锘縅ennifer Colamonico
Welcome to another episode of 红领巾瓜报鈥檚 Vital Viewpoints on Healthcare. I'm your host, Jennifer Colamonico. Today we're exploring the concept of resilience, how local health services and agencies can navigate uncertainty and maintain stability, especially as federal support is evolving. Our guest today is John Eller. John is a managing principal at 红领巾瓜报 in the North Carolina office, and John has dedicated his career to improving outcomes for vulnerable populations through system integration, policy innovation and strategic planning.
Beginning his career as a social worker, John went on to lead the largest social services agency in North Carolina as the director of Social Services in Mecklenburg County. His expertise spans Medicaid transformation, child welfare, behavioral health, aging services, and economic assistance programs. He's played a key role in shaping policy at local, state, and national levels, advocating for evidence based approaches to improve service delivery.
And he also served as a former county manager, for which he was a policy advisor to the Board of Commissioners. Over his career, John has worked to align health care, human services and community based organizations to drive meaningful change. John, thanks for joining us today.
John Eller
Jenn, good to be with you.
Jennifer Colamonico
So, we are talking about resiliency. And, you know, we're recording this in 2025 at a point in which I think this conversation is, is fresh and and perhaps being challenged from, from different angles. And so how, you know, how we provide stability in providing critical services. People have to be creative. So how are you thinking about this right now?
Thinking about and working with local entities, who are facing a tremendous amount of change and a need to figure out how to be more resilient.
John Eller
Yeah, I think in general, when I think about resiliency, I really think about the ability to be nimble, collaborative, innovative in, in a time that has a lot of disruption. You know, we're uncertain about funding. We're uncertain about certain programs, we're worried about sustainability. You know, and what I found is that communities, really rally, during those times.
And so with the support of, local governments at the state level, at the local city and county level, but also between the public and private and, and nonprofit and faith space. We do see a lot of creativity that tends to occur. So you can't really talk about resiliency without thinking about community resiliency, because that's really where it's at.
And I've learned that every community is uniquely different. One size doesn't fit all. And so that's why it can be really challenging when federal policy shifts occur. Because no community looks the same. And so when you think about local governments in the health human services space and their essential services, that they provide, they're really a constant for their communities in the midst of uncertainty for any policy change.
And they have a very high amount of trust. And I think that trust is sometimes underestimated. Trust really helps, push, support. It also helps resting people when they're worried about all this uncertainty. What am I going to do? And really calms them down and centers them in a way that says, look, we've gone through hard times before, we can do this thing again.
And so, really, what I've found is in the midst of an uncertainty, trust is one of the most important elements. And so I've never underestimated that in any community that I've been part of, and thinking about that space. And so, I can't help but think about the Covid, the pandemic, the Covid 19 pandemic, we were constantly having executive orders change from the governor's office, from the federal level.
Every day was something different. And as a county manager, you're telling the public, here's what we're doing today, and it changes. And then here's what we're doing tomorrow. But they trusted their local community. And so even though it was coming from a federal state level, we were able to boil it down. And what does this mean for us?
How are we going to adapt to this? What does it look like in our community? And so I found that, you know, in the midst of this unpredictable world we live and that local governments really are a true resource to their communities, and, and they're trusted. And so to me, that's the differentiator in this space.
Jennifer Colamonico
Yeah. I think that's interesting. You know we tend to face every crisis. You know some of your first instinct I suppose is sort of hair on fire. This is a crisis. But you, you know, I make the important point that these local entities, they have to be resilient all the time. I mean, they face challenges, certainly, as you mentioned, with Covid, right?
Previous, federal changes, but also state changes. So it seems almost a business practice of any local entity serving the public is the ability to be flexible and resilient.
John Eller
Yeah, absolutely. I mean, they have to be so nimble and they have to adapt and, and and sometimes pivot really quickly, as some of them get, you know, a great amount of federal and state dollars, others not so much. And so, you know, if you've seen one county or city or state, you've seen one. I mean, they're all so drastically different.
