Michael Monson of Altarum On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented…

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Michael Monson of Altarum On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented Populations

Improve care for individuals who are dually eligible for Medicare and Medicaid by ensuring that everyone has the option to experience an integrated product. We know that many individuals in integrated products have better outcomes and experiences than those in the fee for service world.

Healthcare disparities continue to affect underrepresented populations, leading to unequal patient outcomes. Social, economic, and cultural barriers often hinder access to care, appropriate treatments, and equitable health services. How can we bridge these gaps and ensure that all patients, regardless of background, receive the highest standard of care? In this interview series, we are talking to healthcare providers, policy makers, community leaders, researchers, and anyone who is an authority about “How We Can Improve Patient Outcomes for Underrepresented Populations”. As a part of this series, I had the pleasure of interviewing (Michael Monson.

Michael Monson is the Chief Executive Officer and President of Altarum. Prior to Altarum, Michael was the Senior Vice President of Medicaid and Complex Care and CEO of Social Health Bridge at Centene Corporation, the nation’s largest Medicaid health plan. He began his career in health care leading strategy and innovation at the Visiting Nurse Service of New York and holds a master’s degree in public policy from Harvard’s Kennedy School.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

I started in management consulting, which gave me a solid foundation in business, but I always knew I wanted to work in the public sector. Witnessing my parents’ roles in public service and public health — my dad for the state of New Jersey and my mom for Planned Parenthood — was central in that desire. As I was planning my next career move, I pulled up a list of the largest nonprofits in NYC (where I lived) and reached out to leaders at those organizations for informational interviews. I met my future boss at the Visiting Nurse Service this way, and it opened a world of new opportunities for me. It didn’t take me long to fall in love with working in Medicaid and Medicare — I found myself deeply inspired and committed to improving our health care system. I’ve seen firsthand how our health care system can help, or hinder, people from living their best lives. It’s this type of impact that truly motivates me.

Can you share the most interesting story that happened to you since you began your career?

Being awarded an unrestricted grant from philanthropist MacKenzie Scott was one of the highlights of my career. At the time we received our grant, you couldn’t apply — they had to find you. Our reputation and dedication to improving the health of individuals with fewer financial resources and those disenfranchised by the healthcare system fortunately garnered that attention. But being found wasn’t enough. We had to prove to them that where we were heading made us worthy. Given that we were in a financial turnaround, I was concerned that maybe they wouldn’t think that we were worthy.

Fortunately, having recently completed our strategic plan, we had a great story to tell. Even with that plan, the executive team still had to work day and night to pull the requested materials together. And then we had a very intense presentation with the team making the recommendations. It was exhilarating and nerve wracking knowing that, if we got it right, we stood to gain so much for our mission. I feel truly fortunate that we were selected. It was a truly humbling experience and a significant milestone in our journey.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Be an expert in something!” Ideally, you’re an expert in something you are passionate about because that also means you’ll enjoy doing it. Ultimately, when you’re an expert, that’s how you grow in your career. You get more responsibility, you get more authority, you get more compensation, and you end up having a much more significant impact.

I wish someone had given me this advice earlier in my career. I just got lucky and fell into something I love! I never thought that I would have career dedicated to homecare. In fact, I faced a pivotal moment in which I had to make choice on my future direction. I remember saying to my wife, “I don’t know if I want to be the homecare guy for the rest of my career.”

Well, here we are more than 20 years later and I’m still a “homecare guy.” And I love it! I’ve gone deep into the Long-Term Services and Supports (LTSS) arena (of which homecare is a key part.) This base of knowledge broadened to an expertise in all things Medicaid and Medicare, including a deep passion for helping improve the system of care for those who are “dually eligible” for both. I’ve been fortunate to be able to take on bigger and bigger roles, but it’s all because I focused on this area as my “major.” By focusing on what I am passionate about and becoming an expert in it, I have been able to grow and make a meaningful impact.

How would you define an “excellent healthcare provider”?

