Teresa Hursey is President of Medicaid Health Plan NJ, Amerigroup, an Anthem Company. Amerigroup is a member of the Quality Institute’s Plan Council.
How is Amerigroup supporting its members during the COVID-19 pandemic? Are there particular programs or resources you want to highlight?
This public health emergency has tested our local plan and we have responded in ways far too numerous to list here. We all know that New Jersey has been one of the most heavily impacted states in terms of the spread of COVID. We have had real leadership from our State partners to rapidly respond with all our plan resources to ensure that care for our members continued uninterrupted, to protect high risk members, and to help our provider partners weather the storm. Specifically, we’ve been supporting frontline workers to make sure they have access to the personal protective equipment (PPE) they need; we’ve partnered with local organizations to help families in need access food and child care; and we’ve supported events designed to provide free COVID testing and offer local communities the opportunity to donate blood and plasma.
This emergency has endured far longer that we like, and now forces us to consider new approaches and technologies to deliver care. While originally these adaptations were necessary to stabilize the health care system, they will ultimately transform it.
How does your role as a former Medicaid director and regulator in Illinois affect how you approach your new role as CEO of the Medicaid Health Plan NJ at Amerigroup?
We all understand that when you’ve seen one State Medicaid plan you’ve seen one State Medicaid plan. That said, there are commonalities and we can learn from our sister states. In Illinois, we did several innovative things and I can bring that experience here. I bring my knowledge of the overall Medicaid program at the federal level and also experience from my work as the CFO of Medicaid in Arkansas. In Illinois, for instance, we received a 1115 waiver that transformed our behavioral health system; it included the approval of implementation of an integrated health home for all three million members. Specifically, with the integration of physical and behavioral — mental health and substance use disorder — and social determinants of health, employment supports, housing support service and more.
True integration of mental health and physical health is still a work in progress here. Drawing upon your national experience, what steps do you suggest to integrate care of both mental and physical health?
When I talk about integration, I never just talk about physical and mental health. It’s also social determinants of health … because you are not going to impact outcomes if you don’t fully integrate all of those. We know that if a person is homeless, has a heart condition, and has a substance use disorder and has depression … these elements may all be connected. You know that you’re not going to really improve those outcomes unless you get them some housing. Now Medicaid as a program can’t actually pay the rent. That’s not what the federal government allows. But what the federal government does allow are those housing supports. And we have also been partnering greatly with some food banks and other partners here to try to make sure that we help with food insecurities. All we have right now for most of the Medicaid population in managed care is inpatient behavioral health care. We do not have any of the outpatient mental health services carved in yet to the program. But we’re working with the state … It’s a work in progress. I do think until we have that we’re going to have a hard time having full integration, and I am a firm believer. Full integration does produce better outcomes.
What do you see as the biggest challenges for New Jersey Medicaid’s system and what role can Amerigroup play to address them?
Something across the nation that we’re all struggling with is “What is the balance that must be struck between social determinants and healthcare to impact the outcomes of the members?” And I think that’s something that we as Amerigroup really concentrate on. We are committed to offering our members a health care plan that provides high quality care while expanding access and improving health outcomes. And I think one of the biggest challenges is bringing in those social determinants of health. You have to focus on the whole person.
Nearly everyone who is sick would rather be home than in a facility. What are your thoughts on best practices that would enable more people to remain at home for treatment? And obviously you’ve got to consider budget realities.
We are required by our contract to do rebalancing, and by rebalancing I mean for the long-term care population. Trying to keep as many members in the community as long as possible, that’s what the LTSS program is all about. It’s a growing program here at Amerigroup. We’re pretty aggressive with it. Part of that is appropriate discharge planning from the hospital and from the rehabilitation facility to make sure that we get people the services that they need in the community. And part of that is those social determinants: making sure that they have meals, making sure that they have somebody coming in to help them with their daily activity. And the next part of that waiver program that the State has involves a community-based waiver. So we are trying really hard to implement that here. We believe it is the fiscally responsible thing to do, but, more than that, we believe it is what is best for the patient. You get better outcomes when you enable people to stay in the community.
As we introduce you to our members, we would like you to share something about you beyond your professional life. So where would we expect to find you on a sunny day? You’ve got no work, no cell phone around.
Well, because I am a new resident to New Jersey and the East coast, I think you would find me exploring my surroundings right now. I am a huge advocate of volunteering. My parents required us to volunteer. We started volunteering at the age of five in my household. And I really enjoy leisure travel and leisure reading.