Bringing Cultural Competence to Health Insurance - Myong Lee, Co-Founder and CEO of Clever Care Health Plan

Michael Carrese: Hi, everybody, I'm Michael Carrese. I don't know about you, but I find dealing with health insurance to be confusing and complicated, and I spent more than a decade working in the healthcare system, so I should be doing better than that. So, I just cannot imagine trying to navigate that complexity in something other than my native language, but that's the reality that millions of Americans face, and it's a real barrier to access to the healthcare that they need and deserve. Well, knocking down those barriers is where our guest today enters the picture. Myong Lee is co-founder and CEO of Clever Care Health Plan,

a culturally sensitive Medicare Advantage plan that's tailored to the customs, values, and linguistic needs of the diverse communities it serves. 

Mr. Lee brought many years of experience launching and leading healthcare organizations to his work at Clever Care, with special expertise in building provider relationships and in contracting, and we're very glad to have you on the program with us today. 

Myong Lee: Thank you so much for having me, Michael. 

Michael Carrese: Great to have you. So, we always start with getting some personal and professional background from our guests. What first got you interested in the health plan space?

Myong Lee:  When I was originally in New York City doing mergers, acquisitions, and stock research and whatnot, I had an interest in learning how to run a real company. Then when I thought about what was interesting to me, I really wanted an industry that was complex, changing, and makes an impact. I just by chance got contacted by a recruiter

from WellCare, which is a national Medicare Medicaid company saying, “Hey, we're looking for someone with your type of background, you don't have to know insurance,” which is good because I didn't know a thing about insurance, but he said if you're willing to learn, you'll learn by doing. 

When I took a step back and thought about what was attractive to me, my thesis was very simple, which was the senior population is ever-growing, and back in 2007 Medicare was not a quote-unquote sexy place. It wasn't quite well understood. Very large even back then, of course, but it was forecast to get even larger, and when I thought about what I enjoyed in the job that I had, in the career that I had developed to the point, a lot of those aspects were part of what it would take to learn Medicare. 

The thing I didn't realize, which I'm happy about, is just how challenging it is because there's so many factors involved with understanding Medicare...the impact to seniors, the financing behind it, how it constantly has changed. The amount of change for the better that's happened in the program in the last fifteen years, has been one of the biggest reasons why I've been so happy that I made this transition because it's very challenging. It makes a massive positive impact if you do it the right way, and ultimately, I wanted to be able to get into a business where in my own small way, I tried to help out as many people as I could and quite frankly, I feel like I stumbled into Medicare, but I've been doing it for the last fifteen years now and very excited that I had the opportunity to do that. 

Michael Carrese: Oh, that's great. So, talk a little bit about some of those positive changes that you mentioned over the last fifteen years. What did you have in mind? 

Myong Lee:  Medicare Advantage is really the privatized version of Medicare, original Medicare. What you've seen happen over the last ten, fifteen years is that as compared to original Medicare, there's just a lot more flexibility. The supplemental benefits that CMS allows is really fundamentally different from what original Medicare currently offers, which is they have their base offering and that's what they do. That's really what allowed me and my co-founders to take that step of being crazy enough to say, let's create a Medicare Advantage health plan, in our case, catering towards seniors who are interested in Eastern medicine and everything else that it brings with that. 

I do think the increase of flexibility, the increase in supplemental benefits, have really helped a lot of seniors. It's demonstrated in the numbers. Medicare Advantage has grown significantly from when it once started to now, I would say almost 50% if not more of seniors are enrolled in Medicare Advantage plans. It helps them financially. It's helped them from a quality perspective, and it's helped them being able to get access to supplemental benefits that they actually use and truly benefits them. I think that's been probably one of the biggest changes and one of the big reasons why Medicare Advantage has become such an attractive product to seniors. 

Michael Carrese: You do hear, on the positive side, folks talk about more of an emphasis on prevention and giving seniors access to wellness classes or balance classes. Is that part of what you're talking about? 

Myong Lee:  That's exactly right. In our case, 90% plus of our seniors or members speak an Asian ethnic language, right? English might be a second language or quite frankly, it's not a language they speak. So, when myself and my co-founders looked at the different offerings within Medicare, the supplemental benefits were pretty solid but didn't really speak to someone like my parents, right? My parents certainly have never been to a gym. They're not going to go to gym to work out and whatnot, that's not the deal. So, when we saw the opportunity to be able to allow seniors to be able to practice healthcare the way they want to -- access to herbal medicine, Tai Chi classes or motion classes -- it felt like there was an opportunity there beyond just the supplemental benefits, but being able to fundamentally provide access for these seniors that don't speak English as a first language. 

Effectively my company is bilingual in multiple languages: Korean, Vietnamese, Mandarin, Cantonese, Spanish, and everything that we built, everything that we do, is based off that premise of meeting the senior where they are and being able to give them what they need in the language that they prefer. We give them the type of benefits that they might not currently have access to, or they can't afford. Being able to provide that through a Medicare Advantage health plan, I think has made a big difference. 

