The Power of Technology in Accessing Medicaid and Public Benefits

<p>hello everyone this is Cole from the American Journal of healthc care strategy I'm joined by a fellow Pennsylvanian or actually a New Jersey a new jerseyan I just realized um autum bori autum please introduce yourself in youru hi thanks for having me Cole I'm autum bori I am the currently the director of healthcare Partnerships at advocacia and a public benefits advocate [Music] you have had just a tremendous career so far in public benefits in trying to help uh people especially uh on I believe you said Medicare right Medicaid yes Medicaid and so a tremendous career and so I'm really excited to have you on because um not a lot of the audience know but I you know work in this industry as we were talking you and I have both utilized some of these benefits in the past and so it's something that's really important I want to ask you though at the beginning of the career way back when you started you know how did you get into this because when I rev these benefits I mean it can be kind of boring right to review this so it's not really something that people you know uh kind of seek out to do starting off so what got you into it into it to begin with yeah that's a great question um so I kind of stumbled into it essentially um I had my first position I was the a senior executive of assistant to the senior vice president of public affairs and marketing at air Health keratos which was Keystone Mercy at the time and I learned a lot in Medicaid um coming into that role but I really felt like I was brought there for a reason and I once I got there I really connected to the mission of the organization and helping those and Medicaid yeah that makes a lot of sense uh a lot of I find individuals they start off you know at a role that's a bit different right than what they in now but how did you how did you get that role if you can just share some insight into that I mean that's that's a pretty you know important role being an assistant to somebody that high level at the organization yeah so um right out of high school I started working and um I didn't have the luxury to you know go to school or anything like that it moved out um and I was working ad doing administrative jobs and the organization I was with had let me go and I was uh going to temp agencies filling out applications back then you know wasn't a really a lot of electronic applications and simplistic processes like they have now but um I got an interview for um that position and it was funny because I was actually applying for the Philadelphia Police Department at the time and I had taken the test and I was waiting and waiting and waiting to get that um acceptance letter in the mail never got it and then the day my first day at AER Health caras I came home and I got the acceptance letter in the mail and I said wow I can either go work for the Philadelphia Police Department and really you know give my life to really helping the philadelphians or I can kind of go in this Medicaid space something I'm passionate about as being I was on Medicaid for you know my entire life up until that moment and and give back that way so I chose to go to the Medicaid route wow impressive and and at that time right how how long do you say it was your first day your first week there the first day I came home I got that letter in the mail and made that decision so you didn't really know exactly what you were into yet not at all it was just a let's let's do it you know and how did that turn out right because you know your first year or two years you're kind of you probably taking in all this information but you kept moving up right I mean you you spent quite a bit of your career at um mer Health right I mean you so you kept moving up you were successful what did you like about the work that you were doing that allowed you to move up to the next role yeah so I worked in um a community um Affairs and uh you know membership member experience things like that and going out to community events and knowing that what I was doing picking up the phone and asking someone to come to an event to get a mammogram these were things that I wish I had when I was a kid you know you know we'd have to there was one um clinic in town that excepted Medicaid and there was no health promotion programs and prevention programs back then and thinking about all of the services that these members have through their membership through Medicaid through REM Health at the time you know was incredible and I I couldn't think that you know fathom someone going through a member handbook and reading about all this stuff and knowing that they have these member benefits so I was like I I need to tell people that they have these services available for free you know they can help them make doctor's appointments they can help them um you know access other services and so I really decided that I needed to stay in that field because I could give my own feedback as well for my own personal journey to help to create a better member experience and a better path of communication to the member to help them to understand what are those challenges and barriers that exist to helping them access care or even knowing when to get care so growing up for me none of this was you know a thing when I was growing up it was only really when I left home that I began to have you know the need for Medicare and and snap and things like that so I I really love your mission and how it's it's really anchored and something that's passionate to you but for those of our audience who have never been exposed to it if you can you know try to imagine um because I was there for a little while where you know kind of a foreign idea right what these these government benefits or government systems look like can you explain your experience on why it was a challenger it's challenging for members to look at the the membership book or to get the information on their own why is that not something that we could just let members handle or or as we were talking about earlier maybe let the government reach out to them yeah you know people who you know a lot of low-income families in those um you know that are experiencing Financial hardships have other things to worry about they're worried about if they're going to eat tonight they're worried about if they can afford asthma medication or you know I've had times where we had candles lit because we didn't have electric because there was no money to pay for electric because we didn't know about the LIE Heat Program you know there's definitely an experience and it really can demonstrate the ability to connect with others who are not in that situation but we need to be a little bit more open to talk about it too you know people open to talk about their experiences growing up in a low-income household I grew up in public housing you know had snap Medicaid all of that back then there was one doctor we could go to one dentist you know and if you that dentist appointment youd had a schedule it six months ahead of time and if you