September 25, 2023 • 15 mins
We're happy to welcome back Doug Wirth, President and CEO of Amida Care, which celebrates it’s 20th year as New York’s largest Medicaid Special Needs Health Plan, providing comprehensive care to New Yorkers affected by HIV. As New York’s larges Medicaid Special Needs Health Plan, Amida Care serves over 9,000 New Yorkers affected by HIV. For more, visit amidacareny.org.
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Episode Transcript
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(00:02):
Welcome to Get Connected with Nina delRio, a weekly conversation about fitness,
health and happenings in our community onone oh six point seven light FM.
Good morning, and thanks for listeningto Get Connected. Happy to welcome back
Doug Worth, president and CEO ofa Metacare, which is marking its twentieth
year as New York's largest Medicaid specialneeds health plan, providing comprehensive care to
(00:26):
New Yorkers affected by HIV. Doug, thank you for being back on the
show. Thank you so much forhaving me having me. It's great to
be back, and we're celebrating twentyyears. It's unbelievable. The website is
a Medacare andy dot org. You'vebeen at a Metacare since two thousand and
six, so I know it's quitea long time for you. Could you
(00:48):
kind of give us to the rundownreally quick? What is a Medicaid special
needs health plan and how does ithelp members access healthcare? Great question,
lots of acronym acronyms. So asniper special Needs plan is a health plan
that's set up to serve particular specializedneeds and populations out of Medacare. We're
(01:10):
the HIV and the gender Affirming careExperts, as you mentioned, were the
largest Medicaid special needs health plan inNew York. And we're proud of our
innovative model of care that puts peoplefirst. You know, we never give
up on you, and healthcare shouldn'tbe you shouldn't have to change to get
(01:33):
healthcare that respects you. Healthcare shouldchange to be responsive to who people are.
And so we worked really hard tosupport positive health outcomes that also produce
long term class savings for New Yorktaxpayers. And we're happy to celebrate twenty
years of service. Twenty years.Can you talk about the origins of a
(01:57):
metacare. We know, many manyyears ago, people living with HIV were
exempted from being in health plans becausethe health plans didn't have the providers,
they didn't have the HIV knowledge andexpertise. But Amdacare exists today because twenty
(02:17):
years ago a group of visionary providerscame together and sponsored our health plan,
a plan that would combine HIV criticalcare standards and best practices with real world
knowledge about people impacted by HIV.And we're still innovating healthcare to this very
(02:38):
day. Going back just to thepoint you made about a metacare's existence today
traditional healthcare plans, they have haddecades to understand the needs of this population.
No. Absolutely, And you know, if you think about it,
there are health plans within the medicKids base in New York who have millions
(03:01):
of members, and so if you'vegot a small group of people living with
HIV, it might even be acouple of thousand individuals, does the health
plan pay attention to the needs ofthe one point two million or the two
thousand and so what we've done isreally concentrated expertise around HIV care and prevention,
(03:25):
sexual health, gender affirming care.And our beginning was a slow and
steady process. When I came tothe plan in two thousand and six,
we had two hundred members, butwe began serving people one person at a
time, and satisfied members shared theirexperience with families and friends, and that
(03:49):
led to remarkable growth to where wehave over nine thousand members today. And
it's really a testament to the trustand the support of the community these that
we serve. Can you tell mea little bit more about your members,
these nine thousand New Yorkers. Absolutely, so, our members have a variety
(04:11):
of experiences, and there are reallykey considerations, right. So there are
people living with HIV, there're peopleexperiencing homelessness regardless of their HIV status,
their transgender, gender non conforming ornon binary persons. We serve the LGBTQ
plus community, communities of color.We've got nearly three thousand members of trans
(04:38):
experience. About fifty five percent ofour members are Black or African American,
and another third identify as Latino orLatin X. And more than forty percent
of our members have experienced homelessness sincetheir HIV diagnosis. So the members are
all over the five boroughs of NewYork City and we're proud to serve them.
(05:03):
About ninety percent of our members alsohave hard drug use history. About
two thirds live with a significant mentalhealth issue, including early life trauma,
trauma from racism, trauma from homophobia, trauma from associated with transphobia, and
(05:26):
the hate that's alive in our worldtoday. So members bring a lot of
needs and our job is to meetthem where they are, connect them,
to care and pay attention to thethings that they tell us they need to
be well so that they could getabout the business of living their lives.
