In the heart of healthcare leadership stands Lisa Wright, a seasoned professional with a mission rooted in compassion and a career dedicated to improving the lives of individuals navigating the complexities of health insurance. Lisa’s journey in the health insurance field was profoundly shaped by formative experiences at the National Marrow Donor Program, where her compassionate spirit found its calling.
Her dedication to healthcare evolved as she spent significant time advocating for patients in need of a bone marrow or stem cell transplant. This advocacy enriched her skill set in health care, due to the extensive collaboration with insurance companies. Over two decades, Lisa has accumulated substantial professional experience in the healthcare industry, focusing on government programs and underserved demographics.
As a WellCare executive in Tampa, Florida, and a leader in UnitedHealthcare’s Texas division, Lisa honed her skills in health insurance. In May 2020, driven by her enthusiasm for positive change, she took the position of President and CEO at Community Health Choice (Community). Here, she leads an impassioned team with a shared goal of enhancing the well-being of the underserved demographic, a cause close to her heart.
Community Health Choice is a non-profit health plan within the local community, offering a range of health insurance programs and services to its Members. Functioning as a Managed Care Organization (MCO), it extends coverage through the Children’s Medicaid (STAR) and CHIP programs, and offers an HMO Dual Special Needs Plan (D-SNP), in addition to providing plans accessible through the Health Insurance Marketplace.
In this exclusive feature, we dive into Lisa’s inspiring journey, exploring her experiences, insights, and the transformative role she plays at Community Health Choice.
A Leader’s Journey at Community Health Choice
Lisa’s arrival at Community Health Choice came during a transformative phase in the healthcare industry. Amidst a team of dedicated individuals, she found a shared purpose in fulfilling Community’s mission of delivering healthcare services to underserved residents in Southeast Texas. Emphasizing the non-medical factors influencing health, Lisa states, “Beyond medical care, Community places a strong emphasis on addressing the non-medical drivers of health, recognizing their significance in improving health outcomes and diminishing health disparities.”
Commencing her journey during the onset of the COVID-19 pandemic, the immediate focus was on mitigating its impact on employees, patients, and healthcare providers. Reflecting on nearly four years at Community, Lisa expresses optimism, stating, “I am optimistic that we will find more effective ways to address the health challenges and make a positive impact on the communities we serve.”
In her role at Community, Lisa strategically drove growth and diversification, resulting in a remarkable 42 percent increase, reaching a record membership of over 550,000 Members, with 25,000 providers and 100 community partnerships. Lisa’s team played a pivotal role in tackling mental health challenges through innovative collaborations, such as partnering with the Harris Center to establish an inpatient facility for the homeless population. This facility provides a supportive environment for rehabilitation and successful reintegration into society, showcasing the commitment to well-being and addressing social needs in marginalized communities.
In Lisa’s words, “As part of my commitment to leadership development, I have implemented new leadership programs focusing on alignment throughout the organization to ensure we not only thrive together but also enhance the services we offer to those we serve.” She encourages leaders to embrace the principle ‘Run it like you own it!’
Tailored Healthcare Solutions for Every Life Stage
Recognizing the uniqueness of each individual’s healthcare needs, Community is committed to providing tailored solutions that empower individuals and families to thrive and lead healthier lives. The range of health insurance plans is designed to cater to every stage of life, ensuring comprehensive coverage and support:
- CHIP Unborn: Prenatal care for the unborn child.
- CHIP: Coverage up to age 19 for those whose parents do not qualify for Medicaid and cannot afford private insurance.
- STAR: Medicaid coverage up to age 21 for U.S. residents who cannot afford health insurance.
- Health Insurance Marketplace: Tailored for individuals and families without coverage through an employer.
- Medicare Advantage HMO Dual Special Needs Plan (D-SNP): Specifically for low-income individuals qualifying for both Medicare and Medicaid, offering extra benefits at no additional cost.
- STAR+PLUS: Comprehensive coverage for adults with disabilities or those aged 65 and older, combining acute care and long-term services and support (LTSS) to promote community living.
