Health Net, a subsidiary of Centene, serves more than 3 million California Medicaid, or Medi-Cal members.
The Golden State is implementing a number of changes to integrate Medi-Cal with other social services and add value-based payments.
Pooja Mittal, DO, chief health equity officer at Health Net, sat down with Becker's to discuss the payer's health equity initiatives and how it is working with the state to improve Medi-Cal.
Question: How do you approach social determinants of health at Health Net?
Dr. Pooja Mittal: We're one of the state's most experienced Medi-Cal providers. What we've learned over the years is that healthcare starts at the community level, and it's best delivered locally. So, a lot of our work focuses on developing relationships, both with our members, our providers, and with community based organizations of all types, including faith-based organizations, county offices, and many other types of organizations so that we can really ensure we're meeting people where they're at in their communities. A lot of that work allows us to integrate non-traditional medical providers into our safety net, and allows us to provide more coordinated and equitable access to whole-person care.
So we think about social drivers. At a high level, we approach social drivers of health, at a population level and at an individual level. So we take a step back and use data to understand where, at a population level we know there may be less access to resources such as transportation, food and housing, particularly in rural areas or urban care deserts. We also screen each of our members for social needs, getting the information from providers as they collect that information, and then communicating directly with members when we talk to them on the phone. We help fill the gaps with what they need for their social support through community and provider partnerships so that we can support them where they're at.
Q. California is implementing a lot of health-equity reforms in Medicaid. How does that factor into your work?
PM: We are so excited to partner with the state on all of the reforms that are coming right now because they really do build on a lot of the work that we've been doing for many years.
For example, there's a new benefit the state is launching on Jan. 1 to provide community-based doulas for members to improve birth outcomes. We did a pilot on community-based doulas in 2019. We're really excited that the state came to see this new benefit as being important, because we've already seen that in our work and we're super excited to take it and roll it out across the state.
Q: What are the biggest challenges to address social determinants of health, and how are you working through those?
PM: I think one key lesson is investing in data and making sure that we're using not only quantitative data, but also qualitative data — talking to people and understanding what they're experiencing — is really the key to removing disparities. We need that quantitative data to be able to understand who we've serving. How do we tailor the programs that we're serving based on people's race, ethnicity, their sexual orientation, their gender identity, whether theyr'e living in a rural place or urban place, and also really collecting data about their experience so we know where we can do better. Starting with the data allows us to design initiatives that deliver more personalized care that's really grounded in that connection, so we're ensuring a good member experience.
We've also learned that simplicity is really important when we're designing a new initiative. When we are able to better coordinate care for people and offer simple solutions, our members are better able to use the resources that we provide, and they have better outcomes.
I think the third key lesson that we have learned, especially in doing a lot of the community-based work over the last few years, is that we have to meet people where they are. Progress and improved outcomes only moves at the speed of trust. Working with trusted community partners, identifying who those partners are, and then ensuring we have a collaborative approach with them, really allows us to meet our members' needs in the best way possible.
Q: There's been a lot of conversation about food insecurity and food as medicine programs. What are Health Net's current programs in this area, and will this become a bigger focus in the future?
PM: We've been going in a different direction with some of our food pilots and really focusing on families with young children and early childhood support around food, and trying to see what those outcomes are like if we provide more access to fruits and vegetables.
One of our key initiatives is a partnership with Vouchers for Veggies, which is a [University of California-San Francisco]-based food insecurity program, where they come into a community and build networks with local grocery providers. We provide vouchers to increase fruit and vegetable access.
What we've been trying to do is really focused on early childhood support around food to see if that makes a difference and see what the outcomes are like, what the uptake is like, and see if that's something that we might be able to expand in the future.
Q: Where do you hope you're able to make strides in the next year, or five years, in health equity?
PM: We're working hand-in-hand with the state to transform and enhance Medi-Cal, and we're one of their key partners in CalAIM, which is California Advancing and Innovating in Medi-Cal.
This program is focused on transforming and strengthening Medi-Cal to increase more equitable care for all Californians and maximizing their health. From our implementation in January of this year, we have learned several lessons, and we'll continue to expand on these lessons as we move forward over the next few years.
Some of our key lessons are that we have to partner extensively with community partners and providers. This effort is a really big lift. We have to be able to support new organizations who haven't necessarily worked with a plan before. So that partnership is something that we are planning on continuing to drive forward.