Michael Carrese: Oh, I'm sure that it has. So, we've talked a little bit about the non-Western quote-unquote “offerings” that Medicare has been open to, but how does CleverCare integrate what we refer to in the United States as Western medicine versus Eastern medicine? 

Myong Lee: That's right. So on the Western medicine side, Medicare benefits are wonderful benefits, and we have incredible provider partners between the hospitals, the IPA partners, the PCP specialists, all the ancillary providers. But what we've done in particular is to make sure that not only do we have the top hospital systems, but we also have highlighted and contracted with hundreds of acupuncturists who speak multiple languages. We've also contracted with dozens of herbalists, right? So we've gone beyond your typical kind of Western delivery network by making sure that we have the providers in the neighborhoods where the majority of our members live. 

As an example, in Koreatown in downtown LA or Little Saigon in Orange County or in San Gabriel Valley, we've made a concerted effort to make sure that we have a ton of network providers for our members to be able to access. But we also know -- and I know personally through my own experience with my parents -- that they also prefer using herbal medicine. They grew up -- in my parents' case, in Korea -- utilizing certain herbal medicines as an adjunct to taking care of themselves. So what we've done is gotten approval from CMS to offer it as a benefit. 

What we see happening in the community is that, especially within the Asian community, the PCPs tend to work pretty closely with the acupuncturists and they communicate and they're aware of what's happening between the two of them, and the member will let them know what's happening as well. The member gets access to the type of healthcare that they're accustomed to, but at the same time, we have some of the best Western medicine so that if something happens, our members are able to access that care as well. 

Michael Carrese: Yeah, it's a great symbiotic relationship if you can pull that off. 

Myong Lee:  That's right. Not easy, but, it is. When we launched the company, I saw the challenges that my parents had, and it was very easy to see how this could be so challenging for so many other people. We looked around the country, didn't really see any options for people who are looking for this type of product and service, and felt -- and maybe it's a little crazy -- but we felt like there was a great opportunity here, and here we are a few years later. 

Michael Carrese: So, it sounds like you have a built-in focus group of two there with your parents. You can run everything by them, right? 

Myong Lee:  That's right. My parents don't live in California so they're not all on my plan, but I do have other family members that are, and I can certainly tell you they let me know when things are good or bad.

Michael Carrese: That's what's great about family. So, you have kind of alluded to the fact that the timing was good for getting in as Medicare Advantage plans grew, and you've found a need in the market. How are you doing from a business perspective and what are your plans for growth? 

Myong Lee:  Yeah, so, we had the amazing luck of launching the company during the COVID lockdown in California. We started out the gate with 500 members, and since then we've really grown significantly. As of today -- having been in business for two years and a couple months -- we're over 11,000 members in Southern California. There clearly is a met need from this population, and we just feel lucky that we have the opportunity to be able to provide the seniors with a product and a service that is very difficult for most companies to be able to produce. 

Michael Carrese: What challenges do you have still, whether it's dealing with Medicare or, you know, reaching out to potential members? What are the hurdles you’ve got to overcome? 

Myong Lee:  We tend to have more members that have never been a part of a Medicare Advantage health plan before. So, there tends to be kind of a higher learning curve as people try to figure out how to access their benefits. The way we've gotten around that is by effectively teaching the members. I think one of the biggest hurdles that other seniors have is they call their insurance companies and find it hard. I mean, you call any insurance company, it's hard to figure out kind of what's going on, much less when it's not your language and you're using a translator, right? So, the fact that we have in-language support across the board has allowed our members to be able to call us. We have multiple community centers where they could literally just walk in the door and ask for help with anything. 

I've seen seniors come in and say, “Can you look at this bill? Like, what does this mean? I don't know what this is,.” And that is the purpose of the community centers...being able to take away those language barriers so that we can help them navigate accessing healthcare, which by itself is already very difficult. I think what it's done is really given our members a way for them to take care of themselves and they feel comfortable and empowered to be able to call us themselves versus previously, they might have their adult children who speak English call on their behalf. But there's always something lost in translation. 

Michael Carrese: Sure.

Myong Lee:  And for them to be able to just call a specific phone number and know that someone's going to pick up in their language, I think what it's done is made people feel more comfortable about how they're able to access healthcare.

Michael Carrese: Yeah, that's very empowering. So, you launched your business during COVID and we launched this podcast during COVID, and so we have been kind of focused on talking about what lessons have been learned about the healthcare system and particularly ways to strengthen it and improve it. So, I want to give you a chance to talk about that a little bit, particularly with the senior population in mind. 

Myong Lee:  Yeah, so I think when you go back to the kind of craziness of COVID and what it did, it really just highlighted how difficult it is to be able to access healthcare, especially when you're told you need to stay home, right? So, what you've seen over the last few years -- both from a regulatory perspective, but also from a provider perspective -- is allowing members and patients to be able to get healthcare needs met where and how they need it. Sometimes it's within the home and sometimes it's somewhere besides the provider's office. 

