Health care executive Jarrod B. McNaughton took an unusual path to becoming the chief executive officer of Inland Empire Health Plan last summer. Several years earlier, the native Californian had moved to Dayton, Ohio, to run a medical center. But he and his wife wanted to get back to be near their elderly parents.

So when Inland Empire’s then-CEO Brad Gilbert recruited McNaughton to come work as the nonprofit plan’s chief operating officer, McNaughton didn’t hesitate. He already knew from a previous visit how the plan had cultivated good relations with the health care community in the vast Inland Empire area north and east of Los Angeles. And he’d already interviewed local physicians about Inland Empire’s methods. “The providers all said, ‘We absolutely love IEHP. They’re phenomenal partners,’” McNaughton recalled. “I’d been a hospital guy my whole career and never heard providers talking that way about a payer.” Less than a year after McNaughton joined IEHP as COO, Gilbert retired and encouraged McNaughton to apply for his job. He was named CEO in July.

IEHP serves almost 1.2 million members in San Bernardino and Riverside Counties. Most are covered through Medi-Cal, but the plan also serves about 40,000 elderly or disabled clients who are eligible for both Medi-Cal and Medicare.

I recently spoke with him about IEHP’s efforts to improve the health of residents with low incomes. Our conversation has been edited for length and clarity.

Q: Tell me about the community you serve.

A: We serve the nation’s largest geographic county, San Bernardino, and another large county, Riverside. This is a massive area with nearly 30,000 square miles. Almost one in four people there is a member. That population needs a lot of assistance. They’ve got special needs — health care needs, behavioral health needs, mobility needs. Our mantra is if it can be done in the Inland Empire, it can be done anywhere.

Because we’re so spread out, we try to make sure our members are connected digitally to providers. We have a 24-hour phone line for folks to get advice from nurses. We use telehealth regularly. We have a robust eConsult program through which a primary care physician can tell a specialist, “I just saw something with a patient, and I’m not sure exactly what is going on.” That specialist can tell the doctor whether to send the patient to him or her or take care of it in the primary care office. IEHP was the first California health plan to get state approval to text our members with reminders about everything from checkups to flu shots.

Q: San Bernardino and Riverside have one of the state’s worst provider shortages. How are you addressing that?

A: IEHP started a network expansion fund, investing $46 million to recruit over 300 health providers to the community. Now we’re going to a second phase, helping students from the Inland Empire attend medical schools locally, if they choose to stay here. And we’ll provide up to $150,000 to help providers recruit everything from neurosurgeons to nurse practitioners to clinical social workers from outside the area.

IEHP has been at the forefront of behavioral health integration with primary care. The two worlds are coming together in a powerful way.

—Jarrod B. McNaughton

Q: How does achieving provider diversity figure into your goals?

A: We partner heavily with providers looking for bilingual staff. I’m excited about this because if you have students from the Inland Empire who know this community, who come from Spanish-speaking or other communities, and who feel medicine is a calling, and if we can help reduce some of their student debt — well, that’s a win for everybody. It’s great to recruit providers from outside, but it’s even better to keep them if they’re local because they’re already connected to the community.

Q:  Where is IEHP going with continuous quality improvement?  

A: We will focus on measuring and improving quality as the hairy, audacious goal it should be. We need to do more to make sure we’re reducing unnecessary or duplicative tests. And we want providers to know there’s integration happening within the network so they can reach out to consult with colleagues without a ton of red tape — the system actually allows you to do that.

Q: How are you using technology to address social determinants of health and to target early intervention?

A: We’ve used data and mapping to discover that in certain practices, more people have behavioral health or complex care issues. In this case, IEHP pulled together a community health worker, a social worker, and a nurse and placed them into those practice settings. Because the mapping software helps us understand our members, IEHP was among the first to create those teams. We now have seven or eight leased spaces in locations where our teams connect with those providers and members. We were doing this before funding came along, because we just felt it was the right thing to do. Then the state started the Health Homes Program, which coordinates care for people with complex conditions and is reimbursed by the federal government.