had an emergency you had to wait and you had to take the day off of work and you can't take the day off of work to take your kids to the doctor because if you take your day off of work you're going to get fired from your job so it's very difficult to navigate caring for family or even caring for yourself back then so it you know there's been a lot of Innovations in the field now people are taking a little bit more um care you've had people like myself who had lived experience taking on these roles in organizations that support people on Medicaid and other health benefit programs so it's it's definitely um a really cool feeli to be in and if you don't have that lived experience I'm sure that someone on your team does and if not there's definitely people out there that I encourage you to to just have a conversation have a conversation with your member go to a community event ask about their experience thanks for sharing that because it it it is really important right I mean growing up I didn't have to worry about you know these things I was not you know harassed or or in an abusive environment I get out into the workforce and I am right you know the workforce where I was working as an abusive environment you had to worry about am I going to have food tonight Etc I mean you've experience similar things it's hard to imagine that unless you actually talk to somebody right and the idea of sitting down and going through a benefits book that's 600 pages long is not really the best scenario and when you can actually call them and speak to them and actually help them out that really means a lot right it takes that mental strain off of them have you seen any personal experiences that you know as as in your role where you've been able to really reach members or reach individuals if you can just share maybe any off the top of your head with us that's really improve their lives and the first thing that comes into mind is I was at a community event in West Philadelphia and it was outside it was um in collaboration with at fqc uh we were providing um you know giveaways uh groceries things like that and uh we had um free health free health screenings um we had entertainment food everything and there was a um a bunch of different people who were coming out of the clinic that we were asking hey come over here we have entertainment we just want to have a conversation you know people from the neighborhood came out and homeless people um you know people who all different types of walks of life and to see everybody come together in the neighborhood and to smile I was giving hugs to everybody because I was just so excited that people would come out and take a minute to learn about Healthcare or to learn about their benefits or to say Hey listen here's a free health screening because that free health screening can save your life and you know to see a look in their eyes that someone cared or someone came in hold their hand and gave them a hug you know was it was just a human experience that really cemented my love for Community engagement and my love for helping people on Medicaid because at the end of the day all anyone really wants is a smile and a and a handshake or a hug or whatever it is and a smile can go a long way and you know treating people like humans and not Medicaid recipients because anybody could be a Medicaid recipient and we need to make sure that we're not stereotyping mediced recipients and and just being a person and just really engaging with them is what I really really enjoy about working with populations because I was there I was that person and I never wanted to be looked down upon or anything like that so you know that was definitely the moment in my career where I knew that this was my lifelong journey yeah thank you for sharing that and especially about the stereotyping right I mean there are many people who were once wealthy who are wealthy they've had issues there are uh people of all different income levels all different careers from all different parts of the country um you know and that's something that's really important as well because when we're dealing with our members we're interacting with our members it's not a one-sized fits-all approach right I mean it's everybody's G to have different problems and that's why you have to customize what you're doing to address these problems to help them live their life so thank you for sharing that that's so important I I want to ask too when we're talking about the business case for this right because it sounds great you know being able to you know help these people uh help our neighbors directly but it's expensive right I mean you're you know we have to pay salaries people to do these things you have to you know develop the Technologies what is the business case for this how can this benefit insurance companies or the community as a whole yeah no that's it's interesting if you take a look and think about the evolution of managed care and you know it being a solution to a state in order to lower health care costs by having an organization like a like a insurance company come in and actually manage the care through out different providers to make sure that they're having healthier outcomes for the for those on Medicaid um very interesting um the way that that has evolved and I think that there's a lot of Community Based organizations that that have been doing the social drivers of Health work for many years that's nothing new but now there's a a greater focus on sdoh and health rated social needs and you know the government has been allowed allowing organizations to pay for different um things to address some of those issues because they realize that it actually lowers healthare cost so just for example enrollment in snap can decrease health care cost lost by 25% about $1,400 in each adult and even more like $2,700 for someone with um hypertension or even more for somebody with coronary heart disease so there is actually health care expenses that uh are avoidable and they can do that for helping to get people enrolled into public benefit programs and by partnering with organizations technology organizations like advocacia for example to be able to say Hey listen we have you know 20,000 members and maybe half of them aren't enrolled in snap and most people who are um eligible for Medicaid are eligible for SNAP why aren't we getting them enrolled you know it's a 14-page application they need help just like how you have the health plans have you know health literacy programs they need benefit literacy and they're not going to get that through the health plan and they're not going to get that through the county assistant office they need somebody else to come in and advocate for them and help them explain and understand that problem process or they're not going to more than likely not going to be enrolled into benefits so healthcare costs healthier member outcomes those are the real reasons why people need to uh ensure that their members are enrolled in these different safety net programs I mean I was in my second year in college