The Glass is Half Healthy

Dan Crogan: Hello, and welcome to ProspHire’s Soaring to New Health podcast. This episode is all about the Glass is Half Healthy. We’ll get into exactly what that means in a minute. I’m Dan Crogan, principal and SVP of consulting joined by Chris Miladinovich, co-founder and chief strategy officer.

Chris Miladinovich: Thanks, Dan. It’s really good to be back, and it’s exciting to have ProspHire’s SDOH leader, Julie Evans, here with us today, along with Dan LaValle, Senior Director of Social Impact from the Insurance Services Division at UPMC Health Plan. Welcome, guys. Thanks for being on the show today. We’re really excited to talk to you about a really important part of healthcare and a special topic today. So, SDOH, let’s talk about why it’s so much more than a buzzword. What is SDOH, what is health equity, and why is it important?

Julie Evans: So social determinants of health, or SDOH, are really coming to the forefront of the healthcare industry for a lot of reasons, and one of those is health equity. Health equity is understanding that different individuals across the country have different health outcomes, and a lot of that can actually be tied back to the zip code they live in. And part of SDOH is focusing on how can we actually hone our efforts in healthcare to address those specific needs and therefore address health equity as well. So a great example is if a child is growing up in a home that has overcrowding and poor air circulation and they have asthma. They’re not actually going to be able to address their asthma needs without appropriate social determinant of healthcare in housing.

Dan LaVallee: No, I think in our communities, it’s so incredibly clear that there’s been inequities for decades. You know, racism, poverty, just under investment in so many. I think it’s an incredible time for us to listen to our community, work together to make sure that we’re building the right programs. The pandemic really shed so much light on what, you know, could be done and the changes of healthcare. I mean, we had one in three Pennsylvanians filing jobless claims during that time. I mean, think about that. Think about us in this room, you know, and what does that mean for healthcare? I mean, I think about, I have two daughters, you know, if I didn’t have a job or knew where our next meal was going to come, I would not be worried about getting to the doctor. And we hear that countless times over and over and again. And I think it’s our chance to, you know, build special programs that can, you know, make things a little better.

Chris Miladinovich: So for our listeners, what does that mean? We have disparities, we have inequities, we have a lot of the population that can’t get to healthcare. You know, break that down for the average listener, that here’s this health equity SDH, what, let’s talk candid. What does that mean?

Dan LaVallee: I think about it in a couple of terms, people that are in either communities where there’s less investment, or, you know, there isn’t the jobs that we have or there’s homelessness, people are not going to find their way to the doctor, then they’re not going to get their diabetes controlled or get the medication they need, or, you know, find, you know, a stable environment. And then they’re going to end up in the emergency room. That is what we see. And the type of care, you know, we want to be on the front end of it. You know, we want to help prevent, we want to help people find the supports and services, you know, they need. I think and for us that starts with, you know, listening. What can we do in each community? Each community is a little bit different, but if we can just help people find supportive housing for 10 months, some of we see it like 10 months consecutive, that changes all the trajectory of their healthcare. That’s just one example of kind of a real-world example of what it means to invest in social determinants and focus on health equity and how they connect, you know, cause that’s what we have to do to really move our region forward.

Dan Crogan: And Dan, you mentioned too about connecting with these members and the challenges it is to make it a priority if they’re couch surfing or figuring out where the next meal is, it’s not at the top of their mind. How have you and other teams gotten through to the communities and made these types of impacts?

Dan LaVallee: I think it starts with finding the community organizations that have the trust of the community and members and individuals. You know, of course, we want to do as much as we can to empower and do it right. We have staff that are incredible, that go into people’s homes, but we couldn’t do it without community organizations. Some that, you know, might get housing supports and dollars from, you know, the federal or state governments to do this work. Our housing program, Community Human Services, based out of the Strip District in Pittsburgh. They do incredible work helping people find emergency housing and then supportive housing. We could not do it without them. So we put our trust and our faith in groups that we hear from individuals, you know, on the street or individuals in communities and who they want to be talking with. So it’s, that’s what makes the partnerships and, you know, that’s what we’ll continue to do.

Chris Miladinovich: So let’s talk a little bit about you and what you do. So, what do you do in your current role? What have you been charged with? And then tell us how you got there.