- Third-Party Administrator (TPA) – Harris Health Indigent Program: Community’s involvement in contracting, claims processing, and provider relations for this program.
Beyond insurance plans, Community Health Choice’s CareerReady program plays a pivotal role in advancing the Medicaid mission, aiming to provide a pathway out of poverty and upward on the economic scale. Targeting young adults between the ages of 17 and 30, including pregnant women, high school seniors, and eligible Marketplace Members, the CareerReady scholarship covers tuition, fees, and books required for job certification.
Adapting and Thriving
Navigating the challenges posed by the COVID-19 pandemic emerged as one of Community Health Choice’s greatest tests. Reflecting on this trying period, Lisa notes, “We adapted by using Telehealth to continue serving our Members effectively during this crisis. We transitioned most of our 800-strong workforce to remote work while balancing productivity and personal responsibilities.”
Throughout the pandemic, the commitment to serving Members remained unwavering. Urgent healthcare needs were addressed promptly, utilizing innovative solutions like arranging transportation for office visits and providing in-home doctor visits. Collaborations with Federally Qualified Health Centers facilitated immunization drives in communities, and a partnership with Mom’s Meals ensured that children had access to food. Regular immunizations for children and check-ins with the elderly were prioritized. Despite the challenges, the dedication to providing continuous service to over 550,000 Members persisted.
Lisa emphasizes, “The pandemic brought forth difficulties but also led us to reevaluate our work strategy. We adopted a hybrid office model, providing our staff with choices for remote and in-person work.” This strategic shift not only allowed flexibility but also placed a renewed focus on employee engagement. As part of this evolution, Community Health Choice is preparing to transition to a new office in the heart of Houston. The office’s design promotes collaboration, communication, hoteling space, and overall employee well-being, aligning with the organization’s commitment to resilience and adaptability.
Embracing Innovation for Enhanced Member Experience
In its dedication to delivering top-notch service to its Members, Community Health Choice continuously explores technological alternatives that streamline plan administration, save time, and enhance Member convenience.
Lisa highlights, “This year, we launched our Member mobile app. This app provides access to benefits from a user’s smartphone or tablet any time, any place.” The app empowers Members to view coverage plan details, locate a doctor, check claims and authorizations, receive notifications, and more.
Community Health Choice extends its commitment to virtual care through various services, including Telehealth and a virtual-only plan. Telehealth enables Members to consult with a doctor for routine medical concerns 24/7, accessible from anywhere via phone, web, or mobile app. Members can request or refill prescriptions, as well as seek advice from healthcare professionals before heading to an ER or urgent care facility.
Looking forward, Community is poised to embrace innovative technologies, particularly in the realm of artificial intelligence (AI). Lisa notes a growing trend in the healthcare sector where AI is employed to assess the necessity of prior authorizations, marking a transformative shift in dynamics between healthcare providers and health plans.
The integration of AI automates the assessment of incoming authorization requests. AI conducts a thorough evaluation, determining the adequacy of clinical documentation against the required authorization criteria. Lisa emphasizes that AI-generated recommendations streamline the authorization process, enhancing overall efficiency.
Lisa envisions, “The implementation of this technology will free our staff from mundane tasks, allowing them the opportunity to enhance their skills and focus on mission-critical responsibilities.”
Pioneering Progress
In its resolute commitment to delivering exceptional services, Community Health Choice actively engages in continuous research and development (R&D) initiatives, aiming to understand evolving health needs within the community. Lisa highlights, “Our aim is to gain insight into the changing health requirements of our Members,” underscoring the significance of these assessments in shaping Member benefits for a closer alignment with unique needs.
Strategically leveraging Member data, Community positions itself to anticipate and address evolving needs and behaviors. Lisa emphasizes ongoing R&D initiatives, including the evaluation of children’s mental health, the impact of nutrition on pregnancy, and studies focusing on non-medical determinants of health (NMDOH).