Most importantly, an excellent health care provider is person-centered. An excellent healthcare provider puts the person first, recognizing them as a human being with real issues, needs, goals, and wants. By doing so, they can provide the right care tailored to everyone’s unique situation. This approach ensures that the care is truly effective. People respond best when the care is designed to meet their needs, not the needs of a provider. Importantly, it is also compassionate and respectful.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I think leaders need to have a diversity of resources to help them be the best they can be. For me that means I stay up to date on the latest insights in health care through some classic resources, like JAMA, NEJM, and Health Affairs. I think I’m one of the few remaining Health Affairs print subscribers! There are also all the daily trades that are important to read like Healthcare Dive, Axios, Fierce Healthcare, and Homecare News (see I’m still a homecare guy!). I also like to keep up with what my clients are reading so that means I get the newsletters from the trade associations (e.g., NAMD, ADvancing States, etc.) We need to stay current in the industry, and you can’t do that without these types of resources.

But I also like to learn what’s going on outside of the health care industry. My podcast feed doesn’t feel like health care at all. Shows like This American Life, Radiolab or Planet Money keep me informed but also inspire me to think more innovatively. I can’t remember which show it was, but I once heard an episode about social impact bonds while on a run. I was so intrigued that I had to stop and send myself a note about an idea that connected it to a project I was working on.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, always! Three come to mind that have the potential to make significant impact.

One is Altarum Medicaid Medicare Services for States (AMMS.) Right now, there are nearly 13 million individuals in the U.S. who are eligible for both Medicare and Medicaid. These two critical programs were never designed to work together, and the burden falls to the states to figure that out. We help states better manage these programs so that these individuals can live the lives they deserve.

Another project is HRSA’s Center for Maternal and Child Health Medicaid Partnerships, which we were recently selected to help lead. The Center aims to strengthen relationships between key federal and state programs, including the Children’s Health Insurance Program (CHIP), state Medicaid programs, and the Title V Maternal and Child Health Services Block Grant program (Title V), to coordinate their services to improve maternal and child health. Unfortunately, most people are knowledgeable about one side or the other. I’m ashamed to say that is true for me too! I’m excited to partner with HRSA to ensure that MCH programs and Medicaid programs work harmoniously. This center will be instrumental in stitching critical programs together in better ways for mothers and children.

Lastly, we are supporting the Public Health Infrastructure Grant (PHIG) national project that will provide direct support to state, local, and territorial health departments to adopt new technology and data standards to better connect health care data into the public health ecosystem. The grave lesson we learned in 2020 was that our public health system is underfunded and under-resourced. We didn’t have the data infrastructure to respond to the crisis at that time. This will position our country for the next pandemic and other public health challenges. It’s thrilling to be a part of this effort and to take our experience to help modernize public health infrastructure.

Ok, thank you for that. Let’s now jump to the main focus of our interview. What are the primary barriers that underrepresented populations face when seeking healthcare?

  • Access. Geographic, financial, and logistic barriers can be barriers to seeking care.
  • Social Determinants of Health. Education, employment, transportation, housing, and social support can be barriers to seeking care.
  • Implicit Bias. Providers may unconsciously hold biases that affect interactions with patients, which can then lead to disparities in quality of care and can discourage patients from seeking care.

How can healthcare providers build trust with patients from diverse backgrounds, especially in communities that have historically experienced medical neglect or discrimination?

One powerful principle to follow is the mantra from the disability community: “Nothing about us without us.” This means involving patients and community members in the decision-making processes that affect their care.

What role does cultural competence play in improving patient outcomes, and how can medical professionals be better trained to meet the needs of underrepresented groups?

Cultural competence plays a crucial role in improving patient outcomes by ensuring that health care providers can effectively communicate with and understand the diverse backgrounds of their patients. People are different, and they bring their own lived experiences to bear. How can you effectively help someone with their health problems if you don’t understand what motivates them?

To better train medical professionals to meet the needs of underrepresented groups, it is essential to incorporate cultural competence training into medical education and ongoing professional development. Ongoing — not simply one and done. This training should include:

  • Understanding Cultural Differences: Educating providers about the cultural, social, intrinsic, and economic factors that influence health behaviors and outcomes.
  • Effective Communication: Teaching providers how to communicate effectively with patients from diverse backgrounds. This can range from the use of culturally appropriate materials to interpreters to understanding how to engage with neurodivergent individuals, and many more.
  • Building Trust: Encouraging providers to engage with communities, listen to their concerns, and involve them in decision-making processes.

