FAIR Health Board Access Interview with Christina Severin
July 20, 2023
An award-winning healthcare executive, Christina Severin was elected to the FAIR Health Board of Directors in April 2023. During her distinguished 25-plus-year career, Ms. Severin has led organizations in the areas of managed care, delivery systems, health insurance, Accountable Care Organizations (ACOs), quality, public policy and public health. Since 2016, Ms. Severin has served as the President and Chief Executive Officer (CEO) of the Community Care Cooperative (C3), which leverages proven best practices of ACOs nationwide to serve MassHealth members throughout the commonwealth. Prior to this role, Ms. Severin served as President and CEO of Beth Israel Deaconess Care Organization and as President of Network Health, a nonprofit Massachusetts health plan. She earned a Master of Public Health with a concentration in Health Services from Boston University School of Public Health and a Bachelor of Arts in Political Economy from the University of Massachusetts at Amherst. Ms. Severin spoke with FAIR Health Access about her experience in the healthcare sector and how healthcare transparency can inform strategies for addressing health disparities.
FAIR Health (FH): What led you to pursue a career in the healthcare sector? What, if anything, has surprised you most about healthcare over the course of your career?
Christina Severin (CS): I am a total accidental tourist in healthcare. Before my healthcare career, during college and after my undergraduate studies, I had a mini career in student-run cooperatives and the food business. When I was about 25 years old, my parents wanted me to focus more on my career direction. At the time, when major newspapers featured job advertisements in print, the Boston Globe ran an ad for an administrative assistant in the Department of Adolescent Medicine at Boston Medical Center, which was then called Boston City Hospital—one of the last public hospitals in Massachusetts. Dr. Linda Grant, an unbelievable clinician and human being, interviewed me but said that she didn’t want to hire me for the job because she thought I was overqualified and that I would be bored. I said, “No, please hire me. I like you and I think it’s a great opportunity.” She hired me, and that was my entrée into healthcare. Dr. Grant was the kind of boss who let me spread my wings and supported me in any way that she could. I learned a tremendous amount. With a scholarship from the City of Boston, I obtained my Master of Public Health degree by taking classes at night while working full-time. That allowed me to expand my career in healthcare.
The thing that surprises me the most is something I learned when getting my master’s degree; I’ve carried it with me. My healthcare finance class professor, Dr. Alan Sager—another hero of my career who supported me during my master’s degree program and for decades following that—was talking about the healthcare finance system. He said, “The US healthcare system is a paradox of excess and deprivation.” As I continue to walk through healthcare, what continues to surprise me is the paradox of excess and deprivation.
FH: In March 2020, with the need to limit in-person contact during the COVID-19 pandemic, telehealth utilization among the privately insured began to increase significantly, a trend that has been reflected in FAIR Health’s Monthly Telehealth Regional Tracker. At that time, C3 and the Massachusetts League of Community Health Centers created the FQHC Telehealth Consortium to provide telehealth access for lower-income and vulnerable communities.
a) What were some of the unique challenges in rolling out telehealth services as part of the Telehealth Consortium?
b) What best practices should be considered when implementing telehealth-based interventions at the state and federal levels to improve access to care and address social determinants of health?
CS: The challenges were very brass tacks. In March and April of 2020, supply chain disruptions made it difficult to acquire laptops. Fortunately, we partnered with IT industry experts who were able to acquire laptops, configure them and put them into the hands of primary care providers and behavioral health clinicians. We learned things that are now hard to imagine we never knew before. For example, how do you pull an interpreter into a telehealth encounter? Regulatory issues that needed to quickly be taken care of were addressed because the Health Resources & Services Administration was nimble and responsive. Prior to the pandemic, there were restrictions on where a provider could be located when delivering reimbursable services. The needed regulatory changes occurred with the appropriate advocacy behind them; these changes not only created a way for health center patients to get needed care, but also enabled health centers to earn revenue from billable patient visits. Otherwise, many health centers would have faced far more dire financial circumstances than they did.
One of our lessons in implementing telehealth interventions is that it is more complicated for people who don’t have much experience with telemedicine and whose lives are more complex—due to poverty, childhood trauma, institutionalized racism and stigma around behavioral health conditions, for example—to adopt new technologies. We created jobs for what we call telehealth navigators, who are subspecialized community health workers who know a community, can work with health centers and be trusted to go into a patient’s home to help with whatever needs to be done so that the patient and/or other family members feel comfortable in accessing a needed technology—whether that’s telephone, video or, importantly, remote patient monitoring technology. It is not just about telling somebody to get a glucometer. People need support in understanding what it is, how to get it, how to use it and how it connects into their doctor’s electronic health record. The telehealth navigators help the individual get from the beginning to the middle to the end.
Policies around telehealth should reflect the unique preferences of the population served, because it’s much more important that a person engage with a modality that they’re willing to engage with rather than forgo needed care. As we move forward, telehealth will continue to play a pivotal role in providing better services for people and will be another tool in the toolbox for identifying a community’s and an individual’s unique social drivers of health, and for helping to alleviate those issues.
