Hello, everyone. This is Jacob Emerson with the Becker's Payer Issues Podcast. Thrilled today to be joined by a special guest. Doctor Puja Mittal is vice president and chief health equity officer at Health Net. Doctor Mittal, thank you so much for taking the time to be with me on the podcast today. Sure. Thanks for having me. And before we dive into everything we wanna talk with you about, can you tell us a little bit more about yourself, your background in health care in terms of your career, and what it is that you're doing today at HealthNet. Sure. So, I am a family doctor. I came to that through, my mom, who was also a family doctor. I grew up in Southern California, and, she was working at an FQHC there with primarily farm workers. And, through just watching her my entire childhood, that that became my goal as well. And so, I went to medical school, became a family doctor, did residency in Southern California working with farm workers, and, really since then have had a career that's focused on caring for the underserved. And so, I was an academic clinician working at Boston Medical and then after that, UCSF for many years before coming over to the plan side. And so I have been at Health Net for, eight and a half years. I've had a lot of different positions here, a lot of different roles, and have had the opportunity to learn a lot of different aspects of health care, I think, Medicaid, commercial, and Medicare. And for the last four years or so, have been the chief health equity officer. And so that means that, I have three essential areas of focus at Health Net. One is broad population health, so really looking at the health of the individual and the populations we serve and improving, disparities in health outcomes amongst those populations. The second is more broadly equity focused benefits, so things like ensuring that we are, have enough community health workers, enough doulas, and other sort of surround staff that we call nontraditional providers supporting our members and ensuring the quality of those benefits. And then the third is is more broadly health equity strategy. How do we ensure that everything that we're doing at the plan really takes an equity focus and an equity lens, to ensure that we're meeting the needs of those who are most vulnerable across the state? And so Health Net really has a pretty broad footprint. We're in 14 counties, everything from very urban counties such as Los Angeles County to very rural counties like Imperial, and, some of the northern rural counties. And so our populations are are quite diverse. And we have, in different regions of the state, different populations that we really hone in on, from my team's perspective to ensure that we're meeting the needs of those who are most vulnerable, those communities. Wonderful. Well, I I really appreciate that overview, Puja, and, and really appreciate you taking the time to sit down with us and share your insights with our listeners. I wanna get started by, asking you what are some of the biggest issues that you're following within health care right now. And I and I ask that question given that it's a time of transformative change, both for private organizations like yours, but, of course, also, policy wise, both the state and federal levels when it comes to Medicaid and things that will affect your members. So, what's top of mind for you? What are you keeping an eye out for in the media, in in the latest data? What are you keeping an eye out for in terms of what's gonna be impacting your your membership? Yeah. There there are a handful of things. One, big one, of course, is, federal funding for Medicaid, because that directly impacts what we're able to do, in our day to day work. And so, I'm keeping an eye on that broadly. What does that look like? Are we going to have to change within our state, who's covered with Medi Cal? And so that's a big one. Another is also looking at federal funding and federal funding subsidies for the Exchange population and where that might shift things. If there is less federal funding for, for, the members on the exchange, that will shift some of the things that I know Covered California has been really successful in doing in terms of supporting benefits and subsidies so that people are not having to pay as much out of pocket for their benefits. And so that's another thing that I'm keeping an eye on, just in terms of trying to understand what type of health care will be accessible to people and if we're going to see any shifts in who is able to access broader health care. Another thing that I'm keeping an eye on is telehealth solutions and, the shift and how those are permeating in different regions of the state and of the country. And so, I think there's been a bit of a push and pull in using telehealth as a way of extending access, particularly in rural areas, and then how that is affecting those who are practicing in those areas and what that does to the way that patients are shared. And so just trying to understand better and kind of keep an eye on, you know, how do we best use telehealth and what does it really mean for access, particularly for those who are underserved. And, you know, there's good data that shows that a lot of the changes in telehealth, availability of, therapy, for example behavioral health therapy, has not necessarily benefited those who are most vulnerable. It really does end up supporting, higher socioeconomic populations. And so really trying to see how that continues to change, if see that become more equitable over time or if there's something that we're gonna need to do from a policy perspective to support that. Absolutely. That's three major topics that I think most health care executives right now are keeping their eyes on. Medicaid reimbursement changes, ACA subsidies, and whether those will be allowed to expire, and then what you just mentioned, Puja, as well, the the telehealth shifts that we're seeing all over the country, especially when it comes to Medicare right now. Yeah. So when you think about your your member population and what you're in charge with in terms of serving them, what what gives you the most concern right now in terms of health equity trends that you are seeing, in the California counties that you serve? I'm gonna come back to the technology piece because I think equitable access to technology is a really important one. And, you know, I think there's real policy implications around the access of broadband, for example, and the inequitable access to broadband. You know, I I we used to talk about, Internet service or broadband access as being something that's a nice to have but not a need to have. And more and more in today's world, it's essential. It's an essential part of our, you know, social drivers of health. If we don't