Recently, the U.S. Department of Health and Human Services (HHS) approved allowing — for the first time ever — Medicaid and Children’s Health Insurance Program coverage of traditional health care practices provided by IHS facilities, tribal facilities, and urban Indian organizations. Ensuring medical professionals have cultural competency training to be able to provide better health care to the Native population is a great step, as is incorporating staff who understand traditional and cultural health care practices and creating partnerships with local tribal entities and offering traditional practices with these partners to ensure the best quality care is provided.

Can you share any successful strategies or programs that have been implemented to reduce health disparities and improve outcomes for underserved communities?

One successful strategy is the Healthy Hearts for Michigan (HH4M) project. This initiative is a three-year quality improvement intervention aimed at improving cardiovascular disease risk factors among patients in 50 primary care practices in rural Michigan. The project focuses on providing evidence-based clinical education to improve hypertension and tobacco cessation, as well as building internal improvement capacity. By optimizing health IT and utilizing telehealth, HH4M addresses barriers to access and health care shortages in rural areas.

How can technology and telemedicine be leveraged to reach underrepresented populations who may face geographic or financial barriers to traditional healthcare services?

One of the key problems for underserved communities is lack of access to behavioral health providers. Building new providers takes time — it’s the “long pole in the tent.” We’ve developed a program that helps these communities better leverage the providers they already have (i.e., PCPs, NPs) to work on mild to moderate behavioral health issues thereby freeing up the behavioral health providers for the more challenging cases.

By spending time with these PCPs and NPs, we understood what barriers existed for them to treat these mild to moderate cases in rural and other underserved communities. They needed not only training on how to treat, but also access to key resources. One of the main barriers was concern over how to obtain patient consent to make a referral to a behavioral health provider (when required) — so we built a tool to help them do that. The result was that screenings increased by nearly 250% times, clinician confidence increased 200%, and behavioral health follow up visits increased 150%.

As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve patient outcomes for underrepresented populations? Please share a story or example for each.

  1. To better serve our increasingly diverse population and ensure equitable outcomes for all, we must build a more inclusive workforce. Right now, there is an underrepresentation in the medical profession. For example, Black medical residents represent less than six percent of all medical residents even though, according to the U.S. Census Bureau, Black and African Americans represent 13.2% of the entire population. While our work in this is just beginning, we are leading work to improve representation in the maternal and child health workforce with the Maternal and Child Health Bureau and 10 HBCUs.
  2. Use Community Health Workers (CHWs) and Peer Recovery Support Services (PRSS) to help mitigate nationwide provider shortages and ensure consumers have people from their communities to interact with. Research shows CHWs improve health outcomes. Social support from peers has been proven successful for those experiencing addiction.
  3. Improve care for individuals who are dually eligible for Medicare and Medicaid by ensuring that everyone has the option to experience an integrated product. We know that many individuals in integrated products have better outcomes and experiences than those in the fee for service world.
  4. Ensure that we have a robust base of research that is fully representative of our population. Children aren’t “tiny adults.” Older adults are different than middle-aged adults. Historically 75% of clinical trial participants have been white and most have been male. Person centered treatments require research that is representative.
  5. Increase training for practitioners on the specific needs and challenges of people with disabilities so that we can increase access for these individuals. Nearly 25% of the people in this country have some type of disability and our providers have virtually no training in how to work with them. Many doctors’ offices aren’t even ADA compliant let alone have scales that can handle a person in a wheelchair.

What specific steps can be taken to ensure that medical research and clinical trials are more inclusive of underrepresented groups, and why is this important for improving overall patient outcomes

Inclusive research is essential for developing treatments that are effective for all populations, ultimately improving overall patient outcomes. The All of Us Research Program by the National Institutes of Health (NIH) immediately comes to mind. This program aims to recruit over a million people from diverse backgrounds to share their health data, ensuring that research findings are applicable to everyone. We are fortunate to have the opportunity to work with this program in advancing this critical mission.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

We need to create a unified program specifically designed for individuals who are dually eligible for Medicare and Medicaid. These are the 13 million people who currently have to navigate between two programs that don’t fit together seamlessly. Let’s put the person at the center of care. Let’s develop a program is specifically designed for them instead of one that is a mish mash between the two programs. Then we can ensure they receive the care and support they need without the complexities and inefficiencies of the current system.

This movement would focus on enacting new legislation that creates a truly integrated program for these individuals. By doing so, we can improve the quality of life for millions of people and create a more equitable and efficient healthcare system.

How can our readers further follow your work online?

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

Michael Monson of Altarum On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.