and I filled out the the application for SNAP incorrectly the first time right I mean so you know we we want everybody in the entire population to be able to fill this out right that's kind of the the metric then why are we you know setting this at a college graduate level if only 30% of the population has a degree I mean it's it's weird right but that's how it is and so we can't assume that they're going to be able to fill it out on their own but it's expensive to have people in person sit there and flood out with them and the government does not really provide that service right we're discussing you know the community uh assistance offices and how you know it's great that if members can get there it's excellent but a lot of the times members have Transit difficulties that's when you kind of was talking about what you did at advoca which is not why we originally reached out to each other but I was just so impressed that this was a solution to this problem can you tell me about kind of your current role and what the organization does to solve this major Gap um so I'm the director of healthcare Partnerships for aacacia um and what we really do is is essentially how it all came to being is that our um one of our co-founders Ryan Brer he was working in revenue cycle management and he came across a patient deila um who he was trying to get care for through the hospital and they Wen enrolled in Medicaid or anything like that she was very sick couldn't go to the doctor and by the time she actually got approved for Medicaid and actually applied for benefits she had already had stage four stomach cancer and unfortunately she did not survive and Ryan really made it his goal and his mission along with his other co-founder Laura in order to develop a tech technology where it would create unified applications in a simplistic and easy to understand way that would enable people to be able to enroll apply screen and enroll into public benefit programs all at one time so rather than having the application for snack the application for Medicaid the application for LIHEAP Wick whatever program it might be there was one application with easy to answer questions that could be done either through their cell phone or through text message or through somebody with boots on the ground or through the hospital that they were um in the emergency room with so financial counselors you know community health workers Etc are enabled with this technology to be able to help people at the time they need care um so it's really an awesome thing and now we're looking at let's do this proactively let's engage health plans to get their members enrolled into public benefit programs it's so easy you pick up your phone you could upload the documents right from your phone you could up you can do e signatures right from your phone you could do it at midnight you could do it at three o'clock in the morning or you could do it when you get off your shift at 8 o'clock in the morning it we really need to take away those barriers to access and we also have our Advocates as well that can help to explain questions you know what does this mean you know it's it gets really complicated when you get into your assets and income and your need your pay stubs you know what does this mean what does that mean especially when you're applying for something like Social Security which everyone knows you get denied at least the first two times you're applying for it because you often forget some type of information or whatever it might be so we have Advocates that actually help to explain the process and follow up with them so if some of these programs like wick for example we can only help to screen and prepare them for the appointment we canot enroll them in the program because they have to do an in-person appointment with the wick office but we can prepare them for that and arm them with all of the documentation that they need and understand the process in order to get enrolled into those benefits so it's a really significant leap in technology and what makes us different is that we have over a thousand different seoh programs that we um screen for we do local city state federal programs we really take a look at the whole person care all of the different metrics for health rated social needs and we're saying are we taking care of food energy you know education whatever it might be how can we put resources back to the person that are there there's over 80 billion dollars left in public benefits on the table each year and we need to get those in the hands of those who need it the most so you actually mentioned city as well so like you you would do Philadelphia city programs correct oh that's awesome that's that's really impr I didn't realize that either before uh this conversation because one of the things that we encounter a lot right is you might have an sop on how to help a member enroll in a federal program um but you know Philadelphia is a big city we have all these surrounding cities right that all have their own individual things going on we don't have Sops written out for all of those so we can't you know we don't know what to do in those situations so that's that's awesome um one of the questions that I have on this too is how how does how does the Partnerships currently work with the health insurance companies are is this like a software is a service is this you know a partnership that you guys put together just what does that look like for people who might be interested yeah so I think it really depends on the partner um you know I do look at as a partnership and not you know a vendor Health Plan relationship it really is a partnership because you know we're we have social care in the back of our hearts at you know at advocacia and we're there to to make a dent and making sure people are enrolled into public benefit programs and I think what that looks like is us coming to the health plan telling them Hey listen all of these benefits are on the table this can go into the pockets of your members we can we can make your members healthier we can give them access to financial Financial programs like eitc or child tax credit whatever property tax rent and rebate programs why aren't you arming your members with these benefit programs you know we're here to you're you're here to make money and in Medicaid you're a Managed Care Organization you know we're here to make sure that your members are healthy have access to food access to health insurance of course and know all of the different things that they qualify for that can improve their life that's nice and so you guys actually do a lot of kind of work you're not just like here's the log to our website no not at all we build it we customize it for our partners you know we could have if if they wanted our self screen or they could have it on their member website that and have it accessible to everyone you know it's just a matter of what the health plan needs are and we also do work with hospitals and providers too so we have Medicaid Eligibility right then and there the hospitals