Dan LaVallee: Sure. It’s been a wonderful journey for me personally. I’m a born and raised in Pittsburgh and you know, I love our community so much. You know, my grandmother had a small little bakery for 60 years on Pitts campus and you know, all she ever wanted was to serve the community. And I watched her and my father, you know, invest and do so much in the community to support underserved communities and people who’d suffered loss and children you know, who had special needs. And so for me, I always saw that and saw health insurance and healthcare as an incredible vehicle and exciting one to be a part of. And that’s all I ever wanted to do. You know, personally, my life has been shaped by, you know, trauma and tragedy. My brother passed away when I was six, he was 21 It was an accident. And you know, I, though, had people surround me with love and care, and I wouldn’t be here without that. But that was because I had that opportunity. It changed my life and my family’s life. But I saw that and I wanted to be, you know, a part of something special. You know, before I came to UPMC about eight years ago, I ran for Congress, you know, won the primary, but got whooped in the general election. You know, it was lovely. I was 26. My wife and I, we got married a month before the election. Which, you know, I didn’t even think we’d win the primary election. So, you know, it was an incredible journey. But I learned in that, you know, people are so trusting and so loving in communities, especially there were hard hits still from, you know, the great recession at that time. They let us into their homes and told us, you know, what they needed for their kids. And we, they all wanted what I now want for my kids. You know, so after that incredible experience, I wanted to, you know, work at a place and for people that I loved and cared for and admired and, you know, looked up to and that was UPMC Health Plan. And you know, I came here and we didn’t have our center for social impact yet, but that’s my day job now. So about three and a half years ago, we created a center for social impact. To do exactly what we’re talking about today because it’s so clear that we have to invest in jobs and housing and benefits access and food programs to help our members.

So my job is, you know, not the charitable side. It’s not to run the lines of business, but it’s to make sure that we’re coordinated, that we have a vision towards each community. That’s a little bit different. You know, which is why we’ve done, you know, a housing program in certain places, why we built a jobs program that I love more than anything that serves members and individuals across the state. It’s been a dream for me personally. The pandemic again, you know, through so much despair offered us a chance to, you know, offer hope to communities and to do it with people and the sky’s the limit for it.

Dan Crogan: Thanks so much for sharing that. It’s clear to see the passion and I’m sure all the communities and the members you’re touching see that too. It’s really incredible. And, you know, as you talk about, I’m sure the evolution of whenever you joined this initiative to where you’re at now, how do you and the team figure out what to prioritize? Because there are so many things to do and you’ve had so many accomplishments along the way too. How do you manage that and balance that along the way?

Dan LaVallee: So much of it starts with, you know, how do we kind of blend and braid funds? How do we work with other public systems? Of course, we’re so driven on providing insurance for, you know, individuals on Medicaid or Medicare, kids on CHIP. So what can we do to work within these other systems? And I think there’s a couple things that we know work that we try to build. So access to public benefits is one, you know, that is incredible to me. I mean, if you look at the SNAP program, you know, 50 percent of people who are eligible are not enrolled. You know, and if you’re on Medicaid, you’re eligible for SNAP, and that is incredible. I mean, there’s a lot of stigma on there.

We hear from the community, of course, but that’s one that we know has long-term positive health benefits on families and individuals. So we look to scale programs like that. We know that meeting people where they are, investing in community health worker programs with community organizations, you know. I think about a group up in Erie called ECAT. They do such incredible work in the east end of Erie, which has some of the largest life expectancy gaps in the smallest area in the state. And it’s all about investing in them so they can go out and reach people that we can’t reach and bring them into services. So we know that works. We know housing works. It’s time for us to continue to scale some of these programs, which we are, you know, as long as we find the right partners and make sure that we’re getting people housed. We know the jobs work. I mean, think about a job. There’s nothing more important than that. In so many ways to provide for a family and we know what that means for long-term health.

So we look at these different things around what we know works and then how we can work with the public workforce system, the public housing system to blend all of our resources together and keep it at the community. But the number one thing is showing up in the community, no matter if it’s individuals, homes, community leaders and organizations, we need to invest in programs that they want and they want to build with us together.

Chris Miladinovich: So you guys are both involved in the RAC program. Julie, why don’t you tell us a little bit about the RAC program and the great things that the program’s striving towards? And you know, give us a big picture of what the state is doing in collaboration with not only the insurance industry, but a lot of the other providers and community-based providers. Talk a little bit about that for our viewers so they can understand that there are a lot of people on this.

