The Other 80

Jacey Cooper, California’s Medicaid Director,  gives us an on-the-ground look at California’s pathbreaking CalAIM initiative that pairs intensive care management with access to a broad range of social services. It’s been a year since the program launched and Jacey reflects on how much communication, coordination, planning and agility was needed to implement a program of this size and breadth. Claudia and Jacey talk about opportunities and challenges as plans and providers navigate new benefits and participate in local housing, food, and community development conversations. 

We discuss: 

• Lessons learned from the first year of CalAIM including the need for more standardization of social care benefits across health plans 
• More details about the first-of-its-kind Justice Initiative which provides pre-release Medicaid services to people in jail and prison
• Behavioral health redesign, payment reform, transitions of care, and administrative integration of mental health and substance use disorder services

Jacey says whole person care is truly a community effort:

"As a collective force, we're making sure that plans are adapted to work with community-based organizations that have been championing these efforts for years. This is why we're focusing on embedding ourselves in the different aspects of care continuums - like housing and homelessness - within our local groups. We have to be present to have a voice in the decision-making, planning, and connection of individuals to vital services. It's not just about navigating people to housing, but ensuring they're connected to voucher programs too."

#healthcare #investments #housing #medicaid #health #socialdeterminantsofhealth #managedcare 

Relevant Links

CalAIM Primer [PDF]

Final Evaluation of California’s Whole Person Care Pilots [PDF]

Fact Sheet on CalAIM Justice-Involved Initiative [PDF]

Fact Sheet on CalAIM Population Health Management [PDF]

Fact Sheets on CalAIM Community Supports [PDF 1] [PDF 2]

Reflections on CalAIM’s first year [Blog]

About Our Guest

Jacey Cooper serves as State Medicaid Director and Chief Deputy Director for Health Care Programs at the California Department of Health Care Services (DHCS). Ms. Cooper is responsible for the overall leadership of Benefits, Eligibility, Delivery Systems, Financing, Behavioral Health, Quality, and Population Health. Prior to serving as State Medicaid Director, Jacey served in various roles at DHCS beginning in April 2016. Prior to her work at DHCS, Ms. Cooper was Vice President at Kern Medical Center, a public hospital and a health care consultant. Through that work, she gained more than 15 years’ experience in health care policy, operations, integrated delivery models, managed care, business development, and quality monitoring.

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.

Sachin Jain is setting out to build a very different kind of company—a nationally scaled nonprofit health plan, grounded in Scan’s founding story of 1970s community activists seeking a new future of health for vulnerable communities. In the last two years the 4.5 star Medicare plan has announced a merger with Care Oregon, launched verticals focused on delivering health services to people experiencing homelessness and LGBTQ elders, and expanded to new markets. 

We discuss: 

• What’s possible with a longer time horizon
• How equity and social drivers are becoming the new hustle
• Why healthcare should borrow less from other industries
• How “no margin, no mission” is creating ethical laxity
• Unfinished business from our time together at ONC

Sachin calls for a new era of accountable leadership:

“We need more ethical leadership in health care. And what I mean by that is we need to make sure that the words on the wall of every healthcare organization, the ethical compass, the values, the mission statements, the vision statements, actually mean something, and that the behaviors of leaders actually align to things. I think we've gotten lost in this glib “no margin, no mission” chatter, that creates this ethical laxity in organizations to begin doing things like aggressively billing their patients, or, you know, going so far as to repossess their assets when they can't pay their bills.”