To address children’s mental health, Community has partnered with futuresTHRIVE, implementing the TweenScreen mental health screening platform. This user-friendly app, grounded in reputable research sources, proactively identifies potential mental health risks among children, offering valuable insights for healthcare providers and parents.
In response to alarming statistics on black maternal health disparities, Community collaborates with Harris Health in the ACCESS Black Maternal Health program, aiming to reduce the risk for black women during delivery and infant mortality. Lisa emphasizes, “This disparity is largely attributed to inadequate care before, during, and after pregnancy.”
Community’s dedication to enhancing services extends to a partnership with ProgenyHealth, offering comprehensive maternity care management services. The co-branded Community/ProgenyHealth app provides Members with continuous, connected support throughout their parenting journey, promoting optimal maternal and infant health.
Addressing the pervasive mental health challenge, Community collaborates with the Harris Center to establish a specialized inpatient facility for the homeless population. This facility goes beyond conventional approaches, fostering rehabilitation and successful reintegration into society.
In a significant achievement, Community Health Choice attains interim NCQA accreditation, aligning with its commitment to enhancing Member health outcomes. As the only dually accredited health insurance plan in Texas, alongside existing URAC accreditation, Community sets a high standard for quality healthcare in the region, reinforcing its dedication to excellence.
Building a Bright Future
In offering guidance to aspiring healthcare professionals, Lisa emphasizes the importance of being prepared for complex, dynamic challenges that demand innovative and collaborative solutions. She underscores the need for a deep passion for improving the health and well-being of diverse populations while addressing the social and environmental factors affecting them.
To succeed in the healthcare sector, Lisa advises cultivating a strong sense of leadership, vision, and responsibility, coupled with a commitment to lifelong learning and professional development. Aspiring professionals are encouraged to actively seek opportunities to expand their knowledge and skills in healthcare economics, policy, management, and delivery. Building networks with like-minded professionals and stakeholders who share similar goals and values is also crucial
She further shares, “My advice to prospective leaders is to focus your energy on what you can control; the rest is gravity.” Stressing the importance of building strong relationships for long-term sustainability, Lisa underscores the value of investing in people and cultivating a team of capable individuals. Recognizing that every day is a learning experience, Lisa advises prospective leaders not to feel pressured to know everything, emphasizing the significance of hiring skilled and knowledgeable team members.
In facing obstacles, Lisa encourages a perspective that acknowledges there is always another way, and a “no” may not necessarily mean rejection but rather a postponement.
Next Chapter in Healthcare
In a significant step towards enhancing the health and well-being of underserved Texans, Community Health Choice is delighted to announce the inclusion of the Texas STAR+PLUS program in its plan offerings for 2024. Specifically tailored to provide crucial Medicaid managed-care services to individuals with disabilities and those aged 65 or older, often among the most marginalized in our communities, Lisa highlights, “The STAR+PLUS program will allow Community to expand its reach by serving an additional segment of the population.”
The introduction of the STAR+PLUS plan represents a pivotal expansion, underscoring Community’s commitment to fostering healthier lives for all. Beyond mere insurance coverage, the primary objective is to deliver comprehensive long-term services and support that cater to the unique needs of program participants.
Lisa emphasizes, “We will implement an enhanced service-coordination approach aimed at optimizing care and delivery, ensuring alignment with the individualized requirements of each Member.” Redesigning Member benefits to better align with specific needs; Community utilizes Member data to proactively anticipate needs and behaviors, enhancing the tailoring and effectiveness of care.
Prioritizing preventive measures, including vaccine promotion, addressing environmental health concerns, and tackling non-medical determinants of health (NMDOH), Community Health Choice aims to enhance its proactive stance. Utilizing comprehensive Member data, the organization efficiently identifies Members requiring preventive measures or assistance in addressing NMDOH, preventing illness and health deterioration.
Lisa envisions the future at Community with a stronger emphasis on addressing NMDOH through the digital transformation of operational and incentive models. Data plays a pivotal role in identifying necessary benefit enhancements to address specific NMDOH factors, further reinforcing Community Health Choice’s commitment to comprehensive, tailored, and effective healthcare for its Members.
