What it Means to Infuse a Whole-Health Approach in Health Insurance Benefits

All Elevance Health-affiliated health plans operate with a whole-health approach; Kalunde Wambua, Staff Vice President Medicaid Whole Health, leads the effort for Elevance Health’s Medicaid plans.

Health insurance in general, and Medicaid specifically, isn’t something I’ve learned about from a distance. I’ve studied Medicaid. I’ve written Medicaid RFPs, and I’ve awarded Medicaid contracts. From policy to operations to measurement, professionally I’ve touched just about every corner of the program. I was also a child who benefited from Medicaid coverage, and it’s possible that my adult daughter, who lives with a disability, could benefit from this program in the future.

I have a vested interest in seeing our health system – and especially Medicaid – evolve to address health more holistically. I want people like my daughter to lead a healthy life, and that means having access to transportation, physical and behavioral health care providers, affordable and accessible housing, and a career that provides a livable wage.

I started my career in the public sector – working at the state level to build, implement, and regulate Medicaid programs. I joined Elevance Health a year ago because I feel like we are on the cusp of truly reimagining the health system into one that addresses the root causes of poor health, so we can turn the tide and accelerate improvement of individual and community health.  We have the talent and resources, within Elevance Health and in partnership with leaders across the country, to reshape the system and create a whole-health approach. We are aligning data streams that have never been aligned before, and we’re using that information to identify and solve problems.

Medicaid plans are committed to supporting not just the physical and behavioral aspects of the Medicaid member’s health, but also the member’s social drivers of health. Importantly, health equity is also measured, i.e., how is a health plan designing benefits and contracting with care providers to advance equal access to care? 

The difference between what was known about health when I first started working and what we know now comes down to data. It reveals what works to drive health in a positive direction. When companies like Elevance Health use data to illuminate the path forward, they can be a catalyst for change and champion whole health. I believe I will someday look back on the work we’re doing and know it had a positive impact on lives and changed the landscape of our healthcare system.

Our health is the result of our daily experiences and circumstances, from what we eat and where we live, to our place of employment and how we get to work. That concept of community health is critical, given that 80 percent of health comes from factors that haven’t traditionally been part of the healthcare picture. Elevance Health’s whole health strategy focuses on the physical health, behavioral health, and social health of our members, and we leverage our vast analytics, digital tools, and care-provider capabilities to put that strategy to work. You can’t reinvent the system overnight, so we focus on places where we can make the biggest difference.

We are focusing on five areas:

1. Maternal Child Health: We seek to improve maternal health and reduce the preterm birth rate and maternal morbidity and mortality. through doula programs, community health workers, and medication-assisted treatment for substance use disorder.
   
2. Chronic Conditions: Food-distribution programs provide more nutritious meals, and remote- monitoring programs help people manage chronic conditions like diabetes, asthma and hypertension.
3. Prevention and Vaccines: There are incentives for plan members who get their regular mammograms. Eye exams are an opportunity to remind members about colorectal screenings. And well-child check-ups in high-risk geographic areas encourage care providers to screen for lead. 
4. Rural Access: In many rural areas, healthcare is not accessible because a doctor may be hours away. We are working with care providers who focus on telehealth and mobile services, and partnering with community-based organizations to broaden the scope. We’ve provided resources to clinic systems to help them recruit and retain physicians and comply with quality measures.
5. Behavioral Health/Substance Use Disorder: We’re expanding behavioral health care and connecting people with the support they need, including during times of crisis. Telehealth options offer quick access for those experiencing mental health conditions or substance use disorder or thoughts of suicide. And we offer diverse provider networks who specialize in supporting people with intellectual or developmental disabilities and autism spectrum disorders.

What does this look like in practice? It’s carefully reviewing our claims for codes that could indicate interpersonal violence, and it’s implementing programs that decrease suicide and overdose events. It’s creating programs for new parents to help them learn the importance of immunizing babies immediately after birth and as they grow. And it’s providing best-in-class pharmacy capabilities that help members easily get medications they need, even if they don’t have transportation.

Here are some specific examples:

• In Nevada, we’re helping members screen for colorectal cancer by pairing in-home test kits with culturally relevant education and instructions. It’s a dedicated approach, and people with health-related social needs are referred to a specialized team for support. 
• In New York, we offer maternal/child health support by partnering with community organizations. Services include home visits, doula referrals, support with health-related social needs, prenatal and postpartum education, and breastfeeding, and resources to support mental health concerns.
• As part of a program in Florida, we’ve connected pediatric community health workers with members ages 6-15 who have uncontrolled asthma.

We’re seeing results.  By addressing the physical, behavioral, and social needs of our members, and ensuring they have access to the resources in their communities, everyone has an equal opportunity to live their healthiest lives. And we’re just getting started.