Julie Evans: The Regional Accountable Health Council, also called the RAC Program, was a DHS initiative started back in 2021. Take me back in time to when we brought together. The managed care organizations, community-based organizations, health systems, providers, social determinants of health organizations, all really working towards the same initiatives, but in a segmented way. And so the goal of the RAC is really to bring together these different entities and say, if we’re all doing this, why can’t we do it together? Let’s find this cohesive way to address the needs of our community members. And so the RAC program really started this initiative to first do an assessment. What are the needs of the community? Looking at the data, what are these health outcomes? Going back to those disparities that we talked about. Where we see one zip code may neighbor another, but we see a dramatically lower health outcome, and life expectancy for individuals who live there. And that really started to drive our work. Where can we focus our attention? What are areas of greatest need in Pennsylvania? And these groups really started to have collaborative conversations, again, realizing a lot of them are already doing similar work, and how can they bring their efforts together? Now, today, we’re starting to see this evolve into a greater state initiative, really bringing together the Department of Health, The Office of Health Equity, the State Health Improvement Plan, and the efforts of, you know, other departments within our state. And there’s a huge opportunity to actually make all of these different players on their different boats, but all end up at the same island. How can we all get to that final point of seeing healthier Pennsylvanians?

Dan LaVallee: I have never in my life seen somebody handle a larger group of different stakeholders and virtually than Julie. So, I mean, that was incredible to watch you do that. And kudos to all this work.

Chris Miladinovich: She is absolutely amazing. And all the great work that that group’s doing, you can feel, I mean, the impact is palpable, which you know, kudos to you guys for doing that and participating and making it such a successful program. So along those lines, let’s talk a little bit about where the opportunity lies and, you know, we work with a lot of Health Plans. So if you’re a Health Plan and don’t have this initiative or don’t have much behind the initiative you’re doing, what is the big opportunity to get involved? How does someone start? Getting involved in a program and setting up a SDOH program or a health equity program.

Julie Evans: Number one thing we hear is, if you’re not talking to the community members themselves, you won’t know where to start. And so the best way to get started is talk to your members, talk to your patients, whoever it is, whether it’s a Health Plan or a health system. If you’re not within your community asking the questions of what it is they’re needing, you’re just making assumptions. It’s important to ask the question and understand, is it food you need? Okay, why do you need food? Is it access to affordable food? Is it, can you even get to the grocery store? Is it, you don’t know where to get affordable groceries, or you don’t have the money for those groceries? So there can be four different reasons right there as to why someone can’t access food, but if you don’t ask the question, you won’t have the answer. So, it’s really great to talk to the community. They’ll drive your interventions forward, they’ll give you the ideas. You don’t need to be that creative. They know what’s wrong. They can tell you how to fix it, too.

Dan LaVallee: A hundred percent, you know, and it has to be community-led and done. And I think you know, as I think about a couple things that we’ve done recently, one being some work within the intellectual disability community. We, you know, realized very early on that, you know, individuals with intellectual disabilities had elevated social challenges, less jobs, less income. It might be living in homes with aging caregivers, you know, and we went to our county government and the county Department of Human Services here in Allegheny County. And they’re an incredible partner, you know, and that is something that plans and others should never ignore. You know, there is a great opportunity to work across systems and now we’ve built such a neat program where we now understand where our members are who have intellectual disabilities, who they’re being cared for by, and then how we can help close gaps in care simply by working in a system that was outside health insurance.

It’s such a neat time right now, given all the energy around social determinants and social impact data sharing to do that right. If we keep the community at the center and work with some of our local partners, it’s a beautiful thing.

Chris Miladinovich: These programs are incredibly important and the impact that they make is just immeasurable. But maybe it is measurable. So let’s talk a little bit about how to quantify those results. And at the end of the day, the folks doing this have businesses to run, you know, how do you measure ROI or not just the impact to the community, but how does the Health Plan run a better business from doing these types of initiatives?

Dan LaVallee: I think for us at UPMC Health Plan, you know, so much is driven by our mission and who we want to serve and who we need to serve and our values. And we love that which is I’m incredibly grateful that we’re able to run so many of these programs and test and try things that few others, you know, have been able to do because of the leaders that we have and how we look at the community. From a financial ROI standpoint, we do know that there are certain programs that work and that we want to continue to invest in. So supportive housing and getting individuals who are housing insecure, homeless and on the streets into supportive housing with care, of course, with case management from a community organization. We just expanded this program that we have. We call it cultivating health for success into Blair and Lawrence counties. We’re hoping to do more because we do see that if you’re in stable housing consecutively for 10-plus months and you stay there, you’re able to have a change in trajectory. We see healthcare savings that we reinvest into the program.