have access to broadband internet, we don't have access to being able to really function in the world, particularly when it comes to health care where so much of it requires that type of access. And so I'm, I'm looking at, you know, what does it look like to really make that broadband access accessible and affordable because we know that it's often more expensive in poorer communities. And then so the broadband access is one piece of it, but then the other piece of it is how are we taking all these innovations that are occurring in technology and being able to apply those to our communities that are most in need? And so looking at, you know, telehealth access to, behavioral health therapy and ensuring that those huge gains that we've made, right, there are many, many providers that are now, bringing in really diverse sets of therapists so that whatever whatever type of background you're seeking in your therapist, you can find. If you're a veteran and you're looking for a veteran therapist, you can find that. If you are, you know, a queer Asian woman, for example, you can go in and find a therapist that sort of understands your culture and reflects that. But how are we ensuring that those technologies, those advancements, are getting out to those, in the Medicaid community who may actually have less access to that type of care already. And so, that's something that continues to be top of mind for me because it's so important in terms of really being able to meet the needs of our communities in the most equitable way. Absolutely. And so you're you're focused on democratizing access to new technologies for for the underserved populations, that's that HealthNet serves. And and I imagine, that access to broadband Internet is a major challenge, especially in some of those far Northern California and coastal counties. So really interested to hear you talk about that. On the flip side of my my last question, what are some of the trends among your your member population that you're really seeing, improvements in terms of health outcomes or technology access, trends where you're you're excited about where things are moving for you and your Health Net members? You know, I've been really excited to see that people are in more and more engaged with care. I mean, really, one of the biggest struggles that, we as a plan have and and most plans have is driving engagement, sort of engaging those unengaged members. And so I think because of our flexibility in multimodal outreach and being able to leverage technology in a way that meets the needs of the people that we're serving, we've been able to drive engagement in new ways. And that's really exciting to me because the first step in improving any outcome is driving engagement. And then the second is making sure that when they are engaging with us that they're having a good experience. And I think we're making progress in both of those both of those, and so that to me is really encouraging. I am also particularly excited about, just from a systems perspective and, like, as a as an industry, the potential for AI to help improve and extend clinical care. And I think that's a really interesting, forefront that we're at now is how we're, how we're going to be able to use AI to extend our reach, right? Can we use it to, build large language models to pull unstructured data from an EMR and then use that to drive insights that we can use to better engage our members, right? So I think there's a we're on the precipice of a huge amount of potential to better use the data that already exists to to meet the needs of our members and give them a better experience. Yeah. And it's so exciting to hear leaders like yourself talking about the potential for AI and and, what it could do to improve health outcomes among your members. Because, you know, I know sometimes it can be very easy for for for media organizations like us to focus on some of the negative aspects, but it's you know, we're we're hearing from leaders constantly about, how this is going to continue to transform the industry and and health outcomes. So really exciting to to hear you talk about that as well, Puja. I I should ask, you know, you've been in this industry for a long time, and you've you've clearly been very successful to to the to where you've gotten. So for our audience of health plan leaders listening in for all all from all over the country, what would you tell them in terms of what, the most effective health care leaders need to be successful, especially moving forward over these next two to three, what are sure to be very transformative years for the industry? Yeah. Thank you for the question. I you know, I think in the equity space, generally, there's always this need to focus on an overall or overarching set of strategies, but be flexible in how you're getting there. Because as things shift, there's different resourcing available for certain things, and there's different interest in focusing on certain pieces. And so I would say a foundation of strength in terms of an understanding a clear understanding of strategic focus, but the ability to be flexible and pivot as needed to to achieve that focus. And I think for us, equity strategy. One is place based work. How are we able to look at a particular region or a particular population, understand what their what their assets are in that community, and then understand where the opportunities are, and then be able to come in as a plan and support to improve outcomes in that particular community. And that really requires being aligned to where the needs are in that community and responding. And so I think place based work is one thing that allows us to like hone in on a goal of improving outcomes, but be flexible about the path to get there. And then the second is really member experience and honing in on member experience being at the center of everything we do, because if we know that we're getting people engaged and they're having a good experience, their outcomes will improve. And so the other is keeping member experience at the center of everything we do and then being creative and flexible about how we influence that. And so, you know, we do have a clear overarching set of strategies, but I've had to be very flexible and pivot many times to be able to continue to drive the work forward, as the environment changes, as resourcing changes, and, and as our focus, continues to to move us forward. Wonderful. I some great advice for our audience and I think a great place to leave things. So, Doctor. Mittal, I wanna thank you for taking the time out of your day to sit down with us and and for sharing your insights with our listeners. We truly appreciate it. Thank you so much, Jacob, for the opportunity. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.