Relevant Links

Dr Sachin Jain on Combining SCAN Group and CareOregon: “We’re Trying to Build a Very Different Kind of Company”

L.A.'s state of emergency on homelessness: How a street medicine team is treating patients in a unique way

SCAN launches new Medicare Advantage plan for LGBTQ+ seniors

How One Health Plan Reduced Disparities in Medication Adherence

About Our Guest

Dr. Sachin Jain has worked in clinical medicine, academia, government, big pharma, and the health insurance industry. His passion is in accelerating the pace of change in health care and building a sustainable health care system that addresses the needs of patients. Dr. Jain President and CEO of SCAN Group and Health Plan, a $3.4B non-profit entity that serves over 220,000 patients.  He also serves as a physician at the US Department of Veterans Affairs.  Dr. Jain was previously president and chief executive officer of the CareMore and Aspire Health, the care delivery divisions of Anthem. He is an Adjunct Professor of Medicine at Stanford University School of Medicine and Co-Editor-in-Chief, Healthcare: the Journal of Delivery Science and Innovation and trained in internal medicine at Boston's Brigham and Women's Hospital. He received his undergraduate (AB), medical (MD), and business degrees (MBA) from Harvard. He has worked in leadership roles at Merck and Company and the US Department of Health and Human Services and has held faculty appointments at Harvard Medical School and Harvard Business School. 

Follow Sachin Jain on Twitter @sacjai. 

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.

Former NIMH director and renowned neuroscientist Dr. Tom Insel joins Claudia to talk about the state of mental health in America today. The conversation dives into the challenges and opportunities for improvement, the potential of technology, and what it will take to scale integrated treatment approaches across the nation. Get a behind-the-scenes look at the Bipartisan Safer Communities Act and learn about Tom's new company, Vanna Health, which is delivering new care and payment models for people with serious mental illness.

We discuss: 

• Why he thinks the criminalization of mental illness is a fixable problem
• That people, place and purpose are the foundation of recovery
• The big engagement issue in mental health treatment
• Why Medicaid patients don’t have access to psych hospitals
• That effective crisis response is more than a new phone number

Tom talks about how mental health is the biggest health disparity in the US today: 

“Someone with a serious mental illness in the United States today is probably going to die 20 to 23 years before someone without… [that’s] the greatest health disparity that we have in the United States [and] far exceeds health disparities due to race or ethnicity. But beyond that, other forms of mortality like suicide and drug overdoses, what we call the deaths of despair, have become a massive public health issue… Suicide rates are up about 30 to 35% from the turn of the century, the mortality from drug overdoses is up about five to six fold from that time. So these are huge increases… That's a crisis we need to start talking about.”

Relevant Links

Tom’s book “Healing: Our Path from Mental Illness to Mental Health”

More about Vanna Health

Mental health provisions in the Bipartisan Safer Communities Act

Explanation of Medicaid IMD (institutions for mental diseases) Exclusion [PDF]

About Our Guest

Tom lnsel, M.D., a psychiatrist and neuroscientist, has been a national leader in mental health research, policy, and technology. From 2002-2015, Dr. Insel served as Director of the National Institute of Mental Health (NIMH). More recently (2015 – 2017), he led the Mental Health Team at Verily (formerly Google Life Sciences) in South San Francisco, CA. In 2017, he co-founded Mindstrong Health, a Silicon Valley start-up building tools for people with serious mental illness. Dr. Insel co-founded Vanna Health in 2022 and currently serves as Executive Chair. Vanna Health is focused on the needs of people with serious mental illness and works with community partners to provide the 3 Ps (people, place, and purpose) for recovery. In 2020, he co-founded Humanest Care, a therapeutic online community for recovery. Since May of 2019, Dr. Insel has been a special advisor to California Governor Gavin Newsom and Chair of the Board of the Steinberg Institute in Sacramento, California. He is the author of the book Healing: Our Path from Mental Illness to Mental Health, published by Penguin Random House. With journalist co-founders, he recently launched MindSite News, a non-profit digital publication focused on mental health issues. Dr. Insel is a member of the National Academy of Medicine and has received numerous national and international awards, including honorary degrees in the U.S. and Europe.

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.

Two things push Medicaid to the front of every equity conversation. First, its scale and focus. Second, its bold moves to improve equity through coverage expansions and addressing social drivers of health. Claudia chats with Dr. Aditi Mallick about Medicaid’s three-part agenda to improve equity, implement whole person care and expand coverage. Dr. Mallick — the Chief Medical Officer for Medicaid & CHIP at CMS — shares the deeply personal experience that fuels her push for health equity and access to care for all Americans. 

