Aetna Better Health of Kentucky CEO Paige Mankovich is zeroing in on improving specific disease states and building health at the community level.
Aetna's Kentucky Medicaid plan received the top quality rating in the state for Medicaid plans from the National Committee for Quality Assurance, at four stars.
Ms. Mankovich sat down with Becker's to discuss Aetna Better Health of Kentucky's quality strategy and top priorities for 2024.
Question: You received the top NCQA quality rating out of all Kentucky Medicaid providers. What goes into achieving that rating, and what do you do throughout the year to maintain it?
Paige Mankovich: It took a lot of hard work and dedication by a large team to achieve that ranking. Of course, staying at that ranking is to take the same amount of that type of work. We really focus on understanding our members' motivations in receiving care, and then we also try to make sure that we're really well aligned with our stakeholders and provider partners who also assist members in receiving the care that they need.
We really have success in focusing on specific disease states that impact a wide swath of our memberships. Kentucky is a state that has a high prevalence of diabetes, cardiovascular issues, COPD and things like that. By really targeting those particular disease states, we were able to impact a larger percentage of our membership.
I think it is worth really noting that focusing on partnering with community stakeholders, community based organizations, provider groups, individual providers was very important to our success. Community-based organizations are people who are boots on the ground, working on the front lines with our members and the communities that they live in. We like to lend support to them as they work to address social determinants of health needs that may present a barrier to our members receiving the care that they need in a timely fashion, and of course, working with provider organizations to support them in delivering the care they want to deliver to our members in both a timely and appropriate fashion.
Q: What does the Medicaid redetermination process look like in Kentucky right now?
PM: We are in the thick of it. We began redeterminations in the late spring, early summer, as a state and we recognized very early on that oftentimes Medicaid members are harder to contact, harder to get in touch with, because if you move, you change your phone number, knowing all of the places where you need to go to update that information can be difficult. I don't know that, especially with redeterminations being turned off for a while, our members necessarily remembered they needed to update that information with the state.
A lot of our efforts in conjunction with the state and with our broader national Aetna organization have been focused on reaching those harder-to-reach members, those that we anticipate will be more difficult to get in contact with. We work with providers — we know who we think is probably eligible but might need to fill out some additional paperwork or whatnot. We really look for any person that might be in an ecosystem that can get in touch with them and provide that information to them.
Q: Are members who are no longer eligible for Medicaid finding coverage on the ACA marketplace or from other sources?
PM: We are seeing that members who are no longer eligible for Medicaid do have other coverage or are eligible for a marketplace plan or maybe an employer-sponsored plan. We try to make sure that when we're making contact with those members we are able to fully inform them of what options they have available to them and direct them. Some may already have the coverage and maybe just are not aware of it, and so we can help them confirm that. Others may need to apply or go through a process to enroll in a different type of plan, and we do want to make sure that our care managers, our member services teams, our provider network are all very well informed on how to assist members with doing those types of enrollments should they no longer be Medicaid eligible.
Q: What's your top priority for 2024?
PM: At a very high level, our top priority is leveraging the resources and the expertise that we have at our disposal to help our members live their best lives, but there are focus areas within that. Quality and health outcomes, maintaining that high quality ranking that we achieved this year is top priority. We want to continue to build on the good work on the good outcomes that we've seen. We'll be focusing on improving preventive services for mothers and children. Those are really important areas of focus, as well as continuing to focus on members with chronic diseases and helping to improve their outcomes.
In the behavioral health space, [we're] really trying to focus on that area to help improve outcomes with a behavioral health need or substance use need through improved screenings and treatment and retention.
Health equity, of course, is a top priority, and really trying to help build health communities within our state. Each community differs on what their needs might be, and we think that health starts there. Health starts at home. Home includes your communities. So we are really paying attention and being intentional with what we've identified, and listening to members in communities to say what are the needs here and how do we help address those. We're going to be really focusing on affordable housing and food security as we move into 2024. We've been focused on those particular factors throughout this year, and we're looking to continue to gain momentum in those particular areas.