The shift to value-based health care creates an opportunity for payers to think harder about how they spend money to improve health. In this post, we hear from Michael B Roaldi of UnitedHealthcare Community & State on how they’re using Federal innovation money to change how they work locally, a topic he’ll share more about at our 2017 symposium, Community Agency & Health.
Pritpal S Tamber: Hi Mike. I suspect everyone knows UnitedHealthcare but what does the Community & State arm do?
Michael B Roaldi: Hi Pritt. UnitedHealthcare Community & State is a division of UnitedHealthcare that focuses on providing services to individuals who are without the benefit of employer-sponsored healthcare. We have extensive understanding in Medicaid with over 30 years of managing physical, behavioral and long term services and supports. We also serve individuals who are dually eligible for Medicaid and Medicare through integrated Medicare-Medicaid programs and Medicare Advantage Dual Special Needs Plans (D-SNPs).
Pritpal: That’s a lot of jargon! So, you’re the Medicaid people, right?
Michael: I guess you can use that as a shorthand. We build on the experience we have with commercial and employer insurance to devise and deliver strategies for individuals and communities that we serve. Serving individuals who rely on Medicaid is a core part of our business. We also have a strong focus on addressing social determinants of health, like access to food, transportation, or employment, as a means to improve health outcomes for the communities we serve.
Pritpal: Ok, got it. Forgive me, I’m only British. So, how does all of that relate to community agency?
Michael: You’re forgiven. As you know, there is a fundamental shift happening from paying for volume to paying for value. Rooted in this transition is a greater focus on holistically improving outcomes for the individuals receiving care. There is increasing recognition of the need to address health factors beyond traditional health services, in other words understanding the impact housing, employment status or access to transportation have on health.
Pritpal: So, you’re literally bridging health care and community care.
Michael: That’s what we’re trying to do, yes. We know that local communities know what works for their community and we strive to work alongside them to ensure that what is being offered is effective and efficient and that those we serve can access available supports. If the communities where our members live are healthier, our members are healthier. They have fewer barriers to accessing care, greater opportunity to engage in preventative services, lower stress levels, healthier options for food and recreation and improved mental health.
Pritpal: Is all this requiring a new way of working?
Michael: The short answer is YES!
Pritpal: That’s emphatic! Capitals and an exclamation mark?
Michael: When we are considering pilots, we are working alongside community partners to understand what challenges are most pressing in their communities, what resources are already in place and where the gaps are. We can help identify where they may need new strategies or collaborations to better support the community. While we have lessons learned from communities across the country that we can bring to the table, we recognize that every community is unique and recognize that community agency is a critical factor in building successful pilots.
Pritpal: Give me an example.
Michael: In Hawaii we are part of a groupof organizations – health centers, community service organizations, social services providers – that is working together to improve the delivery of social supports for individuals in need – especially those who are experiencing housing insecurity or homelessness.
Pritpal: It fascinates me that such a large organization like United is embracing the need for nimble and locally-specific innovation; how has this been possible?
Michael: One, there is a growing recognition across the nation that social determinants must be addressed to substantially shift outcomes in health – so communities and the companies that partner with communities, like ours, are changing the way they think about solving for these social challenges. Two, the shift to value – as discussed earlier – has incentivized strategies to improve health. Third, Medicaid expansion and simultaneously shrinking social services budgets have drawn attention to opportunities to link services to Medicaid.
Pritpal: I didn’t realize social services budgets were shrinking.
Michael: It’s a big factor. And four, federal funding for innovation pilots has provided “seed money” to community collaborations like those we have proposed with partners in Hawaii. These collaborations take significant resources to get up and off the ground. Federal dollars are helping to engage communities, build a common goal and establish some necessary early support for innovations.
Pritpal: Great stuff. We look forward to hearing more about it in May.
Michael: Great, I’m looking forward to it as well.
It gives me hope to see established health care companies embrace the difficult and unpredictable work of collaborating with communities. What I like most about Mike’s answers is how he accepts that not all communities are the same, something that is obvious but flies in the face of the relentless desire for cookie cutter scale. I look forward to hearing his breakout at our May symposium, Community Agency & Health.