NextLevel Health CEO Dr. Cheryl Whitaker meets monthly with community leaders to talk about housing, employment and barber shops.
She recently convened an advisory council of community partners aimed at tackling the social determinants of health. Members of the 30-person group range from behavioral health providers to substance abuse counselors to leaders of federally qualified health centers.
Progress is emphasized.
“Between every meeting, we try to get something done,” Whitaker said.
In a recent interview with Health News Illinois, Whitaker talked more about the Complete Health Advisory Council, the health plan’s embrace of technology and what she thinks about Gov. J.B. Pritzker’s Medicaid buy-in plan.
Edited excerpts are below.
HNI: What is NextLevel doing to address the social determinants of health?
CW: We try to hire people who actually know the community and really care. We put people in areas of the city and we say, “Look, we need you to become an expert in this area of the city.” Because so much of healthcare is local. Most car accidents happen within five miles of home. Most healthcare happens within five miles of home.
So, if you are prescribing somebody to go take a walk, you’ve got to be sure they can go do that. And if they can’t, what are the other options to do that?
We also try to partner with folks who are doing this work. There are great agencies in the city and the county and the state who are doing work around the social determinants. Part of the work of the Complete Health Advisory Council is to bring us closer to those entities.
HNI: Can you explain more about the Complete Health Advisory Council?
CW: NextLevel Health is unique. When we started, we had a preponderance of men who became members.
As you know, when the Affordable Care Act went live, Medicaid expanded. Men who met the income requirements were eligible. As a new health plan, we received a large number of those ACA males. Many of them had never been in care before. So we were really struck with a high level of social determinants that were impacting these men’s health. We saw that only 19 percent of them had been to a doctor within the last year. So we knew, “Wow, we’re going to have a hard time meeting our quality metrics if we don’t figure out how to address some of the issues that are barriers to them going into the doctor.” That was one of the big impetuses to having to start thinking about this issue. We saw a lot of men in the hospital for gunshot wounds. And they would come out really disabled from many different issues.
So then there was the follow-up that was needed. There was also just, once they were well, getting them back into housing, employment, stability. So we were really challenged on that front. That’s why we said, “We need help. Who can we call in the community to help us really think about these issues in a holistic way?” And that was a big part of why we launched the Complete Health Advisory Council.
HNI: What’s happened with the advisory council so far?
CW: Our first convening was at the end of last year. It started out as a feedback session and several listening sessions across the south and west sides of Chicago, four to be exact. And then we said, “You know what? Let’s get together every month and get input. Let’s start linking.” It’s very organic. We have 30 people in the room and they’re like, “Well no, I do this. What, you do? Well we’re going to refer to you when we need to do this function because we don’t do this, but we can help you with that.”
HNI: What’s an example of an initiative the council has worked on so far?
CW: In the last part of last year, the barbers who are at the Complete Health events said, “We think our barbershops could really be a resource. Could you help us figure out how we could be a part of this and support these goals and help our clients?” So what we did is we created the barbershop initiative. We are up in five barber shops now. It’s very simple. There’s a table in the barbershop that’s draped. We have information on the annual adult wellness exam, mental health screening and depression – all from a male perspective. And on the table is, “Hey, here are three health centers within three miles of here that you can go to. Here’s their number. Here is their address. Here are their late hours and Saturday hours.”
So we not only are giving people information, but also an opportunity to take action. A lot of times they don’t know that their health centers are right down the street, who will be welcoming to them.
The goal is in between every meeting, which will be monthly, we try to get one, two or three things done that the council has identified that we can control.
So it’s really action-oriented.
HNI: What can policymakers do to make it easier to address social determinants of health?
CW: This issue is bigger than healthcare …The chronic under-investment in these communities is actually overwhelming. And the gun violence and its impact, along with the mass incarceration of these folks, has left a lot of these communities really crippled.
I would like for us to look at how do we revitalize these communities and invest in families that will promote stability of family. Then they could focus on their health. So that’s a bigger answer to the question that you’re asking, because there’s no sort of one thing. I think we need a true sort of plan for capital investment in these communities.
HNI: How is NextLevel embracing technology?
CW: If I had my druthers, NextLevel Health would be a technology company. Because even low-income people are engaged with technology. We have not figured out yet how to bring our members in through technology. Medicaid hasn’t traditionally done that. We have an app. Only about 55 of our members are using the app.
They go on the website, which is mobile friendly. But they’re not using that app. There’s a lot of functionality in there. But it hasn’t hit them yet.
So, a couple things. NowPow [which connects patients with community resources] is an important partner. VirtualHealth is our care management platform, which allows folks to be out in the community. It’s mobile. It’s cloud-based. Things are uploaded immediately to the server. And then PatientPing. Wow. What an innovation. We talked to them in November. When I heard about it, I pushed the team. I’m like, “Guys, get this up now. Right now.” By Jan. 2, it was live.
It’s a game-changer. The minute a member hits the ER, gets admitted, we know. Before we didn’t know. And some of the people we couldn’t find. We have members who’ve been admitted or used the emergency room like 100 times in a year. Think about the healthcare costs going out the window. Think about the inefficiency for that person getting what they need. We can stop that. So we’re really looking forward to seeing the outcomes of us being able to engage with PatientPing.
We’ve only been live two weeks. We’ve already found out where about 200 people we have been looking for are. We know what ERs they are in now. And we know if they are in the hospital sooner than we would know with the old system.
HNI: Last year, the state embarked on a significant expansion of Medicaid managed care. How do you think that has gone so far?
CW: One of the challenges was likely the speed at which we did it. And probably more of an opportunity to really communicate to people, members and providers, what managed Medicaid meant. So that was a tough adjustment period for many of our providers. One of the things we’ve been doing is doing a lot of on-the-ground work – going out and talking to providers, which they’ve really appreciated.
I think we’ve made a lot of progress addressing some of the issues. It’s a large program. It’s a big state. There are thousands and thousands of providers in the Medicaid program. To educate them all and bring them forward at the same time was challenging.
HNI: There’s been lingering concern from providers over late and denied payments from managed care plans. How do you respond to that? Is that still an issue?
CW: This is something that the department really cares about. And they have asked us to work extremely hard to do whatever it takes to make sure providers understand how to bill. And so the health plan association has spent a great deal of energy, we’ve come together to put together a comprehensive billing guide.
Providers can access that information, so that if there are billing errors being made they can correct those. We’ve been doing a lot of work one-on-one with providers, particularly hospitals, to help them with any billing issues that they might have.
And we are doing everything we can to be sure that we can reduce unnecessary denials or rejections from the processing system. There is a certain rigor now that you have with managed Medicaid. When you fill out that bill, you’ve got to fill the whole thing out or these systems will reject it. So educating providers about that has been a key initiative for the health plan association and for us this year.
HNI: Gov. Pritzker campaigned on creating a public option for Medicaid that would allow residents to buy into the program. Is that something you support?
CW: Anything that can improve overall access and, we hope, better quality for folks, we will be in favor of. I need to understand, though, more details about the program. As you know, the Medicaid dollars are matched by the feds. So with this, would there be a match? How would we create the pool? From an actuarial perspective, how would it be rated? Those are some of the complex actuarial questions I would want to understand.
Overall, I’m intrigued. I’d like to hear more. I’d love to see more people insured rather than not. That I can say with 100 percent certainty.