We discuss: 

• Why addressing social needs is key to achieving Medicaid’s agenda
• Thinking in new ways about maternal and infant health
• Two perennial challenges: workforce and data sharing 
• Where to draw the line on what Medicaid should fund

Aditi reminds us that pure technology plays will never work in this space:

“I think there is a tremendous role for technology here and tech enablement here when done thoughtfully. I think a pure technology business in this space that doesn't have humans or service layered on top of it will not work, frankly, because so much of the implementation success around health related social needs will be predicated on being able to bring together people from a community setting and trusted voices… as opposed to building and throwing something at the community.”

Relevant Links

CMS guidance on covering in Lieu of Services through Medicaid managed care [PDF]

CMS framework for covering health-related social needs through Section 1115 demonstrations [PDF]

CMS “unwinding” website

MACStats: Medicaid and CHIP data book [PDF]

About Our Guest

Dr. Aditi Mallick is a physician, strategic policy advisor, and former management consultant, who is driven to serve and create a more inclusive, innovative, and responsible healthcare system. She is the Chief Medical Officer for Medicaid and the Child Health Insurance Program at the Centers for Medicare and Medicaid Services. Before joining CMS, she was Director of the COVID-19 Response Command Center at the North Carolina Department of Health and Human Services. A board-certified internist, Dr. Mallick has previously held clinical faculty positions at George Washington University and Johns Hopkins University. Dr. Mallick earned her BA with honors from Harvard College, including a Certificate in Healthcare Policy; her Medical Degree from Stanford University with a concentration in Health Services Research and Policy; and completed Internal Medicine Residency training at Massachusetts General Hospital and Harvard Medical School.

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on Twitter @claudiawilliams and LinkedIn.

Abner Mason has spent decades working to reduce barriers to care faced by underserved people, who often experience harm and misunderstanding in their health encounters.  He joins us to talk about how to build trust in healthcare. It means slowing down to really understand and meet each person’s unique needs. That’s the work Abner leads as Founder and CEO of SameSky Health. 

We discuss: 

• That our work is not to judge other people’s choices, it’s to expand the opportunity set they see in front of themselves
• How health plans are learning to have patience
• Advice for entrepreneurs: don’t be too enamored of your own ideas
• Using our voices to oppose hate
• What’s at stake with Medicaid redeterminations

Abner reminds us that people are not quality measures:

“We focus on understanding people's priorities first, which helps us develop and maintain their trust. One of the things we've learned is that people are not quality measures; we need to prioritize them first. By figuring out what's important in their lives, we can truly make them feel heard and understood.”

Relevant Links

SameSky Health website

NCQA stratification of quality measures by race and ethnicity

FCC declaratory on texting for Medicaid redeterminations [PDF]

Results of vaccine outreach and equity campaign [PowerPoint]

Effective Strategies for Collecting Health-Equity-Related Member Data to Identify and Address Health Disparities [Webinar]

About Our Guest

Abner Mason has spent decades working to reduce barriers to care faced by underserved people nationally and internationally, from the federal to the local level. He is founder and CEO of SameSky Health, a cultural experience company that forms meaningful relationships to bring people to health. He has served on President Bush’s Advisory Council on HIV/AIDS, as Chief Policy Advisor to the Governor of Massachusetts, and as part of the Biden-Harris Campaign Policy Committee. He currently sits on the Boards of Manifest MedEx and the California Black Health Network, is a member of United States of Care’s Founders Council, and the American Medical Association’s External Equity and Innovation Advisory Group. He is also the founder of Health Tech 4 Medicaid.

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.

Many investors and founders shy away from building Medicaid-focused companies. Andy Slavitt – policymaker, investor and ‘In the Bubble’ host – joins us to discuss why this is a huge mistake. Medicaid now covers 85 million Americans and is where the opportunities to build meaningful and high impact companies are the greatest. We talk about Andy’s work at Town Hall Ventures and his takeaways from leading CMS in the Obama administration and COVID strategy in the early days of the Biden administration.

