Q&A with UCare's CEO on building an anti-racist healthcare organization

Hilary Marden-Resnik has been president and CEO of Minneapolis-based UCare since March. Following a decades-long career working with Minnesota providers, she sat down with Becker's to discuss how her work advances the company's journey as an anti-racist organization through the prioritization of health equity initiatives and whole-person care.

In practicing what she preaches, she took time away from the Minnesota State Fair to conduct the interview, where she welcomed seniors at UCare-sponsored fitness events.

Question: Health equity has emerged as a key pillar of quality care post-pandemic. How is UCare ensuring that its care gaps are found and addressed?

Hilary Marden-Resnik: We're committed to equitable access for all our members, which is around 650,000 people right now, including many individuals who are first- or second-generation immigrants. Even though that has always been our work, it's never done — we have a responsibility to move the dial in addressing health and racial disparities, and it's why we've been very public in our statements to our workforce and to our community that we're on a journey to being an anti-racist organization.

When we think about health equity, we're considering the full picture of a person's health, including the social drivers, which must be addressed. We go about identifying care using population health, or our internal member data. But we also use internal data sources that allow us to predict social and health drivers — we can then use that data to make informed decisions about what type of interventions are appropriate. 

Q: Mental health is another key area of growth as we emerge from the pandemic, but patients often report lacking provider networks and difficulty accessing an appointment. Where is UCare investing within its network to make sure members can access behavioral and mental healthcare when and where they need it?

HMR: For many of our members, virtual mental health services during the pandemic were and are a lifeline, but healthcare providers are struggling to retain their staff among all specialties. One in 4 mental health positions are vacant right now, and that would have been problematic even if the demand hadn't increased. 

Frankly, with this kind of vacancy rate, even the telemedicine option isn't available to everyone. We're proud at UCare to have a really robust mental health and substance use provider network that specializes in helping our members access services. 

But going further, because this problem can't be solved without long-term solutions, we've joined forces with urban and rural providers to help fund pilot programs that make it easier for prospective mental health professionals to actually complete the final stages of training and supervision. We have a special focus on people of color, rural communities and other underrepresented populations. We're also helping to fund an initiative to strengthen the overall healthcare workforce, which is led by the Minnesota Hospital Association.

Q: There is a mental health crisis among Americans of color right now. Beyond the work discussed above, how can UCare specifically help underserved members receive a diagnosis and access better care? 

HMR: There's a few strategies we've adopted to help our members and the broader community receive a diagnosis and better care. We partner with organizations that serve their communities and we sponsor events that help connect members with care in their communities. We also educate providers through a resource we call our Culture Care Connection so they can provide more culturally competent care to their patients. 

A couple of examples — we partner with the Minnesota Medical Association on an initiative that helps mitigate bias among physicians and other health professionals by developing programming and an anti-racist culture. We're really proud of recent mental health training that we've held for Black barbers and hairstylists in the Twin Cities area, the Confess Project, which was designed to provide tools and communication techniques and resources to help them become mental health advocates, both for themselves and their clients. The mental health stigma is so pervasive in the Black community, so by equipping the stylists in a setting that their clients trust and appreciate really allows them to reduce the stigma and encourage utilization of mental health services.

Q: Are there better strategies payers can utilize to help disincentivize contract disputes and breaks with providers to minimize disruption to member care?

HMR: Our leaders have knowledge of and a deep respect for providers' priorities — we have to view them as our partners, not adversaries. We want to find solutions that work for everybody, so we continue to develop value-based arrangements with providers that have great incentives to deliver healthcare value and positive outcomes. And then we have gain-sharing and risk-sharing arrangements that incentivize lower costs as managed care organizations.

Ultimately, payers and providers have the same priority: Our members' health and well-being. None of us want our members to see disruptions in care, so we must come together and talk about these strategies so that we're able to come up with better outcomes.

Q: UCare has been named a top workplace in Minnesota for 13 years in a row. What approaches is the company taking amid the "Great Resignation" to attract and retain top talent? How is the company approaching remote versus in-person work styles?

HMR: Attracting and retaining talent is very competitive in Minnesota because we have the lowest unemployment rate of any state in the country. Our turnover at UCare remains lower than the industry average, and it's because our employees are highly engaged, believe in our mission and they feel respected.

Here we are about two and a half years since the beginning of the pandemic, and our workforce has primarily been working from home. We call it workforce 2.0, which is made up of four components: care and concern, safety, flexibility, and transparency. All of our decisions have been structured around these, and now as we transition, we're about balancing the convenience and preference that some employees have to work at home with the preference that others have to come back to the office. Overall, our approach is very flexible.

Q: Payers have been required to publish their negotiated prices online for over two months now. How do you believe the cost of care is going to be affected in the coming years because of the transparency in coverage rule?

HMR: A lot of leaders are asking that, but I think it's still a bit too soon to know. The power of transparency may help consumers make better healthcare decisions — it will be useful information. We also recognize that the initial machine-readable formats for the current pricing is difficult to navigate, but I expect new digital-friendly formats next year.

The reality is that the cost of care is very complex. I do believe there's a chance consumers will favor providers with lower costs, but it's also possible that many consumers will equate higher costs with higher quality. 

Q: Final thoughts to share with our readers on industry trends to watch?

HMR: One of the biggest trends and challenges ahead that we talk a lot about at UCare is whole-person care. That includes the social drivers like transportation, food delivery, housing, companionship and even snow removal — which is obviously huge in Minnesota. 

We're prioritizing members' access to and utilization of telehealth, which isn't just challenges with finding a provider. We have to make sure people have the devices, bandwidth and knowledge to use the technology. It's all related to personalization and meeting our members where they are by providing meaningful information and services that add value for them.

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