A: Well, we're currently celebrating the fact that Medicaid is 50 years old this year, and it really is the foundation for what we are. CareSource is a nonprofit, consumer-focused health plan, serving primarily low-income populations, but also Medicare consumers. The Medicare customers we have are primarily low-income seniors who get Social Security but also qualify for what we call "wraparound" Medicaid benefits. Most of the members we serve in our health plan are children; uninsured, low-income adults; and seniors. Our roots are in the community — dating back to the formation of what was then the Dayton Area Health Plan in the 1980s, when local leaders came together in a community task force to look at better ways to provide health care to low-income populations, primarily using Medicaid. Long story short, we got funding from the state and built this concept to a community-based non-profit led by a board of trustees in 1985.
Q: What came next?
A: It took almost three years for us to get the company launched, for a lot of reasons. For one thing, we were a brand new, innovative concept for Ohio — in the country, actually — to mandatorily enroll people into a managed-care model. It was controversial because it was new, and somewhat untested. Some models had been been tried in other states that had failed — we studied those and learned from them. We didn't repeat their mistakes. You can learn a lot from failure. We had tremendous community support, and political support from members of Congress and the state legislature.
Q: Any opposition?
A: Well, early on some traditional doctors who had served Medicaid patients for a long time had an economic fear that we'd open it up and they would lose patients. And in fact, our goal was to open up a broader range of providers for patients to choose from. But the thing they feared did not happen. We were bringing a lot of new Medicaid patients into the system who had not had doctors before — such as people who were using ER care for their main medical care. Eventually, we were able to turn some of the doctors who had been early-on detractors into supporters. We also had a class-action lawsuit from Ohio Legal Aid claiming we were forcing poor people into HMOs. We were able to settle it by agreeing to let them come in and access our records — an open door, we weren't hiding anything. Today, Legal Aid is a supporter of ours.
Q: Reflect on Medicaid at 50.
A: Over the long term, it literally has saved thousands upon thousands of lives. We have a longer life expectancy today as a society because of covering low-income people with health care, and for providing this tremendous safety net for people moving between jobs. It's also supported the whole system of health care providers.
Q: What’s your background? How did you end up where you are today?
A: After college, I gravitated to what is now the County Job and Family Services department — it was the welfare department, then — in Marion, Ohio. I saw first-hand the challenges poor people had in getting access to health care. I knew there just had to be a better way. I was a believer in the HMO option, because it had worked for me personally for my own health care. When I was called to Dayton to take on this new model, to take Medicaid funding and match it with a health care plan approach, I said I'm there. It was a big move for us, and I surprised my husband with it.
Q: Apparently, he was agreeable.
A: He was great about it. I didn't realize it about myself at the time, but I'm a social entrepreneur. Someone pointed it out to me later.
Q: What are the qualities of a social entrepreneur?
A: They love to build, they love to be challenged, they love to innovate. They love to build new models and programs. I was given the opportunity to work with the Medicaid program and a new idea and build what is now CareSource, a very successful company. I'm grateful for that. But the most important thing is being able to have expanded our reach over the last 26 years to cover even more and different consumers. And now with the Affordable Care Act, we're covering more than 200,000 previously uninsured adults through the Medicaid expansion of the law, and serving the "dual-eligibles."
Q: You’ve established quite a footprint in downtown Dayton.
A: We're committed to it like nobody else. We're headquartered here, and we have a tremendous commitment to downtown Dayton. We're in three different office buildings, the main one of which we own. We have a sizable office in Cleveland, with room to grow. We've got a bigger office space in Columbus, also with room to grow, an office in Louisville and a new one in Indianapolis. There are a few other states where we may have a presence in the future, we hope. But the legacy of CareSource isn't in a building or two in a particular city — it's in the impact we have on the lives of our members.
Q: Back to Medicaid. It’s become politicized, especially as it was tied into the Affordable Care Act. There was some thinking that Gov. Kasich might not have agreed to expand it in Ohio after the health care law was passed. What if he hadn’t?
