NYC Health + Hospital insurance CEO: Integration, digitization, SDOH top 2020 priorities

Talya Schwartz, MD, president and CEO of MetroPlus Health Plan, spoke with Becker's Hospital Review about regulatory challenges and new initiatives the 500,000-member insurance arm of New York City-based NYC Health + Hospitals is prioritizing for 2020.

Editor's note: Responses have been lightly edited for clarity and length.

Question: In January, New York City Mayor Bill de Blasio unveiled a $100 million plan to guarantee primary and specialty care to 600,000 uninsured residents. MetroPlus is a big part of the plan. How have you worked with the city on this initiative?

Dr. Talya Schwartz: Since the announcement and executive order, we've been working with the majority of the [city] agencies that were identified under the executive order and trying to figure out the most optimal way to reach out to the population those various agencies serve. That collaboration spans from us physically being present at the various agencies where there is a lot of foot traffic and signing people up for health insurance on premise to advertising in various locations, incorporating our materials and referrals through their digital platforms and collaborating on community events on educating people.

Q: How are you preparing for increased enrollment? What kind of enrollment numbers are you anticipating?

TS: My goal is to make sure people can access us everywhere in New York City. My belief is if we do that, people will come. My focus is not on the particular number. From my philosophical point of view, that's backward. I think you build a good experience, and people will want to be part of that experience.

Q: Have you added any new employees to address this push for better experience?

TS: We are enhancing our operations. It's not necessarily adding people. The more effective and well-respected way to do it is leveraging technology. We announced we'll be launching telemedicine, coming in early 2020. Through that, our members can access care if they're not physically able to seek service for nonemergent issues. We are launching an upgraded provider and member portal, with significant functionality so providers can submit electronic claims, authorization requests, and the straightforward ones will get adjudicated in real time with no delays.

Updates on the member side will be coming out early 2020. Many of the functions members inquire about will be easily available on their phone, through an app and the portal. We're investing a lot in upgrading our system and giving people the experience they expect to receive in 2020 from other industries. There's no reason why they wouldn't be receiving that level of experience from a health plan.

Q: What are you most excited for in 2020? What challenges do you think lie ahead?

TS: We have a big opportunity to be even more integrated with NYC Health + Hospitals. Both parts of the system, and most importantly the patient, can benefit from that integration. We're known for focusing on vulnerable populations: the homeless, foster care children, people coming out of the correctional system. When we're talking about those vulnerable populations, putting together a truly integrated system where patients are covered and receive care seamlessly is a tremendous opportunity, and we're working closely with NYC Health + Hospitals to promote that integration.

I do see us doing bigger and more widespread initiatives around social determinants of health. We have a lot in the pipeline around housing that we are excited about because we know that solving a housing issue for someone has a sustainable impact on their life and by virtue of that, their health.

But what happens on the federal level will continue to be a challenge. There are obviously some concerns around the state Medicaid budget and what that will mean for the plans in the city, although nothing is concrete. Still, I'm more invigorated by the positive than anxious about the potential negatives, because I see a strong path forward.

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