Thank you, Erine, for that introduction. I’m very thankful to be here today, and I’m privileged to be joined, by doctor Valerie Arkoosh, who is the secretary of the Pennsylvania Department of Human Services. Secretary Arkoosh, if it’s okay with you, let’s get started. That’s good, Gabe. It’s great to be here with all of you. When I started working in Medicaid, I came in from the private practice of the law. And I know you have a history of being a physician. So maybe we could start off by asking, what are some of your experiences in this transition from a private practice or a private life to a public role in a public life? Yeah. Well, my transition has been a pretty long one, but it it’s a it’s a pretty good story. I practiced medicine for a little over twenty years in Philadelphia teaching hospitals. I, mostly took care of pregnant women and their families. That was my primary specialty area as an obstetric anesthesiologist, but I took care of all kinds of patients. And I really, truly loved that work. But over time, I saw so many things that were impacting the health of my patients that I could not write a prescription to fix. You know, my patients needed access to healthier food and clean air and clean water and better housing. And so eventually, I went back to school and got a degree in public health while I was still practicing. Eventually ended up running for office and served as a county commissioner for eight years. And then, since January of twenty twenty three, have had the incredible honor serving in the Shapiro administration as the secretary of the Department of Human Services. Well, that’s great. I couldn’t imagine a better person to be in that role. So it’s really fascinating that your experiences were so formative to kinda make you realize there’s more than what, what we traditionally think of as health care that impacts people’s lives and their health. So particularly with respect to Medicaid, as it continues to evolve into more of a personally tailored program and personally tailored experience for the people that it serves. How do you see or or what role do you see these health related social needs fitting into this evolution? That’s part one of the question. The second part of the question would be, what trends are you seeing coming out of CMS right now as it relates to trying to integrate and build momentum around integrating these types of services into our Medicaid health care system? Yeah. You know, Gabe, I think this is one of the most exciting times in the history of Medicaid. Medicaid historically has been an absolutely essential provider of health care for individuals who really had no other way to access any type of commercial or traditional health insurance, largely because it was unaffordable for them. So Medicaid has played this absolutely critical role for decades in making sure that people had preventive care. They had obstetric care when giving birth, and all, you know, treating all sorts of health conditions in the way that any of us would hope that we would have access to health care when and if we needed it. And much like my journey from practicing medicine to this position, the Medicaid program is also evolving. You know, my journey really started by realizing that there were factors outside of that exam room that I couldn’t fix as a traditional practicing doctor and wishing that I had more tools in my toolbox to do that and trying to figure out how to get those tools, how to get that learning, how to impact policy to to affect those changes. And very happily, we’re seeing the same kind of evolution in the Medicaid program. Under the Biden administration, for the first time ever, Medicaid dollars, which historically have primarily only been able to be used for physical health care, are now, being able to be used under an eleven fifteen waiver process for what the administration calls health related social needs. So some of the things I mentioned earlier, food, housing, and and we can talk some more about those details if you’d like. But this is so important because we now know, and and the data is really clear on this, that about fifty percent of your health, just your general health, relates to those social things. Like, do you live somewhere where you can get access to fresh fruits and vegetables? Do you live in a place with clean water and clean air? Do you have stable housing? And, and it always pains me a little bit to say this, only about twenty percent of your health is the actual health care that is provided in our traditional health care system. And and, again, I don’t wanna in any way undersell that. It’s critically important that health care, particularly those preventive health care services. But we now know that, you know, no matter how good your doctors are, you could go to the finest institution in the country, to have your diabetes treated. If you go home to a neighborhood where you can’t access fresh fruits and fresh vegetables, it is going to be extremely difficult, if not impossible, to successfully manage your diabetes. So what’s so exciting right now is that these two ideas are finally coming together. And, here in Pennsylvania, we intend to take full advantage of this opportunity and are working with CMS right now on a a waiver application so that, hopefully, in the future, we’ll be able to provide some of these health related services to folks here in the Commonwealth. That’s so great to hear. You know, I was at TennCare when, North Carolina got approval for their big eleven fifteen waiver around healthy opportunities. And it was really kind of a watershed moment it seemed like at the time because it was the first time we had seen something like that formally approved in a waiver. And it’s nice to see that momentum. And it’s actually a really good segue. The next question I wanna ask you, the founder and CEO of Find Help, Aaron Gray, who just introduced us, speaks often about the new American social safety net that stretches beyond just health care. It it really gets to the conversation you were talking about. And I’m just wondering, you know, through the lens of your professional experiences prior to becoming secretary and then now secretary over the department, how do you see that the various state agencies that might not deal with Medicaid or help deliver Medicaid, but might be dealing with the same members? How could they work together and perhaps over time really help us slingshot this these advancements forward? Yeah. Well, that’s a really great question. And and here at the Department of Human Services, we have a number of those programs under our umbrella. So not only do I oversee the Medicaid program, but, we have what we call our office of income maintenance, which does eligibility for Medicaid, but also for SNAP, our food assistance program, LIHEAP, which is a heating assistance program. We have folks that are working on housing here in DHS, maternal health care, a whole host of areas, behavioral health. We have programs for individuals with physical or developmental disabilities. So all of that is under my roof. And the way that we think about these programs is that they are building bridges to success. Each of these programs provides a vital piece of stability for the families that we serve. And together, holistically, when we weave these programs together in in the best possible way, we do create those bridges to success for the families that we serve. And we’re very fortunate here in Pennsylvania that we have all of these, different program offices together under one roof because it