FH: Federally qualified health centers (FQHCs) are on the front lines of healthcare delivery, especially with respect to primary care, for lower-income, vulnerable populations. In 2018, C3 became an ACO—the only one in Massachusetts to be founded and governed by FQHCs.
a) How has C3’s structure and governance shaped the way in which it serves vulnerable communities?
b) What is the future of value-based care models geared for lower-income and vulnerable patient populations?
CS: C3 is the only and largest 501(c)3 nonprofit Medicaid ACO in Massachusetts and is governed by FQHCs. It is the largest entity of this kind in the country. Our MassHealth ACO has about 230,000 members, representing about $1.4 billion in total cost of care risk. Our structure, particularly the governance, has been the differentiator in terms of who C3 is as an organization. Our management philosophy is a B2B, so unlike a lot of health plans that might identify their primary customer as the enrollees or employers, we identify our primary customer as FQHCs. My Board includes health centers’ CEOs and CMOs. Health centers are much better positioned than C3 or any other health plan in ensuring that people get high-quality care. C3 works with health centers to support them, lift them up and scale them together, so that they can do the brilliant and remarkable things that they do in their communities.
The future of value-based models for people with low to moderate incomes is rapidly changing. When Medicaid was strictly a fee-for-service enterprise, there were some Medicaid managed care organizations, FQHCs and public hospitals in the Medicaid market, but there weren’t a whole lot of industry players. As the Centers for Medicare & Medicaid Services, and therefore state governments, have moved forward with metamorphosizing the fee-for-service model to a value-based environment, other industry players like start-ups, venture capitalists, private equity firms and publicly traded organizations, are now entering the Medicaid market. Their value proposition generally is that they will underwrite the total cost of care risk and cover the downside risk, and in exchange, will take a portion of health centers’ revenue. That’s how I see the market evolving. That’s also how C3 is different because that’s not what we do. Since C3 started doing business in 2018, 98 percent of all the money we’ve saved has gone directly back to the health centers.
Key findings from the evaluation research of ACOs show that physician-led ACOs outperform hospital-led ACOs. If that trend continues, it would seem that, over time, private and public purchasers will want to direct business more toward provider-led ACOs and less toward hospital-led ACOs.
FH: It is expected that the COVID-19 pandemic’s sequelae related to population health and the economy will be felt for years to come.
a) With greater attention now being paid to the importance of preventive public health, what opportunities do you see for strengthening, or rebuilding, a public health infrastructure at the local, state and federal levels?
b) What healthcare issues in the wake of the pandemic should be given greater attention in the public forum?
CS: As we revert to the new normal, my optimistic hope is that our country doesn’t forget that during the pandemic, when a lot of places closed, including medical facilities, FQHCs stayed open and went even further in fulfilling their missions. They were recognized as the country’s premier public health infrastructure for treating people who presented with COVID-19 symptoms and for administering COVID-19 vaccines. I hope that health centers do not become underfunded as they have been in the past. Health centers are providing the preponderance of care around the public health crisis of substance use disorders. When it was thought difficult to find providers who had privileges to prescribe medicines for substance use disorder, health centers already had adopted criteria for credentials needed by primary care providers and behavioral health clinicians to prescribe drugs like Suboxone.
I think it’s critical that all interested parties stay vigilant about policies that protect and advance the financing sources of health centers, for example, the 340B Drug Pricing Program. The program was intentionally designed as a pharmacy program to provide FQHCs with a cost center with a positive operating margin to cover deficits and services for areas like behavioral health and dental services. With that program now deeply under fire, we are working to understand the legitimate concerns about the program and ensure that those who need it, like FQHCs, are not subject to widespread change that would throw the baby out with the bathwater.
An additional area that should be given greater attention in the public forum is the paradox of excess and deprivation in healthcare. Why is it that in Massachusetts a gold-brand health system is paid 10 times the amount for the same bundle of primary care goods and services that health centers are paid to care for a patient who has commercial insurance? It’s market power, but what is the best way to have civil public discourse and enact appropriate public policy to rationalize the enormous discrepancies in payment parity for services rendered to a patient? If we can preserve programs, like 340B, that work for health centers and rationalize the payment system, then I think we will go a long way toward shoring up the public health infrastructure and continue to help those served by health centers.
FH: FAIR Health has continued to lead as a source of independent and objective price and utilization information. Looking to the future, how do you predict FAIR Health’s role in the healthcare sector will evolve? What role might healthcare transparency play in addressing health disparities and improving patient engagement?
CS: As a new Board member, I certainly don’t want to represent that I am expert on the amazing organization that is FAIR Health. I look forward to gaining knowledge about the company as I continue to serve on the Board. Looking to the future, FAIR Health may be able to play a bigger role, from an objective and independent perspective, around disparities between price and utilization in the Medicaid environment—for example, how individual characteristics of race, language, ethnicity, disability, zip code and prevalence of specific conditions, like behavioral health, relate to issues that FAIR Health may uncover regarding characteristics of price and utilization variation. That would then lead toward addressing health disparities and promoting healthcare transparency.
*FAIR Health interviews reflect the views of the interviewee in his or her individual capacity and not necessarily those of FAIR Health or other organizations with which the interviewee is affiliated.