Health+Benefits Vital Signs the November 2022 issue

Insurer Tackles Wellness Through Public Health Lens

Q&A with Sanjiv Shah, M.D., Chief Medical Officer, MetroPlusHealth
By Tammy Worth Posted on November 1, 2022

Among other benefits, MetroPlusHealth recently established a new, free, annual, dietician benefit for New York City workers.

Tell me a bit about the health plan and whom it covers.

MetroPlusHealth is a New York City-based health plan that has been in existence for about 37 years. Our parent company is NYC Health + Hospitals [H+H]. We work with a large network of providers that encompasses H+H and others like NYU Langone Health and Mount Sinai Health System.

We have over 680,000 members, all with a New York City geographic footprint, and we market ourselves because of our strong association with NYC and its health system as its health plan. We don’t go beyond the city, and we know it well. We have a number of business lines but predominately are in government-sponsored, with 470,000 in managed Medicaid. We also have a plan that includes benefits in Medicaid for people who are not documented but are Medicaid-eligible. We have a plan for people who are low-income but not low enough to qualify for Medicaid. We also have people enrolled in Child Health Plus [an income-based state children’s plan]. And we have about 20,000 employees enrolled in MetroPlusHealth Gold, which includes New York City employees, MetroPlusHealth employees, and staff at H+H.

You implemented a free dietician program in July in MetroPlusHealth Gold. What made you decide that was a needed benefit?

We can use dietitian visits to treat a broad array of medical conditions, so we made it available to almost every gold member for 26 visits a year for no cost.

One area that we did want to focus on is nutrition, because it can literally transform a person’s life. When a person talks with a dietician who comprehensively deals with them, there is the possibility of creating change. And it is infectious, because once someone is eating healthy, it can rub off on their children or their neighbor. It’s a very visible change when someone has better health, is in better shape, and a condition like diabetes is under control.

Lots of studies have shown health improvements with serial dietician visits—they have to do it regularly—medical nutrition can improve lipids, blood sugar, BMI [body mass index] and blood pressure.

What is the uptake on the benefit so far?

Uptake has been modest. It’s still early, and we have to make eligible members aware of it. And we have to get primary care doctors aware of it and encouraging members to seek the service.

People have to stick with it. They need to participate and get encouraged by a dietician. We offer services in person and through telehealth, but people have to really avail themselves of these benefits. What we have to do is keep promoting it.

We are very committed to working with our colleagues at H+H, City Hall, the mayor, our own membership and encouraging primary care doctors and endocrinologists and cardiologists to promote this benefit so New York City employees can live their best lives.

How are you doing that? One of the challenges with wellness benefits is getting people not only to use them but, as you said, stick with them over time.
There’s an array of interventions that can be used. We use social media and text messaging to let people know where they can access information on different programs. Also, much of our messaging is very focused, so when we see areas of underutilization, we target texts there. For instance, if we know H+H will have a mobile COVID-19 vaccine van out on a particular day, we text people in those areas to make it easier for them to get shots or boosters.
Uptake has been modest. It’s still early, and we have to make eligible members aware of it. And we have to get primary care doctors aware of it and encouraging members to seek the service.
Sanjiv Shah, M.D., Chief Medical Officer, MetroPlusHealth
You also offer a lifestyle medicine program to city employees as well. Why did your organization and the city feel this was important?

The lifestyle medicine program is at some hospitals, like Bellevue. It’s not just focusing on diet and the services of a dietician but shifting away from a meat-based diet to a plant-based one, taking things to the next level. Our own mayor was diagnosed with diabetes and controls it without medicine because of that shift.

We also focus on a multipronged approach and can incorporate cognitive behavioral therapy. One’s ability to change their behavior is couched in life experiences, and changing one’s behavior is not always so straightforward. If you try to change something like driving too fast or exercising more or eating better, one often needs some behavioral modification. It may seem easy but is often difficult once you actually try to make a change.

Why do you place such focus on preventive care? Did COVID-19 highlight this need?

