Community Health Choice (CHC) is a Houston-area, nonprofit managed care organization. It was started in 1997 by the Harris Health System, the region’s public academic healthcare system. While based in Harris County, they also serve 20 other counties in southeast Texas. According to their website, CHC is “committed to helping improve the health and well-being for Texas residents,” and they “proudly offer a complete array of affordable and no-cost health insurance plans, along with one of the largest provider networks in southeast Texas.”
Lisa Wright, CEO of Community Health Choice, joined the organization a couple months into the coronavirus Pandemic. It was a time of tumult and change. We asked Ms. Wright to reflect on the challenges and opportunities presented by this unique era in health care.
“I joined during this time of obviously great change, not just for Community but, honestly, the nation and the world.” And so, what was interesting is, as you know, all this change is just sort of organically occurring,” said Wright. “You have an organization that has a new CEO at the helm, and so there was already naturally going to be change, but then I joined during this complete transformation of the industry,” she continued.
“And so it really got me to sort of slow down and to really sort of think about one; how do we focus more intently on our membership? Because as we’re going through this change – all of our members and providers – everyone is going through change. And so I always believe, if you first focus on the member, everything else will sort of align.”
“And that allowed me to really figure out how to position the organization for growth. Just understanding that with all the changes because of the public health emergency, that there was just going to be this natural growth that was going to occur, how do we really position ourselves for growth and prepare for different populations?”
Wright said that when CHC’s staff transitioned from office to remote work during the pandemic, it created an opportunity and a necessity to work on “enhancing our culture.”
Community Health Choice serves underprivileged communities, and those communities tended to get hit harder by the pandemic, “so we saw everything with the health inequalities that came along before, and then when vaccination was available, and everything with mental health. They were hit a lot harder, and just having access was a challenge,” she said.
In other states, those underserved communities are often served by Medicaid. But Texas has resisted the Affordable Care Act’s incentives to expand Medicaid to more people, in spite of having the nation’s highest rate of uninsured, at 18 percent. Wright feels that Medicaid should be expanded, and added, “I always say that it feels like in Texas, the most unfavorable words in a sentence are ‘Medicaid expansion.’”
“I completely support decreasing the number of uninsured,” she continued. “We have way too many uninsured, at over 5 million. And whether we do that by finding an affordable choice, on how we expand coverage through the exchange, and provide subsidies so more people can go on the rolls that way, or we find a way to increase the federal poverty limit, so more people have access to Medicaid, CHIP and other services. But we do have to find a way to decrease the number of uninsured.”
Since Texas hasn’t expanded Medicaid, elected officials have instead taken advantage of the federal 1115 Waiver, which pays health care providers for unreimbursed care. Community Health Choice, according to Wright, doesn’t directly benefit from the waiver. “The 1150 Waiver is more for Harris Health System, as one of the public hospital systems,” she said, “and because we are contracted with them, and with HHSC, we do receive the payments, but those payments are dispersed back out to the hospital systems around Texas.”
Can Texas do better? “I don’t think it’s the best that we can do because you’re thinking about emergency coverage, and emergency coverage doesn’t get into preventative and long term, and we have so much technology that can help us with preventive services,” she said. “And because you’re just going in for emergency coverage, you’re really missing that preventative care. You do get reimbursed for uncompensated care, and so they are receiving dollars, but we are thinking about how we are taking care of a person holistically. The 1115 Waiver will not do that.”
In Austin, the Texas Legislature is currently in session. During the last session, in 2021, the Legislature passed a law to expand postpartum Medicaid coverage from two months to six months in order to address Texas’ higher-than-average maternal mortality rate. Community is pushing to expand that coverage further. “We did six months with the postpartum coverage…and now we’re back fighting for 12 months,” she said.
“Fingers crossed,” she intoned hopefully.
Wright comes across as very empathic, which is a beneficial quality for a person in her position. She often speaks passionately about the challenges faced by vulnerable populations. “You can’t focus on healthcare if other things in your life are taking priority,” she says.
