Errol Pierre is the senior vice president of Healthfirst, a New York City-based nonprofit health insurer serving 1.7 million people across the state of New York. Mr. Pierre spoke with Becker's Dec. 1 about the organization's latest efforts to expand health equity through the launch of Healthfirst ADVANCE.
Question: Can you talk a little bit about Healthfirst ADVANCE and the mission behind it?
Errol Pierre: We were founded in 1993, so nearly 30 years ago, when we were first created, we were built on a bedrock and a foundation of advancing health equity. And so we have 30 years of experience of doing this work in one of the biggest, most diverse cities in the world, where there are so many vulnerable populations. And the key for us is really to show the work that we have done so that other stakeholders, health plans and providers can understand what we're doing, and also to differentiate ourselves. We really believe we're a different type of health plan where healthcare is local. And I think it's perfect timing, especially during the pandemic, where people are really focused on health equity. So it's really a call to action for other stakeholders, principals, insurers, that they can actually join us in being a force for good in our communities.
Q: What are your top goals for the next year with the launch of ADVANCE?
EP: So we do this work every day. Healthfirst has 1.7 million members; 1.2 of the 1.7 are Medicaid eligible, which means they're making less than $15 an hour. Fifteen dollars an hour in New York City doesn't go a long way. They don't have a lot of disposable income. So these are our most vulnerable members, and we still have the ability to have avenues of health equity with this vulnerable population. So over the next year, the idea is to continue to show on our website, which will be continuously updated, examples of us partnering with the care delivery system, with community-based organizations, to advance health equity so that people can draw from our examples, case studies and research and see what we're doing and emulate them if they so choose.
We want other industry stakeholders to see what's possible. While we're the largest nonprofit in New York, there are so many other communities and markets that we're not in, and stakeholders in those areas should see that this work is doable.
Also, we want to specify how different we are and we think that we should be treated as different. We're owned by what we call "sponsor hospitals." Fifteen hospitals sit on our board. We work with them. A typical health insurer will have a hospital contract and they debate rates. Hospitals want the rates to be higher and insurers want the rates to be lower. Since these hospitals are on our board — and they're the most popular, recommended and world-renowned hospitals in New York — we're working as a team, not so much as an adversarial when it comes to contracting. And we want to show that we are putting healthcare over profits. We're not focused on how many admits we can have. It's more about the health outcomes of our members.
Last year, during COVID, when there was lots of social distancing and people weren't going to the doctor, many health insurers saw billions of dollars in profits. Those profits were shared with their shareholders. In our model, we return that money to our hospital partners and our physician groups. So that was upwards of $400 million that went back into the community. Just because people didn't get care doesn't mean they weren't sick.
So I think over the next year, we want to explain that story of why we're different and show tangible research and examples of how it can be done, especially with the population we're serving. They have social determinants of health that create barriers for them to get the healthcare that they need. And we work in tandem with the community to help them overcome those barriers. Whether you live on Park Ave. in Manhattan or Park Ave. in the Bronx, everyone deserves the same access to quality care.
Q: What is Healthfirst doing in response to the influx of people seeking mental healthcare as a result of the pandemic?
EP: So one of the first telemedicine specialties that we saw spike during COVID was behavioral health. If you talk to insurers, they've seen telemedicine subside, as people are returning to care, but behavioral health telemedicine is still high, which is awesome. So in light of the pandemic, the first thing we did was make sure that our 1.7 million members all had access to telemedicine, whether through our mobile app or through their direct physician, so that they could continue having access to behavioral health.
Pre-pandemic, we partnered with one of our hospital sponsors, Mount Sinai, to focus on Medicaid members that have the most acute behavioral health issues.
People with mental health needs, especially when those needs involve a substance use disorder, tend to get their care in the emergency room or in inpatient settings because once they lose medication adherence, their physical health is impacted as well. In partnering with Mount Sinai and community-based organizations that provide peer support, educational services, family counseling, and helping people find jobs through vocational expertise or transportation or housing assistance, we actually reduced costs by $50 per member per month, which equated to $1.3 million in savings. And the reduction was in waste as opposed to skimping on care.
Patients got the care they needed, and the care was being done in a PCP setting as opposed to an emergency room visit. When COVID happened, everything changed, but this was a bonafide evidence-based pre-COVID solution for behavioral health. We hope to continue these types of arrangements with the community to extend access to behavioral health, because we know it's going to be a post-COVID issue as well.