Elevance/Wellpoint New Jersey is a member of the Quality Institute’s Plan Council.
First, welcome back to New Jersey. What drew you back to your home state?
I was born in Princeton Hospital and grew up in East Windsor. I obtained my bachelor’s degree from Rutgers University and my medical degree from UMDNJ Medical School (now Rutgers New Jersey Medical School.) I have fond memories of my upbringing and education in New Jersey. After three decades working in other states, I felt it was time for me to come back to my roots and the state I call home. I relish the opportunity to lead Wellpoint in New Jersey and to make a difference in the lives of Medicaid beneficiaries in our great state.
Is there a program or priority that you are most excited about sharing with our readers that Wellpoint (formerly Amerigroup in New Jersey) is focused on right now?
We are working closely with our state partners in the Murphy Administration to implement a series of innovative NJ FamilyCare program changes to integrate care and address health related social needs. We are proceeding with the federal government’s approval under what is known as a Medicaid waiver program.
The New Jersey Department of Human Services remains on the cutting edge — and we’re particularly excited about the housing supports the Medicaid waiver program will provide for Medicaid recipients, such as pre-tenancy services, tenancy sustaining services, home modifications or remediation services, and move-in support services. It’s about keeping people in their homes and ensuring that their homes are habitable, safe places for them and their families. It might entail ensuring that someone and their family has a safe place to live until more permanent housing can be secured for them. Housing stability is so critical to well-being. It’s difficult to focus on your health if you don’t have a secure and safe place for you and your family.
Your organization is one of New Jersey’s largest coordinators of Medicaid managed care benefits. How can health plans, especially those serving residents in greatest need, ensure that residents get timely care, an essential element of quality outcomes?
For us, it’s about having a robust network of high quality, high performing providers so we can ensure that our members have access to care as close to their home as possible, and providing transportation supports when needed to ensure that our members can get to and from those critical appointments. Annual physical examinations remain a keystone of preventative care for both children and adults. By identifying and addressing health concerns early, more significant or lasting consequences of illness can be prevented or managed. Wellpoint’s care managers assist members by coordinating care with health professionals, assisting with scheduling appointments, and contacting members after appointments to manage adherence. In this way, we hope to drive better health outcomes for our members and the communities we serve.
You completed your post-doctoral training in psychiatry and forensic psychiatry at the Yale School of Medicine. As someone with a deep understanding of the connection between mental health and overall health, how do you think we can better integrate care?
Throughout the 19th and most of the 20th century, mental health and physical health were viewed as distinct and separate. The state asylum system was devised specifically to segregate from mainstream society individuals with a behavioral health condition. Proponents of the model considered state mental health institutions as places of respite and protection from the perils of society. But what it really did was isolate individuals and separate them from the communities in which they lived — away from their family supports and communities.
Over the last 60 years, there has been a concerted effort to transition people from institutional placements to more integrated community settings. The U.S. Supreme Court has held that individuals who are institutionalized and who could otherwise live in the community safely have the right to do so. While individuals may have transitioned from state institutions to the community, the systems developed to provide services and supports remain constrained by the ways state and the federal government are structured, with responsibility for behavioral health and physical health often managed by separate entities.
We now have a better understanding of the interconnection between mental health and physical health. It is well established that individuals with significant behavioral health conditions are at higher risk of poor physical health outcomes. They have higher premature death rates, a greater number of physical health comorbidities, and higher disease burden with conditions such as hypertension, diabetes, and high cholesterol. We also know that individuals with significant physical health conditions have higher rates of anxiety and depression.
We need to integrate the health delivery and health care payment systems and make optimal use of available health care analytics data if we hope to address whole health. We’re moving in the right direction, but we’re not yet fully integrated. Medicaid Health Homes, in which patients receive person-centered care coordination and case management, show significant promise in addressing the health and social needs of individuals. I’m excited by the prospect of further advances in the delivery of holistic, person-centered care. The Medicaid waiver program we are now working to implement will move the needle on whole person care in NJ FamilyCare and integrate outpatient behavioral health services along a phased schedule. This has long been a policy priority for stakeholders like the Quality Institute and we are excited to make this happen starting in 2025.
Finally, we like to ask a question beyond a person’s professional work. If you could choose anyone (throughout history or alive today), who would be your hero?
For me, it’s Sir Isaac Newton. He fundamentally altered the way we understand the natural world and operate within it. His contributions to the fields of astronomy, physics, mathematics, and even theology have profoundly impacted our lives. Many of the complex mathematical formulations that we rely on today for so many aspects of our lives are derived from Newton’s principles and published works. He is an understated champion of human progress.