Indiana’s holistic approach to health insurance works

By Steve Smitherman

Health insurance has been a hot topic lately, and not just in the managed care sector. The landscape of how we operate and provide care has changed dramatically over the past few years in Indiana, and it’s going in the right direction.

The days of handing someone an insurance card and sending them out the door are over – we recognize we are part of a bigger system impacting our members’ overall health and wellness. We can get people to the doctor and pay their insurance claims, but if we don’t address issues with housing, transportation, childcare, and other barriers to wellness and self-sufficiency, we’re missing a giant piece of the puzzle.

As safety net organizations face increasingly strained resources, we all need to take on broader responsibility and accountability for health in ways we have not done in the past. We’re seeing this kind of partnership and collaboration through our unique approach to the Medicaid expansion in Indiana.

The Healthy Indiana Plan – also known as HIP 2.0—is a health insurance program offered by the state of Indiana for non-disabled Hoosiers ages 19 to 64 who meet specific income levels. It pays for medical costs for members, and vision and dental coverage for some. It also rewards members for taking better care of their health. When it was first introduced, not everyone was on board with HIP because it was such a departure from what the other states were doing with Medicaid expansion. Yet it’s working in Indiana, where nearly 430,000 Hoosiers now have coverage.

Nearly three years into HIP’s expansion, we’re seeing the next-level impact of expanded access: newly-insured and engaged members asking for help with what we call “downstream” needs (“my doctor told me to work on my diabetes and my weight, but there’s no place to get fresh food near me”). In turn, the health and wellness safety net — from local programs to statewide managed care plans — is rising commensurately to meet these holistic health needs.

CareSource, which recently began serving HIP members, understands the role managed care can play in breaking down silos that have traditionally separated medical care from other aspects of health and wellness. We have created programs like JobConnect, which helps members find and keep sustainable employment, and have placed Community Health Workers in local communities to help members connect to area resources.

The state of Indiana continues to fine-tune HIP as we learn best practices and discover emerging needs. While the first version of the expansion sought to enroll as many Hoosiers as possible, the program is now evolving to address the drivers of the outcomes and costs we’ve seen so far — tobacco, chronic disease, substance use disorder, and under/unemployment. This “in the lab” flexibility is an example of how the program aims to be more than just an expansion of health coverage, but instead one that makes impactful changes in Hoosiers’ lives.

The HIP 2.0 model could serve as a blueprint for other states because of the great success it’s had in Indiana. This is due in large part to the transdisciplinary partnerships and public health principles underlying its implementation. What we are creating is a model for how communities, the government, and managed care entities can work together to move beyond expanding coverage and supporting our fellow citizens to lead healthier, more fulfilled lives.

— Steve Smitherman is the Executive Director, Indiana for CareSource. Smitherman has over 15 years of Medicaid and commercial health plan leadership experience. Currently, he oversees CareSource’s Indiana office with responsibilities including managing the day-to-day operations of CareSource in Indiana. In this role he has led the development and implementation of CareSource Marketplace, Medicare Advantage, HIP 2.0 and Hoosier Healthwise products in Indiana.

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