(05:46):
Our guest is Doug Worthy's president andCEO of a Metacare. He's been president
since two thousand and six. It'sNew York's largest MEDICAIDS special needs health plan,
a SNIP, providing care to overnine New Yorkers affected by HIV.
The website is a metacare ny dotorg. You're listening to get connected on
one oh six point seven light FM. I'm Nina del Rio And anyone who's
(06:10):
a member of a metacare Doug alsohas access to a range of services that
go beyond the typical healthcare plan.Absolutely. So this is about out life
care, right, So what doour members need in order to utilize the
healthcare that they're entitled to? Sowe provide outreach service. We provide so
(06:31):
if people drop out of care,we don't wait for them to come back
in through the emergency room. We'reknocking on doors, We're we're calling their
cell phone or reaching out any waywe can to say, hey, what's
going on. We see that youdropped out of care. You're living with
maybe two three pretty important healthcare conditions. How can we help you? Know?
(06:55):
Sometimes people are like, you're fromour health plan and you're talking to
me because I'm not getting care,meaning you're not spending money on me.
Really are who are you and whereare you from? And we really spend
time with people connecting them to carebecause we don't want them to get sick.
We don't want them to end upan emergency room or the hospital,
(07:15):
and we want to help them addresstheir health conditions. And we've got lots
of good medications for hepatitis C,for HIV, for serious mental illness,
and our job is to help peopleavail themselves of those services and health supports.
And how have you been able tomeasure how those services and supports have
(07:40):
impacted your outcomes. We have remarkablesuccess at ensuring that our members are in
regular care. Over ninety percent ofour members are getting regular primary care visits.
We're connecting people to behavioral health specialists, particular for people who are HIV
positive. We've supported our members abouteighty percent now are virally suppressed. Their
(08:05):
HIV is untransmittable because the virus issuppressed in the body. We've helped cure
about twelve hundred people of hepatitis C. Hep C is a leading killer of
people living with HIV and about sixtypercent of our trans members have gotten access
(08:26):
to gender affirming care, including surgeries, so we don't put speed bumps in
the way of getting care. Weactually our job is to take out the
speed bumps and to solve problems andhelp people get the services that they need
to be well. Last we spoke, I'd like to go back in time
a little bit, was in twentynineteen, and then there was a statewide
(08:50):
roadmap to bring new HIV infections tobelow seven hundred and fifty per year.
That was by the end of twentytwenty. We had a pandemic in the
meantime, but by definition, thegoal was to end the HIV epidemic in
the state. Where are we now. We continue to make a significant progress
in many places in the state andmany places in terms of communities, but
(09:16):
we've still got work to do.About seventy five percent of New Yorkers living
with HIV are people of color,and Black New Yorkers in particular represent about
forty per six percent of all newHIV diagnosis, but only about fourteen percent
of PREP users identify as Black orAfrican Americans, so there's a gap.
(09:39):
Transgender people, particularly trans women ofcolor, are particularly impacted by HIV and
the work now really because medications areavailable, care and services, we really
need to continue to break down thebarriers of stigma, the discrimination, the
socioec economic challenges and poverty that peopleexperience that kind of take up their field
(10:05):
of view where healthcare might might takea back seat. And so we continue
to ask New York State to investin the medicaid program. We really need
frontline strategies that address racism as apublic health crisis. And ultimately it's about
working with our members and our providersto make sure that they get the care
(10:28):
they need when they need it,for as long as they need it to
impact the health outcome. That's howit will end the HIV epidemic. PREP,
as you mentioned, has been aroundI think about ten years or so.