A: It was definitely a blessing that he did, and we appreciate his support for it. We also advocated for it. If it hadn't happened, some of those low-income consumers would have had the option to go to the federal exchanges, where we also operate, and have had enormous success. That's what has happened in Georgia and some other states where Medicaid wasn't expanded. But certainly, we think Medicaid is the better approach — and it's brought in billions of dollars to the state that have helped hospitals, some of which were struggling, and who were having to pay for uninsured people who were coming into their ERs that they could not turn away. I think the benefits of Medicaid expansion have far outweighed the political turmoil it took to get here. And the Medicaid expansion group continues to grow — every month, we get maybe 5,000 to 7,000 new members who choose CareSource.
Q: What are your thoughts, then, on the politics that attached themselves to the ACA overall? Certainly, the law has been good for CareSource.
A: I think the Supreme Court has put it to rest, totally. I think Chief Justice Roberts said so, even into the future. I think the politics has all been for show, more than anything. That's not to say the law is perfect, or that it won't continue to evolve and change. It will. I think, too, there will continue to be reforms to both Medicaid and Medicare in the future. But we've seen so many changes over the last 30 years, most of them positive.
Q: For instance?
A: Well, I think of where we are today, at the 50-year mark for Medicaid and Medicare, and now having the Affordable Care Act on top of those, and all it has offered in terms of covering 11 million people in the country who now have access to health care, and the security that brings — peace of mind, and the financial security that comes from access to health care. Some of our new consumers have said to us that had not seen a doctor in 15 years or more. That blows my mind, actually. Now they have the peace of mind of knowing they can get preventive care, a mammogram, see a doctor routinely, or buy the prescriptions they need. I recently saw a story in USA Today comparing states that expanded Medicaid with those that did not — it looked at Kentucky, which did, vs. Tennessee, which did not, and a gentleman who was a low wage earner, self-employed, and lost a limb in a horrific accident. The bills were astronomical, he lost his livelihood — he lived on the border of the two states, and the story compared what would have happened to him differently if he'd lived just a few miles away. It really hit home to me how fortunate we are here and Kentucky, where CareSource operates, as well.
Q: Where do you think the resistance comes from?
A: A lot of it is consternation directed at the president, not wanting him to have his legacy. That's been written about many times, and I think it's true. But he certainly was brave and bold in making this the real signature program for his administration. But I think a lot of it also runs to a misunderstanding and stereotyping of poor people. And by the way, there are more and more of them — many low-income seniors who have to go food banks, whether they want to or not. It's the old stereotypes that people who are on welfare and Medicaid are lazy and don't want to work. And that's just not true today.
Q: What are some things you’re working on?
A: One of our new directions is something we call the Life Services Model. It's exciting. We've always viewed our members as a people with lives, goals, desires, but lots of challenges and obstacles in realizing those goals. And we've tried to help them with the various things that interfere day-to-day with good health care — having your electricity shut off, no food for the kids….
Q: Poverty issues.
A: Right, the things people experience that keep them from thinking, Oh right, I need to go set up my preventative care appointment with my doctor. So, we will help you informally with those things. Now, Life Services is our attempt to formalize that help — where we will systematically help with those needs so that people can focus on their health. It has many components that we will build out, over time.
Q: Such as?
A: One we've started with is Job Connect. It's in the pilot stage in Montgomery County now — a voluntary program where our members can get help becoming job-ready — help with their resumes, interviewing skills, proper dress, the right behavior after they get a job. And we're partnering with 14 16 local companies, including Fuyao, where we've placed 25 CareSource members. The employer gets ready-to-go candidates to interview, who we support every step of the way. Our team members will even talk to them before the interview, to build confidence, give them a refresher. To me, there's no better gift you can give someone than helping them live better lives. About 500 of our members have volunteered for Job Connect, and the response from the partner employers has been tremendous.
Q: It sounds sort of like you’re adding another wing to the house.
