Dr J. Mario Molina: Medicaid, the Marketplace, and Social Determinants of Health

Molina Healthcare seeks to provide quality care to those receiving Medicare and other government help, with particular emphasis on the Medicaid population and the behavioral and mental health issues involved. Overall, J. Mario Molina, MD, president and CEO of Molina Healthcare, believes the healthcare industry is getting better at acknowledging the social determinants involved with health, yet housing still remains an issue.

AJMC: While some peers have struggled with being on the ACA health insurance exchanges, Molina Health Care hasn’t had that issue. What do you attribute to this?

First of all, I wouldn’t say that we haven’t struggled. We certainly struggle, but our approach has been different, I think, than most of the other health plans. We are primarily a Medicaid plan and we view the marketplace, or the exchanges, as an economy of care vehicle so that people that were with us on Medicaid, and transitions went off into the exchange, would be able to stay with their doctor and stay with their health plan. And that has been our whole strategy; we only offer exchange products or marketplace products where we have Medicaid plans.

AJMC: And what is it about Molina’s focus on Medicaid populations that has contributed to the company’s success?

Right, so if you look at the mission of the company, it’s to provide quality care to people that are getting government assistance. So that means for us Medicaid, but it also means Medicare, people that are dual eligible, and the marketplace. And that’s really been the mission and the focus of the company. If you look at our members, virtually all of our members are under 200% of poverty so they have a lot of things in common and the social determinants of healthcare play a big impact on their lives.

AJMC: Do you think that the healthcare industry is doing a better job of acknowledging the social determinants of health and in what ways can there still be improvements in that area?

I think that as an industry we’re definitely getting better at acknowledging the social determinants of health and healthcare, and how they impact healthcare delivery. I think this is especially true for plans that are participating in things like these integrated Medicare and Medicaid plans, where we have all of the funding for the medical side coming from Medicare.

So physician, hospital, and medications are paid for by Medicare, but the long-term care services aren’t provided through Medicaid and they’ve combined that into a single contract. One of the things that that does is prevent sort of interagency fighting or the confusion that comes about when you’ve got 2 different government programs, sometimes operating at different levels, trying to take care of the problems of a single individual. By putting this all under control of the health plan, the health plan becomes fully responsible for all aspects of that person’s care.

Another thing that came up a lot at this meeting [America’s Health Insurance Plans’ National Health Policy Conference] is the issue of housing and how do we tackle that. It’s ironic that Medicaid has no problem paying thousands and thousands of dollars for people in long-term care facilities or in acute hospital situations and yet it doesn’t encompass housing for those people. So we’ve got to find a way to bring that into the solution. Right now what we have to do is work with social service agencies to try to find and place people in housing. But it’s a big task and sometimes it’s an impediment to providing the care that they need.

AJMC: At the recent J. P. Morgan Health Care conference you discussed Molina’s investment into mental health and abuse services. Can you explain the importance of having such a strong presence in that area?

Well the reason that we want to be more involved in the behavioral health and mental health services is that we’re finding that many of our patients’ medical conditions are complicated by behavioral health or mental illness.

About half of our Medicare dual eligibles have some form of chronic mental illness and oftentimes what’s driving the medical costs are their social and behavioral health issues. So we purchased a company that is primarily a provider organization and they have about 5700 client-facing personnel, such as social workers, psychologists, psychiatrists who are involved in the day-to-day care of those patients. The other issue is substance abuse and they have experience with that.

These kinds of things impact our members, and having a wider organization that has experience dealing primarily with Medicaid patients, and then behavioral mental health issues, will, I think, strengthen our ability to do a better job of serving our members.