It's a medication that's been extremely usefulin preventing HIV transmission. I saw
there's also an injectable version of PREPthat's working its way through sort of the
(10:50):
approval process. Who would that bedesigned for? Would that, you know,
sort of aid that population that doesn'thave access to it or doesn't have
the education about it yet? Imean, I think injectable PREP is a
game changer as well as injectable HIVmedications. I mean, if you think
about I don't know if you takevitamins. I take vitamins, but sometimes
(11:13):
I get up in the morning andI dash out the door before I've taken
my vitamin C and might be complexbecause I'm busy, I'm behind. Well,
those same kinds of life challenges canget in the way of taking a
once a day prep PUOTE or oncea day HIV treatment. And so I
(11:33):
think we're gonna we're gonna make surethat our members have the knowledge and the
access to both injectable prep but alsoinjectable HIV treatment that is going to be
a game changer with regard to reducingnew infections and helping people stay keep their
HIV suppressed over long periods of time. Who has access to special needs plans
(12:00):
like this one, maybe years inparticular, and who would you like to
see the eligibility be expanded to include. Right now, we're able to serve
individuals who have New York State Medicaid, who are HIV positive, who are
homeless part of the city's shelter system, and transgender New Yorkers, but gay
(12:26):
men of color are experiencing high ratesof new HIV infections, and we'd like
to help bring the number of newinfections down by serving individuals placed at higher
risk for HIV. Currently, ifyou're a young, gay or bisexual man
of color in New York City,you wouldn't be eligible to join mediccare.
(12:52):
We'd like to see eligibility for SNIPSexpanded to anyone who's placed at a higher
risk for HIV, and then weget about the business of supporting them with
sexual health services, regular primary care, mental health, and substance abuse treatment.
And we think that that could alsocontributing contribute to accelerating our success in
(13:18):
ending the epidemic here in New York. Finally, why should listeners follow this
issue even if you don't think itimpacts your family directly. Well, I
think that all of us, whetherwe perceive ourselves at risk for HIV or
not, should care about public healthand care about our neighbors. And I
(13:41):
think that ultimately, think about this, we're in a generation where we could
end the HIV epidemic together. Andif you're a New Yorker who cares about
other New Yorkers, electing officials whowill care about these issues and finance them,
(14:03):
supporting your local community health center ordesignated ADS program, talking in your
family about HIV risk, the availabilityof prep. Those are all things that
you can do as a New Yorkerand play a role in helping to end
the HIV epidemic. And I'm imploringeveryone to choose what you want to do
(14:28):
and take that action and be apart of the solution. Doug Worth is
president and CEO of a Metacare,now marking its twentieth year as New York's
largest Medicaid special needs health plan.You can find out more at a metacare
andy dot org. Doug Worth,thank you for being on Get Connected.
Thank you so much, Nina.Have a great day everyone. This has
(14:50):
been Get Connected with Nina del Rioon one of six point seven Lightfm.
The views and opinions of our guestsdo not necessarily reflect the views of the
station. If you miss any partof our show or want to share it,
visit our website for downloads and podcastsat one oh six seven lightfm dot
com. Thanks for listening.
Welcome to Get Connected with Nina delRio, a weekly conversation about fitness,
health and happenings in our community onone oh six point seven light FM.
Good morning, and thanks for listeningto Get Connected. Happy to welcome back
Doug Worth, president and CEO ofa Metacare, which is marking its twentieth
year as New York's largest Medicaid specialneeds health plan, providing comprehensive care to
(00:26):
New Yorkers affected by HIV. Doug, thank you for being back on the
show. Thank you so much forhaving me having me. It's great to
be back, and we're celebrating twentyyears. It's unbelievable. The website is
a Medacare andy dot org. You'vebeen at a Metacare since two thousand and
six, so I know it's quitea long time for you. Could you
(00:48):
kind of give us to the rundownreally quick? What is a Medicaid special
needs health plan and how does ithelp members access healthcare? Great question,
lots of acronym acronyms. So asniper special Needs plan is a health plan
that's set up to serve particular specializedneeds and populations out of Medacare. We're
(01:10):
the HIV and the gender Affirming careExperts, as you mentioned, were the
largest Medicaid special needs health plan inNew York. And we're proud of our
innovative model of care that puts peoplefirst. You know, we never give
up on you, and healthcare shouldn'tbe you shouldn't have to change to get
(01:33):
healthcare that respects you. Healthcare shouldchange to be responsive to who people are.
And so we worked really hard tosupport positive health outcomes that also produce
long term class savings for New Yorktaxpayers. And we're happy to celebrate twenty
years of service. Twenty years.Can you talk about the origins of a
(01:57):
metacare. We know, many manyyears ago, people living with HIV were
exempted from being in health plans becausethe health plans didn't have the providers,
they didn't have the HIV knowledge andexpertise. But Amdacare exists today because twenty
(02:17):
years ago a group of visionary providerscame together and sponsored our health plan,
a plan that would combine HIV criticalcare standards and best practices with real world
knowledge about people impacted by HIV.And we're still innovating healthcare to this very
(02:38):
day. Going back just to thepoint you made about a metacare's existence today
traditional healthcare plans, they have haddecades to understand the needs of this population.
