Health check
Executive takes the helm at local insurance nonprofit at a pivotal time
Lisa Wright, a former executive at Tampa, Fla.based WellCare and UnitedHealthcare’s Texas division, joined Community Health Choice in May as the local insurer’s new president and CEO, two years after executive Ken Janda stepped down from the role.
She takes over as the health care landscape is in the midst of an evolution: Insurers and hospitals are at odds over rising costs and network contracts, and the coronavirus pandemic has challenged the limits of traditional health care.
In her new role, Wright will oversee the day-to-day operations of Community
Health Choice, a local nonprofit health plan with nearly 400,000 customers in southeast Texas. The plan, designed in the late 1990s to serve pregnant women as well as children covered by Medicaid and CHIP, expanded greatly under the Affordable Care Act.
Wright spoke with the Houston Chronicle about what the future holds for the organization. The following interview has been lightly edited.
Q: What are your main goals for Community Health Choice this year?
A: This is a really complex and complicated year. One, how do we deliver health care, considering that we’re in the middle of
a pandemic? How do we take a community that’s used to going into the doctor and visiting the dentist, and get them more comfortable with telehealth, as opposed to faceto-face visits? Second, I would say Community is community not just because of what we do in the actual community, but because of the team and the culture that we’ve built within. There’s a team here that is used to having that direct contact with one another. How do we continue to keep up with making certain that we’re connected and we’re having those conversations and doing it in a way that’s still engaging to the team, and still inspires them want to continue to do more around health care?
I think about not just for the end of 2020, but just into the future for all of health care. This pandemic has taught us a lot. It’s taught us that some of the ways we traditionally deliver health care may not be the same in the future. How do we do more around using data and being able to move from ill patients and sick visits to how do we sustain the wellbeing of our members?
Q: What are some of the lessons you’ve taken away from your experience working with WellCare and UnitedHealthcare in Texas?
A: I’ve always worked in government programs, and working in government programs, you’re working with the most vulnerable populations. Being able to come to Community and continue that work and having those connections from being in Texas has proven to be very beneficial to me. It’s allowed me to move a little bit faster, and to just pivot into some of the conversations a lot easier.
One thing I was looking forward to in coming here is really being able to not just make a difference from a health care standpoint, but more from a social determinants standpoint. You’re trying to get to the whole self. It’s like with anything else — you can’t focus on health care if other things in your life are taking priority.
Q: What’s driving insurers to re-examine health care costs at hospitals?
A: One of our goals at Community Health Choice is to build the highest quality networks with the most affordable costs. Houston’s diversity of hospitals and providers often provides great flexibility to have both at the same time. Providers go in and out of networks fairly regularly, and while sometimes the decisions are around the balance of cost and quality, at times a provider wants to focus on a specific patient demographic and seeks out insurers who serve that demographic. When a provider goes out of network, insurers do everything to communicate with members as we always want members to understand they have a choice. Regarding Kelsey-Seybold or anyone else not currently in our network, we’re always open to this conversation. We always want the highest quality network of providers possible for our members.
Q: What’s the outlook for the health insurance market right now?
A: Utilization is down just due to the fact that elective procedures were halted as we had the shelter in place. As we start to open up, we start to see more people that had scheduled services prior go in to get their services. We have to make sure we are looking at the whole picture. Understanding that pent up demand is just going to be a part of our reality moving forward, and that we don’t know exactly when that’s going to hit. But we do recognize that will come back.
Really, it’s unknown what’s going to happen over the next six months. We’re just not sure how many people, because they’re afraid to go out, are going to continue to delay their health care because they're afraid of going to the hospital. That isn’t a good place to be because we know that whatever disease and condition they have could get much worse.
Q: What’s it like being a nonprofit insurer now, when for-profit companies are facing a lot of upheaval?
A: When you’re at the unemployment levels that we are, it’s good to work for a company that it’s proven from our quality scores, just the way that we provide access to care and service. So it feels good to know that as people come into the system, they can trust Community to deliver a really quality product to them.
Q: What’s a challenge Community Health Choice will face this year?
A: When we think about what we call integration (of behavioral health doctors with medical providers) , that’s really looking at physical and mental health. In health care, you normally focus on physical. Mental health is a portion of it for some people, but not for all. I feel like as we go through the pandemic, mental health is continuing to be an increased focus. How are we going to start integrating those two together where they’re on parallel paths and so we continue to look at the whole person? The pandemic has really highlighted the true need for mental health for all of us.
Q: How will you approach that?
A: We used to contract out for mental health services and we’ve recently brought that department back in. One of the factors is that we’ve got to work together — we have a psychiatrist on staff, we’re continuing to hire other mental health professionals so they can work in tandem with our medical directors and nurse case managers.
Q: Any plans for expansion down the road?
A: That’s always an option for us, whether the expansion is geographic or product. We already serve primarily women and children in these vulnerable populations; we should do more because we have a quality product and have something outstanding to offer.
We have this amazing careerready program, where we focus on getting high school seniors, and even our pregnant mothers, through to college. We provide scholarships, mentors and coaches that teach them how to study, help them just navigate life while they’re trying to go to school and help them find jobs. When we’re thinking about social determinants of health and us being a leader, that for me just speaks volumes because we’re actually in the community. The program started in 2018 but we are continuing it.