and providers that we work with when someone comes into the er um they're being screened for Medicaid A lot of the times people are afraid to go get Care at a hospital because they don't have insurance and they don't know that they would actually qualify for Medicaid which happened unfortunately with Dila which inspired the um the launch of Avoca well and then that's you know they they don't get care right because they're afraid of that or or another issue and then they go to the Ed when a real crisis comes along and then the hospital ends up kind of not getting paid for the care it ends up you know creating further issues with the community in terms of the emergency room weight times so it's and of course the me the patient has a terrible experience which is one of the bigger problems as well is we know patients with insurance whether it's or commercial Etc have much better experiences in the hospital than patients without which is a shame but it's the truth and so that's something that that I was thinking is how much could hospitals save in terms of you know they could actually get paid for so many of these procedures if you could sign them up right away um one of the questions I guess that I'm having on this is um is what about states that require a physical signature or something like that I know that there are some states that you know like New Jersey that require that that is this in all 50 states that you guys are active in and how do you deal with situations like that yeah so we actually have a print button so we can print the entire go through the screening of of process and fill out the application and actually print the application get it to the get it to the person who's applying to have their signature what signature on that and then it gets mailed to the agency we keep copies you know if if you start to fill out the application and then you can't stay on the phone for a long time or stay on the on the portal for very long you know you can log back in and all your information is still there so there's a way to print the application and we can actually assist with that to make sure that it's getting it's getting mailed to you for your for your and then do a followup did you send your application into the agency how can we help you just checking in that's your organization that does that yes oh well so this is not something that our Organization for example would have to pay employees to do that would be something that you guys offer included correct and then we follow them too through the enrollment Journey we can actually reach out to them if if if they opt in for text messaging and say Hey listen or pick up the phone hey it's been six months did you get your Snap application approved and be able to say yes we were able to close a loop on that so that's the other important part of it because sometimes people they initiate the application they get frustrated they don't understand what a question is or they ran out of time you know you're you're doing this you're you're you have to make dinner for the kids you know you I'll pick this up later and then something else happens bath time happens and then you fall asleep because you've been working all day and just took care of the kids until nine o'clock so you know this this system that we have it it it's so easy to you don't even need a an email address to to be able to log in to screen and apply for benefits um they use of course it's very uh compliant and secure of course but we took we took out all of we looked at all those different barriers and really addressed all of them it's inter I I think back to an experience um with my my wonderful sister-in-law she's she's at all these circumstances has been a challenge for her but she you know applied for benefits two or three times to get Medicaid and um and snap and I'm and she keeps getting denied and I'm like this makes no sense to me because I know you know her financial status she was living on my couch at the time I'm like she's not you know doing well financially that she should qualify and she just couldn't do it and then one day my wife sits down with her cuz you know my wife had some time she helps her felt the application and within a couple days she gets approved for everything and it's just because she was missing a couple things that did not make sense right because she had not you know gotten education in high school on how to fill out government documents right and so that's just it's incredible and so now she can be a productive member of society she can you know able to get a job because she can get health care she could get food so she can go to work and it's really important that we do this so I love the mission that you are doing what do you think the future is though do you think things are going to get better in this area do you think more people will be able to access benefits well I think with Technologies like ours we're really helping to um you know bring that access to people make it easier I think that the challenge lies in where who is responsible for doing this Outreach and um you know i' I've spoken to a Health Plan before and they said this is a great but we don't believe it's our responsibility it's the state's responsibility and that's an was an unfortunate answer I believe it's everyone's responsibility you know we as people elect the government the government are the ones that are creating these processes you know we have to be advocates for there to be change you know some of the agencies like Snap and Wick don't necessarily communicate or they believe that there might be some privacy issues there and depending on the state you're in so it's really become politicize which is unfortunate um so I think that as long as there remains strong Advocates organizations like Sherer strength um who were the part of the mediced food security network um other organizations that are out there that are doing the good work of talking about changing government systems is really important but getting a diverse group of people Health Plans providers Tech um banking everybody is responsible for the health care of humans you know it's not just one one party that's responsible for it because you're on Medicaid doesn't mean that the health plans are only responsible for this everybody's responsible for this and we're all going to be a lot better off if we can take care of each other absolutely and that's why these safety net programs exist and we need to enroll people into these safety net programs y thank you so much Autumn for coming on and sharing this this is really encouraging that this technology and companies like yours exist and we really appreciate it we're going to of course link you on LinkedIn as well as advocation so that people can check it out we encourage you to take a look at it uh if you're an insurance company provider um Etc we encourage you to go and learn more this was not a sponsored episode but it's it's uh something that very is interesting to me so thank you for coming on and I hope we can have you on again in the future</p>