No. Absolutely, And you know, if you think about it,
there are health plans within the medicKids base in New York who have millions
(03:01):
of members, and so if you'vegot a small group of people living with
HIV, it might even be acouple of thousand individuals, does the health
plan pay attention to the needs ofthe one point two million or the two
thousand and so what we've done isreally concentrated expertise around HIV care and prevention,
(03:25):
sexual health, gender affirming care.And our beginning was a slow and
steady process. When I came tothe plan in two thousand and six,
we had two hundred members, butwe began serving people one person at a
time, and satisfied members shared theirexperience with families and friends, and that
(03:49):
led to remarkable growth to where wehave over nine thousand members today. And
it's really a testament to the trustand the support of the community these that
we serve. Can you tell mea little bit more about your members,
these nine thousand New Yorkers. Absolutely, so, our members have a variety
(04:11):
of experiences, and there are reallykey considerations, right. So there are
people living with HIV, there're peopleexperiencing homelessness regardless of their HIV status,
their transgender, gender non conforming ornon binary persons. We serve the LGBTQ
plus community, communities of color.We've got nearly three thousand members of trans
(04:38):
experience. About fifty five percent ofour members are Black or African American,
and another third identify as Latino orLatin X. And more than forty percent
of our members have experienced homelessness sincetheir HIV diagnosis. So the members are
all over the five boroughs of NewYork City and we're proud to serve them.
(05:03):
About ninety percent of our members alsohave hard drug use history. About
two thirds live with a significant mentalhealth issue, including early life trauma,
trauma from racism, trauma from homophobia, trauma from associated with transphobia, and
(05:26):
the hate that's alive in our worldtoday. So members bring a lot of
needs and our job is to meetthem where they are, connect them,
to care and pay attention to thethings that they tell us they need to
be well so that they could getabout the business of living their lives.
(05:46):
Our guest is Doug Worthy's president andCEO of a Metacare. He's been president
since two thousand and six. It'sNew York's largest MEDICAIDS special needs health plan,
a SNIP, providing care to overnine New Yorkers affected by HIV.
The website is a metacare ny dotorg. You're listening to get connected on
one oh six point seven light FM. I'm Nina del Rio And anyone who's
(06:10):
a member of a metacare Doug alsohas access to a range of services that
go beyond the typical healthcare plan.Absolutely. So this is about out life
care, right, So what doour members need in order to utilize the
healthcare that they're entitled to? Sowe provide outreach service. We provide so
(06:31):
if people drop out of care,we don't wait for them to come back
in through the emergency room. We'reknocking on doors, We're we're calling their
cell phone or reaching out any waywe can to say, hey, what's
going on. We see that youdropped out of care. You're living with
maybe two three pretty important healthcare conditions. How can we help you? Know?
(06:55):
Sometimes people are like, you're fromour health plan and you're talking to
me because I'm not getting care,meaning you're not spending money on me.
Really are who are you and whereare you from? And we really spend
time with people connecting them to carebecause we don't want them to get sick.
We don't want them to end upan emergency room or the hospital,
(07:15):
and we want to help them addresstheir health conditions. And we've got lots
of good medications for hepatitis C,for HIV, for serious mental illness,
and our job is to help peopleavail themselves of those services and health supports.
And how have you been able tomeasure how those services and supports have
(07:40):
impacted your outcomes. We have remarkablesuccess at ensuring that our members are in
regular care. Over ninety percent ofour members are getting regular primary care visits.
We're connecting people to behavioral health specialists, particular for people who are HIV
positive. We've supported our members abouteighty percent now are virally suppressed. Their
(08:05):
HIV is untransmittable because the virus issuppressed in the body. We've helped cure
about twelve hundred people of hepatitis C. Hep C is a leading killer of
people living with HIV and about sixtypercent of our trans members have gotten access
(08:26):
to gender affirming care, including surgeries, so we don't put speed bumps in
the way of getting care. Weactually our job is to take out the
speed bumps and to solve problems andhelp people get the services that they need
to be well. Last we spoke, I'd like to go back in time
a little bit, was in twentynineteen, and then there was a statewide
(08:50):
roadmap to bring new HIV infections tobelow seven hundred and fifty per year.