Q: You’re doing a lot of work on behavioral health. What progress have you made?

A: IEHP has been at the forefront of behavioral health integration with primary care. The two worlds are coming together in a powerful way. Studies show that if you have a behavioral health issue that goes undiagnosed or untreated, your lifespan can be cut by 20 years. So we see it as our duty as a health plan to play a quarterback role and say, “Communities, we’re going to pull you together and do everything we can to make sure you’re doing the right thing, that we’re reimbursing you appropriately, and that the member has access to the right services.”

Q: Can you tell me about how your personal experiences affected your thinking about behavioral health care?

A: When I was in seventh grade, I had a 19-year-old cousin who committed suicide while my family was on a Thanksgiving trip to Oklahoma. My aunt was getting our feast ready. I vividly remember hearing that noise. It was a gunshot. That had a big impact on me. Nobody knows the struggles other people are going through when we interact. When I pass a colleague at my office, when I’m out in the community, when I’m with a family member, I have no idea what’s really going on in the minds of others. There are times you know something’s happening, but a lot of times you don’t.

Across our country, there’s an epidemic of young kids committing suicide. I believe we have a sacred calling to make sure we’re doing everything we can to connect our members with the providers who can make a difference in their lives. I wish my cousin had shared with somebody that he was struggling. That Thanksgiving experience has been a clarion call for me to make sure that if people say something, you do everything in your power to make sure they get the resources they need.

Q: It’s great you see it as a calling. Do you also have evidence that integrating behavioral health and health care saves money?

A: Our team has just done some great studies looking at folks who are high users of care, have complex conditions, and are homeless. Some of those folks have behavioral health issues, and when you’re able to connect them to care, the use of all other health services goes down dramatically. We have some preliminary numbers that indicate there are significant cost savings for those who were once homeless and are now being housed through our housing initiative, which combines with wraparound services such as case management. I’ll share more on that soon. All I can say now is it’s thousands of dollars of savings per member per year.

Q: California officials are studying opportunities around the next Medicaid waiver in an initiative called Medi-Cal Healthier California for All. Do you have any special hopes for that process?

A: Our team’s excited about it, but a lot is yet to be determined. We believe the right move is for the state to create initiatives that pull together care teams and a reimbursement model that pays for things like housing, wraparound services, or first month’s rent, as well as care management for people with complex conditions. I’m concerned about the pharmacy carve-out idea [having reimbursement for prescriptions managed by a separate contractor] — they want to pull that out of the plan, which feels like the antithesis of what Medi-Cal Healthier California for All is proposing to do.

Q: Disintegration instead of integration?

A: Yes. There is a proposal to carve in a lot of different pieces like behavioral health. The pharmacy carve-out would take pharmacy oversight out of the plan’s responsibility and with it a lot of connectedness with our providers and members.

Q: Are you concerned about the Trump administration’s new public charge rule? It’s held up in court now, but I’m curious if you’ve already seen impacts?

A: We’re concerned about any rule that would potentially dissuade people from seeking preventive care or membership in the plan. It’s important that folks get the care they need and don’t feel threatened or intimidated. So far, we have not seen in our region any dramatic change in membership that we can attribute to the potential rule.

 Q: What else is on the agenda at IEHP?

A: Some employers have told us they’d love to use IEHP for their workplace health plans. We’re not set up to do that today, but we’re looking at it. Should we be third-party administrators for self-insured employers? Should we get into Medicare Advantage? Should we be part of the Covered California market? We’re considering those things now, and we should know more later this year.

Rob Waters

Rob Waters is an award-winning health and science writer whose articles have appeared in BusinessWeek, Mother Jones, Stat, San Francisco magazine, the San Francisco Chronicle Sunday magazine, the Los Angeles Times, and many other publications. He is the founding editor of MindSite, a digital publication covering mental health news scheduled to launch in fall 2021.

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