I think that’s a beautiful thing where we’re, you know, able to do things here. Some of the savings that we generate, we invest back into the program to expand and build and do that more with our community organizations. We know that benefits access leads to better health outcomes. Like we talked about with SNAP and low-income housing assistance and other public benefits that we’re able to pair with the care that we have.

We just had a study come out that we were able to see our kind of Medicaid and special needs plan members, you know, that were not on SNAP and then that were for an equally distant time and able to see there is a significant change in healthcare. And it’s not just the ROI savings that we have, but people are going to the doctor. They’re working with us and others. And that’s what’s exciting about it, is that this changes the trajectory, not just the now, not just avoiding one ED visit, it’s, you know, taking the right medications to make sure that they can get off that medication someday, or get into a job with us. I think that’s been one of the coolest things, is we connect programs that have a financial ROI for our bottom line, but then also, you know, help the community thrive as a community. So we are actively doing it. And that’s why we prioritize evaluation in our work. We have an incredible side of our business called the center for high-value healthcare that evaluates different programs that we run. They’re a part of our center for social impact as well. Part of their time, of course, they do so much other wonderful work. And, you know, that’s helped us think through, you know, how we look at what the impact of programs are. And we’re looking to test that in a new food is medicine program that we’re launching other parts of the supplemental side of some of the businesses that we have on the Medicare and special needs plan side to see what works that is social impact related and then be able to expand it. And Dan, you alluded to the impact of the members and obviously this success in ROI to the Health Plan. Whenever you’re looking at a member or patient, how do you measure the success for them? How do you know this program is working and making an impact that can scale or, hey, we need to evolve this or disregard it.

So the best part about our programs is that we seek member feedback at all times. And this wonderful team that we have that does a lot of this work that is trained in interviewing and gathering feedback. So we hear about things we need to do. We had a job training program that we ran, you know, recently, and through going back to everybody realized we needed to shorten it up a little bit. We were compensating people through it, and it was wonderful, but it wasn’t, you know, exactly where they needed to go. And that was just simply by asking. You know, the housing program, very early on, as we talked to people, you know, we were trying to figure out the best place where they might go in the county.

But they, every individual wanted to be where their support system was, whether it was McKee’s Rocks or South Hills or in the city. But again, you know, that wouldn’t have come without, you know, having a constant loop of qualitative feedback to do this right. And you know, we all do that. We all expect that of our leadership on social impact and others to be so close to it, whether it’s the community organization or the individual served. So I will continue to do that. And I think that is what kind of makes us, you know, special in so many ways. And we love it.

Julie Evans: When you think about ROI from a Health Plan perspective and a member or patient perspective for our Health Plans out there. Think about STARS measures, HEDIS measures, CAHPS measures. These all tie back to these quality incentives that not only benefit you, but by serving your member, making sure they get the support they need, that they are satisfied with the care that they’re getting, that there are gaps as far as receiving care, making sure they’re healthy, or all closed, you have an immediate return on investment as an organization. So at the end of the day, you know your members are going to be happier, your CAPS scores will show that and you’ll actually see the money come through in the end if you invest wisely.

Chris Miladinovich: Let’s talk a little bit about the future of SDOH and where we’re going. Are there any gaps or specific barriers that are just impossible to address right now?

Julie Evans: There are many. So unfortunately, the impact of the pandemic really brought to light when one domino falls for an individual, they all kind of follow that domino effect we’ve seen hit vulnerable individuals far more than anyone else through the pandemic. And so what we’re seeing today is through the pandemic, there was an influx of funding that really supported community-based organizations and Health Plans to address the needs of individuals. And as the public health emergencies lifted, a lot of that funding is going to go away. So it becomes a very important initiative, I think, for many, but also a notable barrier that the funding is just not going to be the same as it was over the past few years. While the impact of the pandemic continues, if not is exacerbated by the continuing difficulties in the economy.

So, we’re seeing that as a huge barrier right now. And when you think about the future of SDOH, there’s a lot you could get into. But I think housing and transportation are two that have a big spotlight on them right now, specific to safe housing, accessible housing. Transportation, especially in rural communities where they may not have access to a vehicle to take them where they need to go. So I think those are some things we’re hearing a lot from our clients right now, concerns in how to address those needs, especially without the funding that may have been existing in the communities before.

Dan LaVallee: Yeah, I think of affordable housing. It’s always a journey. It’s different in every community, you know, and we think we’ve been very excited to make some recent investments with some of our partners in the foundation community into Western Pennsylvania around, you know, helping to preserve affordable housing, whether it’s, you know, rental and of course, home ownership is so incredibly important. And I think we’ll see hopefully more of that, more chances to do that.