I think because of COVID, there's just a lot more flexibility with all the telehealth that's become available, and some of the key things that we've been working on is making sure that our seniors get access to the same options and flexibility, but in a culturally sensitive manner. If someone comes to their door and speaks their language and understands their culture, they understand how to interact with them. That makes a significant difference in terms of seniors feeling comfortable with being able to get access to healthcare. And while there's so many horrible things that happened because of COVID, I do think what it did was show that with flexibility and creativity, we could provide our seniors with very high levels of care and kind of breaking out of your typical access. 

Michael Carrese: Yeah, there are some silver linings for sure. So, Osmosis is a teaching company and we love to bust myths and fill gaps in knowledge. Is there a topic you're particularly interested in where you think it would be great if medical students and the medical community got this and knew this and they don't know now?

Myong Lee:  I've had this thought for many years. At some point, I hope to be able to do it but I do feel like medical schools need to have a class around how the financing of healthcare works and truly what the direct impact is on the healthcare practitioners, because it does have quite the significant and direct impact on their careers and their jobs and their day-to-day activities and how things work. I mean, a fee for service reimbursement model versus a risk-based model are truly two fundamentally different models. 

Not to say that anything is perfect, it certainly isn't, but for medical students to have exposure and understand the options that are available to them, it would make, in my mind, a significant impact. If they know early on that if you go and work in a fee-for-service environment, your day job is literally in seven-to-ten-minute increments. And that's probably not what most people think of when they see themselves as a primary care physician, right? Versus if you're in a risk-based model, you're focusing your attention more on the people who need more help and you're able to give them more time. Not to say it's perfect, it certainly isn't, but having that knowledge of how these financing models have such a profound impact on how you practice, I think that's education that every medical student, and quite frankly, any healthcare practitioner, needs to understand, especially with how the financing mechanisms within all of healthcare are really quickly changing. 

Michael Carrese: That's a great point, and I think a lot of medical students might not understand that in value-based care and these risk models, the providers have a lot more say, they have a lot more control and input into decision-making. They don't have the insurance company looking over their shoulder about every single thing they do. COVID was a great example. 

We had some guests on that were in a value-based model caring for seniors, and they wanted their seniors to stay home and stay safe and not go get groceries and not go pick up their prescriptions. So, this practice was able to pay for renting vans and hiring drivers to go around and do that. Under fee for service, there was no billing code, there was no way that they were going to get reimbursed for that. So, I hope it's something that's understood at the medical school level that this is actually -- and again, as you say, nothing's perfect -- but it certainly addresses some of that frustration that physicians have, like “I'm just in such a tight little box time-wise and also in terms of what I'm allowed to do,” and value-based care sort of offers a different landscape. 

Myong Lee:  That's exactly right. And when you just look at the outcomes, when you have a value-based care or risk arrangement in place where you align the physician with effectively the health outcomes of the patients, it's a different way of thinking and the way you allocate your time is fundamentally different. You need a lot of infrastructure to be able to deploy and implement that type of arrangement. But in the end, with the way healthcare costs are accelerating, I do believe that we have to continue to drive towards more value-based care models, and there's a ton of them. But at this point, getting away from fee for service and going down that risk continuum is going to be critical for everyone involved so that we could drive towards healthier outcomes and be fiscally responsible.

Michael Carrese: Well put. So, we always like to wrap up with getting some advice from our guests to our learning audience, and you started this interview telling us about how you didn't start out thinking about health insurance as where you were going to go with your career. So, talk a little bit about that mindset of being open to opportunities or anything else you want to get across to our audience.

Myong Lee:  I mean, for myself, I'm lucky in the sense that I knew that I wanted to make some sort of positive impact. I didn't know how. At that point, my experience and skillset was really more in the finance aspect of the world. I could not have seen fifteen years later that I've done the kind of these things that I've done. But the kind of lesson that I got out of this, or one of the many lessons I got was, I just kept doing new things. I think in every position that I got, I had never done that job before in healthcare. Someone was willing to take a risk on me and give me the opportunity, and I took it. I dived in and made plenty of mistakes. I learned as much as I could, and then I went on to the next opportunity and just kept effectively learning as much as I could. 

Without realizing it, I started to understand different aspects of how managed care works. And lo and behold, four or five years ago, I reached a point where I was lucky enough to be able to get investors who were willing back the concept and idea of what we're doing so that I could try to put it all together. That’s not to say that everyone should be a founder of a company. That's pretty crazy, launching a company from scratch. But I do think that, especially for the audience who's listening to this, there's so much opportunity for improvement out there. 

I would just say, keep doing things that you haven't done before and keep learning because the connections that you make when you have what looks like a random or weird background -- when you get the right experiences in place -- it does give you really profound insights that quite frankly, most people never get, and that's going to put you in a position to be able to do probably really interesting, if not impactful work. 

Michael Carrese: Right. You can see how the dots connect in hindsight, but at the time you're like, “this does seem like a random thing or it's taking me off my path.” But usually, the right answer is to say yes to an opportunity. 

Myong Lee:  That's right. 

Michael Carrese: Well, listen, it's been wonderful to have you on the program. We really appreciate you taking the time to be with us today and fill us in on what you're doing with CleverCare. 

Myong Lee:  Thank you so much, Michael. 

Michael Carrese: I'm Michael Carrese. Thanks for checking out today's show, and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.