We dive into: 

• Why Medicaid-focused founders should think of states as 50 potential customers, not as governments
• A few of his portfolio companies: Eleanor Health, Cityblock Health, Plume and Spark Pediatrics
• How states can get better results from Medicaid managed care
• The wide range of impacts from Medicaid expansion: lower medical debt and bankruptcy, increase in home ownership, and improvements in maternal, child health, cancer and cardiac outcomes

Andy talks about the deep impact on people’s lives from having Medicaid coverage:

“In every single study, all of those outcomes – every single one of them that are quality of life and health related – are better under Medicaid expansion. And it makes sense. If you put a little bit more money in people's pockets, put a little more security underneath them, they're going to live their lives, they are going to take that risk and take a better job, they are going to not worry as much … the kids are going to be healthier and more stable.”

Relevant Links

Town Hall Ventures website

Health Affairs post showing far higher investments in Medicare- than Medicaid-focused companies 

Medicaid facts and figures

ASPE study estimating that 15 million people will lose Medicaid coverage with the end of continuous enrollment  

RWJF study showing that almost two thirds of Medicaid enrollees don’t know about upcoming redeterminations

About Our Guest

Andy Slavitt has led many of the nation’s most important health care initiatives, serving as President Biden’s White House Senior Advisor for the COVID response, President Obama’s head of Medicare and Medicaid and overseeing the turnaround, implementation and defense of the Affordable Care Act. Slavitt is the “outsider’s insider,” serving in leading private and non-profit roles in addition to his government services. He is founder and Board Chair Emeritus of United States of Care, a national non-profit health advocacy organization as well as a founding partner of Town Hall Ventures, a healthcare firm that invests in underrepresented communities. He co-chaired a national initiative on the future of health care at the Bipartisan Policy Center. He chronicles what goes on inside the government and across the nation at town halls, in USA Today, on his award-winning podcast In the Bubble, and on twitter. He is the author of Preventable, a best-selling account of the U.S.’s coronavirus response, released in 2021. A graduate of the University of Pennsylvania and Harvard Business School, he and his wife have two grown sons.

Listen to Andy’s podcast ‘In the Bubble’

https://lemonadamedia.com/show/inthebubble/

Read Andy’s book ‘Preventable’

https://us.macmillan.com/books/9781250770165/preventable

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on Twitter @claudiawilliams and LinkedIn.

Investing in housing for Medicaid enrollees is one of the ways Dr. Bradley Gilbert has pioneered Whole Person Health in California. He’s an original population health thinker, from his start as a county public health officer to decades of service as CEO of one of the nation’s largest Medicaid managed care plans and his most recent role as Director of Health Care Services in California. Dr. Gilbert chats with Claudia about lessons learned along the way and why we need to focus on what’s good for people, not just saving money. 

Relevant Links

Evaluation of IEHPs housing investment

Overview of CalAIM

Recent CMS guidance for states offering social supports through Medicaid managed care

About Our Guest

Dr. Bradley Gilbert, MD, MPP was Director of California’s Department of Health Care Services in 2020 and helped lead the state through its first response to the COVID-19 pandemic and initial implementation of CalAIM. Before that Dr. Gilbert headed the Inland Empire Health Plan, one of the largest Medicaid Managed Care plans in the nation. IEHP serves more than a million Members in Riverside and San Bernardino Counties in California. Previously Dr. Gilbert was the Public Health Officer for San Mateo and Riverside Counties. While he was CEO at IEHP Brad was board chair of the organization Claudia led, Manifest MedEx

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams or on LinkedIn.

A move to whole person health in America is going to take a shift of the entire health ecosystem. In this episode, Claudia chats with Dr. Mini Kahlon, the founding Vice Dean of Health Ecosystem at Dell Medical School, about health beyond the clinic, the role of “traditional medical care” and medical schools in moving towards whole person health, and why we need big, visionary goals for the health of people and communities.