A: It does, doesn't it? We have to find a way to pay for it. Maybe through grant funding, or some state funding we may qualify for. But we think people are better off having jobs — and if our members want our helping finding one, we will do that. Our foundation is providing most of the financial support for the program at the moment, so we'll have to work that out. But there's no question in my mind about the value of this. Eventually, we'll also build out housing options, and food. For many people, food and hunger are a constant, daily struggle. Often when our nurses are in members' homes, they can observe there's no food in the house. Often the case with low-income seniors, who can't get to a food pantry. So we need to help them with that immediate need. We want solutions to help with food. Also, education will be another building block of the program, another pillar, along with life-coaching to help people manage their financial situations.
Q: This sounds like something that could change the whole direction of your organization.
A: It's possible. Many of our employees see that as something that could happen, and there's much discussion around that issue. It could be the whole focus of the company, at some point. Health care would just be one of the pillars. That would actually be a dream come true, but it would take many years.
Q: How does philanthropy fit into what CareSource does?
A: It comes directly from our mission. We're very much mission-driven and we're also tax-exempt, so we formed the CareSource Foundation in 2006 to formalize our charitable giving, and to be much more deliberate about which programs we fund. We also fund all over the state of Ohio, though of course Dayton gets a disproportionate share, because it's home. But we're proud to support the other organizations we help. We have some big initiatives, too — one is the March of Dimes, funding around prenatal research. Also, we worked with United Way to more fully institute its 211 information referral line all over Ohio; we think it's a really important service, to be able to call 24-7 and find answers you need for social-service and safety net questions, and there were some parts of Ohio that did not have it. So we partnered with United Way to make sure every person in Ohio has access to it. So we aren't just supporting community organizations, but we're doing some significant partnerships for bigger impact; this is largely due to the great work of Cathy Ponitz, who leads the foundation, and Tom Maultsby of the United Way of the Greater Dayton Area, who's our foundation board chair.
Q: Talk about your own leadership style.
A: Oh, I've learned many lessons over the years. One thing I had to learn was to fail. We're all programmed for success, and that was hard. But it's really important, because I've learned more from our failures than from our successes. You have to dare to fail, and not play it safe all the time. The Life Services program is a huge risk, I think, a huge undertaking. Some of our board members were just a tinge skeptical. How are we going to pay for it? they wanted to know. I said, we're going to figure that out. To their credit, they said, OK, let's try it. And they've been very supportive when we've wanted to expand outside the Dayton area. They put me through my paces, too: What are we risking? What are the chances for success? They've asked all the right questions, but they're also willing to take risk, try new things, innovate.
As a leader, I try to pay a lot of attention to our employees, who are our greatest assets. Words are cheap, so you’ve got to back them up. The culture at CareSource is unique — our mission, our focus on consumers, the way we make a difference for people every single day. Even though not all our employees are member-facing, we bring it home to them that everything they do, too, still helps the consumer. Everyone here is connected to that. We’re proud to have a high-performance culture. We are efficient, and that drives our productivity. We’re known for best practices and low administrative costs — so we can invest back into the business, especially in technology. That in turn helps us be even more efficient, which means we have more money to spend on our members’ health care. We’re a nonprofit; our competitors are publicly traded companies, and they don’t operate this way.
Q: What worries you, moving ahead?
A: Things are going well, but you can never take success for granted. Things that keep me up at the moment? We're waiting to hear on a bid we've put in to take our business to Georgia, which would be a significant expansion opportunity for us. It's very competitive, but we have to be grounded about our chances. But like I said, if it's not meant to be, we will learn from our setbacks. I worry about employee issues, and how we can keep people from struggling. I want everyone to be successful; we take every step we can to help everyone be a success. I'm always trying to think ahead and look to the future, making sure CareSource is agile. As we get bigger, we have to make sure we can still turn on a dime when we need to.
Q: Looking back over the history and growth of the organization, how does that feel?
A: It's pretty astounding, but I also feel a great deal of pride. And it's important to emphasize that I did not do this alone. I took some of the early risk, and I have a vision of making the way we provide health care better, but many people have been involved in building this. A lot of emotions run through me when I step back and look at what we've accomplished. But I can't think of a better job, or a better way to have spent the last 30 years.
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