 18 months
08:31 leading up to when the redeterminations process
08:34 started.
08:35 We did a huge outreach campaign.
08:39 Within the first month, we had already
08:42 done 9 million calls out to our members
08:44 and that rate and pace just continued through the process.
08:48 Whether it was phone calls, mailings,
08:52 we actually got to text.
08:53 So I want to come back to that because that was
08:55 a pretty important thing.
08:57 We did 15,000 community events, again,
08:59 just in the first couple of months,
09:01 partnering with those institutions and those community
09:04 partners that are really good conveyors of information
09:07 and education, whether that's churches, pharmacy partners,
09:12 clinical partners, really making sure
09:14 that our members understood what was coming,
09:16 they understood the process.
09:18 And to the extent that we could, partnered
09:19 with the Medicaid agencies to help our members
09:22 through that process.
09:23 And we were certainly not alone in that.
09:24 I think the industry stepped up broadly in a big way.
09:27 But it is a consistent challenge in making sure
09:32 that we can communicate with our members the way, frankly,
09:35 they want to be communicated with.
09:37 So one of the challenges coming into redeterminations
09:39 of TCPA and the fact that it actually precludes us
09:43 from directly texting members.
09:45 And so Congress sort of waived that through this process.
09:49 And the chairwoman of the FCC did some awesome work
09:52 to make that possible.
09:53 But I think it speaks to the fact that, in many ways,
09:57 Medicaid is due for a modernization,
10:00 not just from an infrastructure standpoint or a process
10:03 standpoint, but frankly, from a consumer standpoint.
10:06 To think that our Medicaid moms are not
10:09 attached to their phones, to think
10:11 they're not juggling 8,000 things is completely naive.
10:14 And we need to be in a position and be
10:16 able to be in a position to serve them
10:18 and to support them the way that they want
10:20 to be supported as consumers.
10:22 So I think we saw some great strides.
10:24 But it's an opportunity to push that forward.
10:26 Great, and we have a question over here.
10:29 Hi, my name's Tim Leshin.
10:31 Excuse me.
10:32 I work for the Association of Schools and Programs
10:34 of Public Health.
10:36 And what you're describing is a very public health approach,
10:39 which is fantastic.
10:41 Can you talk a little bit about how
10:44 we can scale this model in order to have even a broader
10:47 impact across the whole country or the world, potentially?
10:52 Yeah, I think so two things.
10:54 One is, to me, scale is kind of the power of the fabric,
10:59 understanding that health care and public health
11:02 is local in delivery and in sort of nuance.
11:06 But then how do you extract and extrapolate best practices?
11:11 And so the first thing is making sure
11:14 that we have an integrated approach
11:16 and that we embrace this idea that the drivers of health
11:19 are not just some buzzy, progressive way of talking
11:22 about health care.
11:23 They actually work.
11:24 The math works.
11:26 And we should be investing, from a public dollar standpoint,
11:31 in health outcomes in this way.
11:33 And then I think the other bigger answer, longer answer,
11:37 but I'll make it pithy, is data.
11:39 Because if we have broad access to data
11:44 and we do the work to make that data liquid
11:47 and to really look at it, not just around local best
11:51 practices, but then where is there connectivity?
11:54 Where do you get scale and proof about what
11:57 should be sort of standard of practice,
11:59 that that's how we're going to start
12:02 taking some of these great local innovations
12:04 and pushing them out across the country and across the world.
12:07 And that is really sort of at the core of Centene's thesis,
12:10 which is our platform of 28 million Americans in 50 states.
12:13 We see where the innovation is.
12:16 And we have that data.
12:17 And being able to pull that up and integrate that
12:20 into the conversation, whether that's policy, operations,
12:22 service, that's really how we innovate.
12:26 And quickly, before we're out of time, you got to--
12:30 Hi, I'm Shobha.
12:30 Sorry, OK.
12:31 Question in the back.
12:32 Very quickly, you mentioned scaling.
12:35 I wonder how you are working across states,
12:38 because you're 50 states.
12:40 Only a few of them have those 1115 waivers,
12:42 like you just mentioned.
12:44 How do you work across so many states that aren't even--
12:47 hadn't expanded Medicaid at all?
12:51 And how do you get the social determinants into those places?
12:55 Well, so part of-- it's a great question.
12:57 Part of why I am so enamored with this polling that was done
13:02 is that, to me, it is proof that while 1115 waivers certainly
13:07 are increasing in their adoption,
13:12 that sitting in 32 states for Medicaid,
13:16 very different politics.
13:18 But when you get on the ground, there
13:20 is not actually a difference in terms of what people
13:22 know makes a difference.
13:23 And being in a managed care spot,
13:27 we can actually direct those dollars
13:29 and create the proof points, and then
13:33 move the conversation regardless of the politics.
13:36 Great.
13:37 Thank you, Sarah.
13:38 Good note to end on.
13:40 And thanks again for being here.
13:41 Thank you.
13:41 [APPLAUSE]
13:43 [BLANK_AUDIO]