Relevant Links

Dell Medicine “health beyond the clinic” website

Results of loneliness study conducted by Factor Health

For more on health impact of loneliness, see this report

About Our Guest

Dr. Maninder “Mini” Kahlon is a founding vice dean of Dell Medical School, where she develops innovations that advance health beyond the clinic. Kahlon is an associate professor in the Department of Population Health and the founder of Factor Health. The Factor Health laboratory develops programs that rapidly improve health in people’s lives, testing them through community-based trials. Kahlon was previously the executive director and chief information officer at the University of California San Francisco’s Clinical & Translational Science Institute. She is an award-winning technology leader with experience in industry and academic medicine, building consumer-facing and research-enabling tools. Kahlon is a behavioral and systems neuroscientist. She received her Ph.D. from UCSF and is a graduate of Bryn Mawr College in Pennsylvania.

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams or on LinkedIn.

Why is whole-person care so important? And, is it even possible to shift our current model in that direction? Former North Carolina Secretary of Health Dr. Mandy Cohen joins us to talk about why a shift to whole-person care is the right approach and how she generated bi-partisan support for North Carolina’s groundbreaking Healthy Opportunities Pilots which are providing food, housing and other services to Medicaid enrollees. She shares leadership lessons from COVID and perspectives on the data infrastructure states will need to support whole person health. 

Relevant Links

Health Affairs article: “Buying Health for North Carolinians”

https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01583

Federal approval of Healthy Opportunities Pilots

https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nc-medicaid-reform-demo-cms-approval-attachment-g-healthy-opport-pilots-eligib-services.pdf

Kaiser issue brief on North Carolina Pilots

https://www.kff.org/report-section/a-first-look-at-north-carolinas-section-1115-medicaid-waivers-healthy-opportunities-pilots-issue-brief/

About Our Guest

Dr. Mandy Cohen served as the Secretary of Health in North Carolina from 2017 to 2022, where she led the State’s COVID response and the transformation of the Medicaid Program - focusing on whole-person care and the social drivers of health. Dr. Cohen also served as the COO and Chief of Staff at CMS, helping implement the Affordable Care Act. She was recently named the EVP of Aledade Inc and the CEO of Aldade Care Solutions - scaling value-based care with doctors in charge. Dr. Cohen received her MD from Yale University School of Medicine and her Masters in Public Health from Harvard Chan School of Public Health. Dr. Cohen has been elected to the National Academy of Medicine and is an adjunct professor at the UNC Gillings School of Global Public Health. She trained in internal medicine at Massachusetts General Hospital. 

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow Claudia on twitter @claudiawilliams and LinkedIn https://www.linkedin.com/in/claudiawilliamshealthdata/

Welcome to The Other 80 with former senior White House advisor and entrepreneur Claudia Williams. Claudia is opening a new conversation about the move to whole person health in America. Stay tuned for more.

About our show

The Other 80 brings you real, honest dialogue about the things that help keep people healthy beyond traditional medical care – like housing, social connections and food – and the cutting edge policies and programs supporting whole person health. Join former White House advisor, entrepreneur and host Claudia Williams for deep conversations with the innovators, implementers and policymakers bringing these new models to life. We’ll talk about what’s working, what’s not and how to move towards whole person health rapidly and equitably across the US. 

About our host

Claudia Williams is a healthcare executive and entrepreneur who is passionate about creating the conditions, policies, systems and learning to enable health for all. Claudia was the founder and Chief Executive Officer of Manifest MedEx – one of the nation’s largest health data sharing initiatives. She served as Senior Advisor for Health Innovation and Technology at the White House under President Obama, building policies and programs for care transformation, data sharing, and precision health. Claudia is a graduate of Harvard’s Chan School of Public Health, where she earned her MS degree in Health Policy and Management. Claudia served as a Peace Corps volunteer in Botswana.

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To connect with our team, please email [email protected].