Wright expanded on her thinking; “At the base of every health care episode is a human.” How might it feel to exist in vulnerable circumstances? “If my rent isn’t paid, my lights aren’t on, my children aren’t comfortable, they’re not at school, then I’m always going to be last on the list,” she said. “And so if I’m not making certain that my children have adequate nutrition, they have a roof over their head and their lights are on, then I’m not going to focus on my own health care. Wright continued, “we’re really sort of expanding the definition of health care to really take care of the whole person. We’re starting to do a lot more where we’re focused on the whole person.”
Community Health Choice has a relatively new program called Dual Special Needs, which is a combination of Medicare and Medicaid. It’s “something new for Community we started about three years ago,” Wright said. “What’s interesting about the Dual Special Needs is that although it’s probably been in existence for 20 years now,” she continued. “I think it actually just got certified by CMS (Centers for Medicare and Medicaid Services) probably less than five years ago. And so it’s really critical to the organization.”
“You’re talking about the sickest of the sick, the poorest of the poor, people who not only qualify for Medicare, but also qualify for Medicaid, in a state where the FPL (Federal Poverty Level) is 17%, so these people really need help,” Wright said. “It’s important to our growth because, what we’re finding is that we have a lot of people that are on Medicaid rolls that could actually qualify for Medicare, which would get them the extra supplemental assistance that they need. So it’s not only important for us as a growth trigger, but also to be able to help educate people so they understand what other services and coverage that they have.
But Community Health Choice also deals with private health insurance. “On the private side, you’re either driven by individuals or the employer,” Wright told us. “What’s interesting is that we’re finding that more people want to take control of their own healthcare and really have a lot more choice. And so I think, if I’m on the private side, I’m trying to figure out, how do I actually deliver that?”
“I don’t want to give my employer $20,000 a year for my family coverage anymore,” she continued. “I want my employer to give me money, and I’ll just control it myself. So finding a way to be able to leverage what employees need and to give choice, I think that’s one of the biggest things that the private market is looking at.”
In recent years, many experts have declared a mental health epidemic. “Mental health is big, especially since the pandemic, there’s just been so much light shed on it,” she said. “We have a large population of women and children, so one of the things that we’ve been doing is really focusing on our adolescents, and just trying to get really smart about how to educate parents on how to access care.”
She also spoke about the challenges presented by the stigma of mental health care, especially when dealing with underserved populations. CHC tries to help vulnerable populations see mental health care as a benefit, and not something that should be seen negatively. Wright describes it as “helping you figure out how to navigate life. How to think about things in a different manner. How to have different approaches.” For instance, CHC held town halls during the pandemic to teach people how to deal with having children home all day, how to balance working, and being a teacher.”
When looking back at her career and her time spent elsewhere, Ms. Wright talked about her time as president of UnitedHealth Group in Texas. “United really fostered this entrepreneurial spirit,” she said. “They always used to say, run it like you own it.”
At WellCare – where she served as North Region President – “WellCare was really good about innovation.” Their philosophy; “No idea was a bad idea. Let’s try it and fail. The only thing that was bad was not trying.”
Since Wright joined Community Health Choice, the client base has grown by 100,000 customers. That’s impressive growth. Can it continue? “If I had a crystal ball,” she quipped, “I would say this growth probably will not continue at this rate, only because things are starting to normalize a bit.” Wright described the pandemic-induced fluctuation in the workplace, with people working remotely or starting their own businesses, as a driver of their growth. “With the unwinding of the public health emergency, we’ll start to see some people that should fall off the rolls that can now make a transition to another product,” she said. “I don’t think you’ll have that accelerated growth.”
On a personal level, Wright places a high priority on exercise and taking care of herself. “Self care is not selfish. I have two kids under seven. I carve at least 30 minutes – or an hour – for me and I do not budge on the time. That’s my time to either meditate or work out, but it’s something for me.”
“You have to really be centered,” she said. “I think in order to effectively run an organization, you have to have balance.”
“Part of that is just exercise and mental well being,” Wright added.
What is Wright most proud of at Community Health Choice? “Our commitment to the mission. I have never worked for a company where there is so much alignment around the mission. People believe in the mission here. They believe in the population that we serve. Everyone really wants to do a good job for them.”