Even before COVID, medical nutrition was an important part of how we dealt with many disease states like diabetes, hypertension and hyperlipidemia [high cholesterol]. But COVID has heightened our awareness and focus on preventive care on both the physical and mental health side. COVID made everyone realize quickly that if we don’t keep our eyes on prevention, in many facets, the health progress we made as a city can be unwound pretty quickly.

One example is, as a result of COVID, people weren’t accessing appropriate primary care visits for themselves and their children. Now, we are concerned about children and adults being under-immunized for preventable conditions. Vaccinations are probably the single most important advancement made in medicine in terms of preventing illness and death.

Right before COVID, there was a measles outbreak in the city because of an under-immunized population. A case came into the country, and there was spread in that community. And we’ve seen recent concerns around polio.

A lot of people say, “A focus on prevention sounds good, but is it really effective?” But we can focus on things like vaccinations and cancer screenings, eye screenings for diabetics, and other monitoring that we do on a preventive basis. And diet can mitigate or lessen disease states, which became apparent that we needed to do during COVID. The need for mental healthcare and screening also became apparent during the pandemic. If you underscreen, you [also] underdiagnose, under-refer and undertreat for these conditions. There is a domino effect to what you do.

You have to think about people’s barriers to getting care and find the root causes and how to address them. Unless you look at it as a public health issue, that’s not possible.
Sanjiv Shah, M.D., Chief Medical Officer, MetroPlusHealth
Should insurers play a proactive role in the wellness/prevention space?

You can look at the Medicaid populations when they are enrolled in managed care. We work to provide things like cervical cancer and breast cancer screenings and to control hypertension and A1C levels in diabetics. We can leverage the data we receive on our members’ side and make these issues front and center.

Insurers can remind people about prevention, dental care and nutrition, and in that regard, we are really a major force to assist providers with that work. We can encourage people who are insured but not using care or people who are perceived as healthy but just haven’t been to a doctor in a long time for screenings. That’s where we can, and really have, moved the needle in many of these measures.

It doesn’t mean we are perfect, but the goal here is that we know that individuals who use primary care and get medications if needed and use medical nutrition therapy, over time, are less likely to be accessing care in more expensive settings like ERs and urgent care or hospital admissions.

When COVID-19 hit New York City in early 2020, MetroPlusHealth wanted to find a way to assist its vulnerable beneficiaries in finding not only healthcare services and vaccines but also assistance with food, prescriptions and other social services. The plan created a list of more than 80,000 people at high risk of health complications if they contracted COVID-19. With the help of Amazon Web Services, the company created a chatbot to check in on those beneficiaries, establish their needs, and connect to local services. MetroPlusHealth reached out to nearly all of these members by the end of May 2020 and tracked the services they needed and their engagement rates.

What can others learn from what you are doing? Are there things they could implement in their plans or workplaces?

If you are going to be providing a benefit like this that says the employee has no premiums, deductibles or co-insurance and then offer dietary services free, 26 times a year, what you are really saying is, “We want to promote primary care and appropriate specialty care like medical nutrition.”

Then, you have to look at things from a public health lens to see why people aren’t accessing an important benefit like primary care. You have to understand and mitigate barriers that may be in place. Some is messaging and understanding what is available on their plans. But I also think it’s about working with the primary care network. You have to think about people’s barriers to getting care and find the root causes and how to address them. Unless you look at it as a public health issue, that’s not possible.

That’s why, as a New York City plan, the focus for us is to know our communities, their leaders, the importance of faith and churches and other groups that can help to advocate that message for you in a credible and tangible way. That is an area we have succeeded in.

There are a lot of employers that currently have shifted the lens toward public health and reward employees for seeing a doctor or getting a primary care visit. If a beneficiary sees a provider or if they do things like walk and log it, their premium may be less. That gets people encouraged. If people feel more empowered and engaged, they will feel that their company is thinking of them. I don’t think the upfront investment is so expensive that it’s not worth it. Employers will see some of those benefits down the line in reduced healthcare costs, and it may create the appropriate buzz to attract people to join the efforts.

Tammy Worth Healthcare Editor Read More

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