allows us to work together very effectively and really kind of row in the same direction and and see how we can make it easier for folks to understand what is available to them, easier for them to enroll in those benefits, and get all of the benefits that they’re eligible for and that, you know, frankly, that that they need to make sure they get themselves and their family to that place of stability, and then they can grow from there. Yeah. That that seeming opportunity to make it administratively less burdensome for families to access these services and be able to have them kind of all working in the same direction with the same budget authority seems like it can be a dream come true for policy limited folks like you. That’s great. We’ve got some work to do, but we are on our way. We’re very That’s right. Getting ourselves. That’s great. Well, so it’s maybe kind of digging in a little bit deeper on that specific point. How does your agency currently using find help, and and what does the future look like? Yeah. Well, I’m very, very excited about the program that we’re calling PA Navigate, here in Pennsylvania that is built on that find health platform. So, you know, I’ll just take you back to when I was that doctor. Many times, and and I think probably every, health care provider’s had this experience, you know, you’re talking with a patient, and you have a pretty good sense that maybe that individual, does not have access to that healthy food or they don’t have access to enough food, you know, something that we might call being food insecure, or it’s housing insecure. And you wanna talk to them about it, but you don’t know what you’re gonna do if they say, yeah. I don’t actually have enough food. You know, what as a doctor in your office or a nurse practitioner, what are you gonna do with that information? Navigate will allow is when it is fully implemented, a physician or nurse practitioner will like they would refer that person to a social worker or they would send a prescription to a pharmacy, they’ll be able to send a referral to a food pantry near where that patient lives, and they’ll be able to look it up very easily. It can be looked up by ZIP code or by address. And then, this is, you know, very exciting, that food pantry will actually get notice that that particular individual’s been referred to them. And when that individual comes to the pantry, they will be able to work with that client, and then they’ll be able to send back to the health care team what they did with that individual and what kind of services they were able to provide for them. So this is just a game changer. This was something I sort of dreamed of having access to as a physician. And when I became a county commissioner and had a whole county under my purview for eight years, these were the kinds of, assistance that our teams that work directly with our constituents, helping them get connected to services, they would have just loved to have. So we’re really excited about it. And and by the way, just to be clear, any person will be able to go on to PA navigate, type in their ZIP code, click on some boxes about, what they are looking for, and they can self refer to any of these services as well. So it is really exciting. I think we’re gonna be leading the country in, being able to do something like this, which technically is a closed loop referral system. We’re really leading the the charge here for a service that will be so helpful. That’s great to hear. And it’s so you know, Pennsylvania, in in some regards, you may find this funny and others might as well, but it reminds me a little bit of Tennessee and that there’s a pretty diverse state. We’ve got some really deep rural areas, and we got some very rural areas. And it’s so difficult a lot of times as a policymaker when you don’t have access to easy to use technology like the Find Help platform to be able to connect make those connections across the state. So I’m frankly, I’m jealous of you that you have the opportunity to do what you’re doing with this type of tool and technology. Yeah. So how do you see the continued evolution of health related social needs in Medicaid? Do do you think do you fall on the sign that it’s pretty much a fixture now? Meaning that even if there are changes in the administration in November, do you see rollbacks, or do you think that we’re in a position with data and with understanding and with clinical improvements and with actual on the ground results that health related social needs and Medicaid are kind of here to stay together? I believe that they are. I think that if you look objectively at the data, there is no question that the path forward in the Medicaid program to achieve the goals of the program, which include keeping people healthy, but also being very careful stewards of the taxpayer dollars that fund this program. The way to meet both of those goals most effectively is to marry those two, is to marry access and attention to, meeting the health related social needs that an individual client may have along with those traditional health care needs, whether it’s behavioral health or physical health care needs. It is those two coming together that will have such an impact on reducing avoidable emergency department, emergency room use, as well as reducing avoidable hospitalizations. There’s already a fair amount of data out there around food as medicine, around housing supports, and really significant impacts that those programs can have on reducing those types of admissions. I mean, imagine that you have diabetes and you are currently unhoused and your insulin needs to be kept in a refrigerator. What are you gonna do? And so what happens today for many of those folks is out of necessity, they go to the emergency room because their insulins, you know, as it warms up for several days is less effective. They start to feel sick, and and they end up in the emergency room. And so it it’s really, I think, the way forward. And, from my perspective, something that I’m just so glad is finally being appreciated at the highest levels because I think a lot of us on the ground have known that this was the case for a long time, but we are just thrilled that the entire program is now taking note. That’s great. And, you know, for the record, I’m in your camp. I I believe the same thing. And in fact, I was on a panel earlier talking about exactly that. And one of the things that I get so excited about is that we are seeing more eleven fifteen waivers trying to incorporate health related social needs into the programs. And I think all that’s going to do is even give us give the agencies from a policy perspective even more rigor showing that over time when you evaluate these demonstrations, they do in fact work. Yeah. So Yeah. I think it’s just to add to that, that’s one of the great things about the eleven fifteen process is that we are required to have ongoing evaluation. And, you know, we have metrics, and they’ll be evaluated. So we’ll really get a better understanding of of what’s working right here in Pennsylvania, which will be very helpful for us. Right. Well, I can I can I’m sure I speak for the audience when I say we’re we’re we’re over here cheering you on and your agency on, and we’re excited to see that things are gonna continue to come from Pennsylvania, with all of your leadership and with PA Navigate there to be an essential tool? So thank you, Dr. Arkoosh, for, for being here. Thank you for your public service, and thank you to the audience for having us today. Thanks, Gabe. It was a pleasure.