Dan Crogan: It appears you guys are staying ahead of this. You know what the challenges are upcoming. Are there other exciting initiatives that UPMC is getting ahead of or rolling out here to address the shortness in funding or other challenges?

Dan LaVallee: I think for us, it’s about, again, finding and funding what we know works. You know, I think about our incredible partners in places of Wilkinsburg, Hosanna House, Neighborhood Resilience Project and Father Paul and, you know, places up in Erie and others in Helwood and other areas around Western Pennsylvania in particular. And as we look at others, it’s all about how we can, you know, find our members and individuals, help engage them and then activate them to seek care. So, you know, we are actively investing in organizations to hire community health workers to go out and do this work. And, you know, we’re not going to stop. And we see that as, you know, something that is a model that can be scaled and replicated and continue to be built around communities that we have. But again, it all comes from the trust in the community, finding those groups that did the work during the pandemic, you know, and can continue to do so. And it’s great to partner.

Julie Evans: And it’s helpful to be able to anticipate the needs of a given individual. So one thing we’re seeing increase significantly right now across health systems and Health Plans is SDOH screening. So a lot more of that is happening so we can better serve our members, get ahead of those needs, and say, you didn’t have access to this or you no longer have access to this. Let’s make sure you get the community-based care you need or let’s get you on SNAP benefits and enrolled for food services. So really just anticipating those needs through assessment.

Dan LaVallee: I see that coming so much. That is incredible. Julie, I see that coming through so many of our provider partners. I find so many you know physicians no matter where they’re from, of course, inside our UPMC family and outside who are so excited to do more of that, to talk a little bit more with their patients about social needs. But if they know that there’s something, you know, on the back end. We just launched our first UPMC Health Plan neighborhood center in the East Liberty neighborhood of Pittsburgh. It was an incredible journey. Thanks to so many people that helped us get there. It’s not meant to be a clinic. It’s meant to be kind of the first space that we have that answered some needs from the community and what we heard from providers and others. Health insurance navigation, of course, making sure people are resigned up for Medicaid. We know that’s a massive challenge. But then to be able to, you know, talk with a community health worker, sign up for a jobs program, link to some of the housing supports that we have. And I think the cool thing there, it’s a big like 8, 000 square foot like former warehouse, if you will. It’s very exciting, you know, but we’re trying to get as many people there as possible to know that, our door is open. And I think it’ll just take a little bit of, you know, continued grassroots organizing to work with our community and providers, especially to know that if they have someone who’s with them, a family or a single mom or who needs a job, you know, there’s an answer.

Dan Crogan: You talked a lot about working and collaborating with communities, but it appears the Health Plans are also collaborating and working together for the member. Can you talk a little bit about how the Health Plans are working together and might be a little bit different than other lines of businesses in the insurance game?

Julie Evans: Yeah, I think it’s an interesting question because Health Plans, do you have to work in the interest of their organization, but it’s in everyone’s best interest to work in the interest of the community. And so we are seeing that increasing community-based organization support from Health Plans. And there’s a lot of, I would say, duplicate investment in similar community-based organizations where that impact is just immeasurable and invaluable. So, I think you see it most through partnerships like that. You also see it through community health worker investment, really getting people out into those communities of need. And through the PAMCO organization. The Medicaid Managed Care Organizations across the state actually get together monthly to problem solve for issues that are all experiencing together. And on behalf of the Medicaid Organizations, they’re able to fund programs and address needs that are being driven from the state level to really collaboratively address those issues.

Dan LaVallee: I see this as such a unique time I mean, we’re all together in this effort and we have an incredible Department of Human Services in the Pennsylvania Commonwealth level. You know, we wouldn’t have this jobs program we have without them encouraging us to think through a new Medicaid work supports program You know, they’ve helped us all, I think through how we can make the best, you know, investments. I see it nationally. Plans in other states that we look at different models that we share openly about what can work and how to make these things work the best that we can. It is a truly, you know, a time for us all to be together towards this. And I think the stars are aligned for, you know, community investment and making it all work.

Chris Miladinovich: You guys are truly both unique individuals doing really great work for not only our clients and our organizations, but, you know, some of the world’s most vulnerable people. And that’s what we need to do as good humans. So thank you guys. That concludes this episode of ProspHire’s Soaring to New Health podcast.