When Innovation Meets Empathy

Editor's Note: As part of Oliver Wyman's ongoing mission to close the gender gap in healthcare with launch of our Women in Healthcare Leadership 2019 Report, we present this interview with our very first Women in Healthcare Leadership Award winner, Amber Cambron, to highlight her perspective on driving success amidst an industry in transformation.

Q: The BlueCare team serves nearly 500,000 Tennessee Medicaid beneficiaries by providing access to the care and social support they need, bringing an array of programs and services to bear within local communities across the state. What are some key accomplishments from over the years?

Amber: We’ve always been a member-focused organization, serving neighbors with unique and challenging needs. We’ve paired empathy with innovation to make a difference in the lives of the people we serve.

One of my biggest career highlights has been launching the CHOICES program to coordinate long-term services and supports for Tennesseans with disabilities. Before CHOICES, many people in our state, especially those without a lot of resources, were typically limited to institutional care. And a lot of people were sitting on a waiting list before they could be served.

CHOICES helps people live as independently as possible, through home- and community-based services. Last year, we successfully transitioned 158 members out of nursing home care and closer to their families and communities. We also diverted 85 percent of members from entering a nursing facility.

Watching members build relationships with our care coordinators and ultimately thrive has been so rewarding. Our care coordinators work in the communities they live in. They know the community and the resources available through community partners. A care coordinator is assigned to a member when he or she enrolls in CHOICES. Over time, because of their regular interaction with members and the member’s family, they're often referred to as “extended family.”

We launched CHOICES in 2011. We then expanded the program in 2017 to support Tennesseans with intellectual or developmental disabilities. We’ve seen people get jobs, move into their own homes, and build stronger relationships. All those efforts are centered around their personal goals, and we work to build on the support they may already have in place. Around 23 percent of our eligible members are working today.

Some other highlights have been watching our outreach strategies evolve. We’re connecting with members using social media and text messaging, for example. More than half of our members are getting texts that remind them to get screenings or keep appointments. We’ve sent over 1.5 million messages using this platform. Most importantly, we’ve seen an average 12.8 percent claims rate for our gaps-in-care campaign, meaning these members are getting the care we’re encouraging them to get.

We’re taking a holistic approach and collaborating with community organizations across the state, knowing that needs and services may be different in every community. These efforts matter because assisting with food and housing security can provide the stability members need to also address medical and behavioral healthcare needs.

Last year, we successfully transitioned 158 members out of nursing home care and closer to their families and communities. We also diverted 85 percent of members from entering a nursing facility. 

Q: How has your team made a difference in the lives of Tennessee residents?

Amber: One of the best parts of my job is hearing about how we’ve helped improve the lives of our members. Our team builds relationships and changes lives every day. We have more stories than I could count, but here are a couple that stand out.

Caleb Wilson is a young man who suffered a traumatic injury in high school. He made an amazing recovery but still needed help with personal care if he wanted to go off to college and live independently one day. Caleb’s family was initially paying out-of-pocket for a new trial system used across Europe, one so new, there was no Centers for Medicare and Medicaid Services code for it at that time. One of our representatives, Michelle, worked tirelessly to ensure Caleb's needs were met. Michelle collaborated with external vendors and our staff to ensure Caleb’s authorization process was aligned, that he had support managing his bills, and that Caleb's needs were covered by his insurance. Thanks to Michelle, Caleb spent the anniversary of his accident studying abroad in London. He even plays in wheelchair softball tournaments. Her efforts helped him thrive on his own at college. He graduated last May.

Another memorable story is that of Charles Henderson, a member from the Nashville area who was homeless. A care coordinator on our team, Kelly, who actually works out of a primary care provider’s office, came alongside him and helped him address his medical and social support needs. She was the first person Charles called when he got into housing.

Q: BlueCare's patient populations have a wide diversity of care and social support needs. How important is building diversity within your leadership team, all the while, staying in alignment with a common vision or strategy?

Amber: We focus on diversity, inclusion, and cultural competency, and that makes us better able to help improve the health of the people and communities we serve. It’s important to note embracing those values is simply the right thing to do. Of course, that starts with recruiting. We want a diverse workforce that reflects the communities where our members live. Representation and understanding are critical for building trust with members.

That’s why we take each employee through a training called “A Day in the Life” that helps them understand social determinants of health. They get to see what juggling the stresses of limited resources, family commitments, and healthcare needs looks like. And they’re trained to recognize situations that are barriers standing between our members and better health.

Our team puts that training into action by recognizing — through a phone call or in-person visit — when a member is experiencing a situation that hinders their ability to get care. Because we’re all so connected to the community, our people can help with practical needs like getting someone’s electricity turned back on or getting a hot meal from a local food bank. And then we help members learn how to access those supports independently. We're able to help improve the health of the people and communities we serve in this way because of our focus on diversity, inclusion, and cultural competency. Not giving everyone the chance to be heard means we'll unintentionally leave people out along the way.