That was by the end of twentytwenty. We had a pandemic in the
meantime, but by definition, thegoal was to end the HIV epidemic in
the state. Where are we now. We continue to make a significant progress
in many places in the state andmany places in terms of communities, but
(09:16):
we've still got work to do.About seventy five percent of New Yorkers living
with HIV are people of color,and Black New Yorkers in particular represent about
forty per six percent of all newHIV diagnosis, but only about fourteen percent
of PREP users identify as Black orAfrican Americans, so there's a gap.
(09:39):
Transgender people, particularly trans women ofcolor, are particularly impacted by HIV and
the work now really because medications areavailable, care and services, we really
need to continue to break down thebarriers of stigma, the discrimination, the
socioec economic challenges and poverty that peopleexperience that kind of take up their field
(10:05):
of view where healthcare might might takea back seat. And so we continue
to ask New York State to investin the medicaid program. We really need
frontline strategies that address racism as apublic health crisis. And ultimately it's about
working with our members and our providersto make sure that they get the care
(10:28):
they need when they need it,for as long as they need it to
impact the health outcome. That's howit will end the HIV epidemic. PREP,
as you mentioned, has been aroundI think about ten years or so.
It's a medication that's been extremely usefulin preventing HIV transmission. I saw
there's also an injectable version of PREPthat's working its way through sort of the
(10:50):
approval process. Who would that bedesigned for? Would that, you know,
sort of aid that population that doesn'thave access to it or doesn't have
the education about it yet? Imean, I think injectable PREP is a
game changer as well as injectable HIVmedications. I mean, if you think
about I don't know if you takevitamins. I take vitamins, but sometimes
(11:13):
I get up in the morning andI dash out the door before I've taken
my vitamin C and might be complexbecause I'm busy, I'm behind. Well,
those same kinds of life challenges canget in the way of taking a
once a day prep PUOTE or oncea day HIV treatment. And so I
(11:33):
think we're gonna we're gonna make surethat our members have the knowledge and the
access to both injectable prep but alsoinjectable HIV treatment that is going to be
a game changer with regard to reducingnew infections and helping people stay keep their
HIV suppressed over long periods of time. Who has access to special needs plans
(12:00):
like this one, maybe years inparticular, and who would you like to
see the eligibility be expanded to include. Right now, we're able to serve
individuals who have New York State Medicaid, who are HIV positive, who are
homeless part of the city's shelter system, and transgender New Yorkers, but gay
(12:26):
men of color are experiencing high ratesof new HIV infections, and we'd like
to help bring the number of newinfections down by serving individuals placed at higher
risk for HIV. Currently, ifyou're a young, gay or bisexual man
of color in New York City,you wouldn't be eligible to join mediccare.
(12:52):
We'd like to see eligibility for SNIPSexpanded to anyone who's placed at a higher
risk for HIV, and then weget about the business of supporting them with
sexual health services, regular primary care, mental health, and substance abuse treatment.
And we think that that could alsocontributing contribute to accelerating our success in
(13:18):
ending the epidemic here in New York. Finally, why should listeners follow this
issue even if you don't think itimpacts your family directly. Well, I
think that all of us, whetherwe perceive ourselves at risk for HIV or
not, should care about public healthand care about our neighbors. And I
(13:41):
think that ultimately, think about this, we're in a generation where we could
end the HIV epidemic together. Andif you're a New Yorker who cares about
other New Yorkers, electing officials whowill care about these issues and finance them,
(14:03):
supporting your local community health center ordesignated ADS program, talking in your
family about HIV risk, the availabilityof prep. Those are all things that
you can do as a New Yorkerand play a role in helping to end
the HIV epidemic. And I'm imploringeveryone to choose what you want to do
(14:28):
and take that action and be apart of the solution. Doug Worth is
president and CEO of a Metacare,now marking its twentieth year as New York's
largest Medicaid special needs health plan.You can find out more at a metacare
andy dot org. Doug Worth,thank you for being on Get Connected.
Thank you so much, Nina.Have a great day everyone. This has
(14:50):
been Get Connected with Nina del Rioon one of six point seven Lightfm.
The views and opinions of our guestsdo not necessarily reflect the views of the
station. If you miss any partof our show or want to share it,
visit our website for downloads and podcastsat one oh six seven lightfm dot
com. Thanks for listening.
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