And so, you know, even when you're thinking about natural disasters or, community issues that arise or drastic shifts in policy, they really learn to be nimble and, and in the midst of unpredictability, you know, they they've always risen to the occasion.
Jennifer Colamonico
Yeah. And you're in North Carolina, so you obviously went through a natural disaster quite recently. Do you think that some of those community resources are taxed or a bit sort of wiped out from the hurricane response, or do you feel that they're kind of doing okay to, to weather this next, you know, policy storm.
John Eller
Yeah, I think that's a I think that's a great example to think of, you know, Hurricane Helene, definitely was a hit to us, you know, some of our communities. And the response to that is have just been, just an outpouring of love. And, no, we haven't bounced back fully. And in the midst of, you know, people still suffering and struggling from that, you know, there's still a lot of uncertainty that exists.
But, you know, I think because of the variances that, the local folks, the local governments experience in this space, you know, and some have those dollars and others don't. You have a lot of local dollars, a lot of, innovative communities across the country that they fund a significant amount of what happens in the community. So, they're not solely reliant on a federal dollars.
So when they're cuts like we're dealing with right now, they really diversify their revenue streams. And so they're able to weather those storms a little bit better. I think it's when, you're in situations like a storm recovery or, when the diversification isn't there, they have to look at really, really hard things. And make some hard choices from reassessing their tax rates.
Trying to figure out how to see foundational supports, strengthen their public private partnerships, consulting with nonprofits about how to solve problems that government used to solve on their own. Because now government can't do it all on their own. And regional collaborations and partnerships that exist. So when I think about, you know, what the storm did to, to our state and others, I know, you know, I can't help but think of a statement, that I heard someone say wants is like, everyone wants to coordinate, but no one wants to be coordinated by anyone else.
They don't want to be told how to do it. And what we found with, the storm here is no one waited for the federal government. We were happy they were here. But you'll see from across the country we had volunteers, nonprofits, faith communities, businesses, and even local governments rallying together. And they were able to meet their needs.
I mean, it was amazing to see the resources. You can't backfill, you know, hundreds of thousand dollars and millions of dollars of damage or need that needs to occur. But the one thing that stood out to me was the resiliency, that was in that space of the human spirit. And, you know, when you can't give anything else, you can always give hope.
And I think that's the greatest example, when government couldn't do everything and when the need was so great and the response time had to be so quick, everyone lifted together. And I found in the end, in those situations, the end result is usually always stronger and even smarter sometimes than as a local government employee that we could have even come up with on our own.
So, it's a great example of how communities rally together when something big happens that they can't control. But they're willing to lean in and do anything they can to help.
Jennifer Colamonico
Do you, so that that's that gives you hope, right? You sort of hope that it does, roll out that way. And I wonder if maybe we could get a little specific to, you know, what communities are facing now, and it's all theoretical now, right? Obviously the bills are theoretical and construct coming from the feds.
But anticipating that, you know, we'll see cuts, in some form to services, coming from the federal government and funding. So I guess the question is that, you know, if you were in your county manager role, I mean, what kind of advice, would you be giving your agencies? I mean, do you and and do you expect, you know, do you expect that the communities, the foundations, the community, actors that you talked about are going to be able to fill the gap here?
John Eller
Yeah, I think it would. Well, first of all, you know, I would have to point out to my team that this isn't the first time we've we've weathered, a storm from the recessions that we've had before, to natural disasters now, to, to major shifts and policy change. I think the tricky part is when we think about, you know, the partisanship of a particular state or the color of the state.
What we have to remember is there are many states that have remained one color, or one party for a long time, and when a disruption like that happens where they shift people who are, experiencing things, a certain way, you know, it's drastic and and it causes people to panic. There are many, though, that are in states where, you know, one party has been whether it's a liberal state or a very conservative state, and they've had to navigate federal shifts, I think of North Carolina as a purple state.
You know, we never know which way we're going to swing. And so because of that, we have to operate a little bit differently, because, you know, we have to focus on what needs to be done. Who do we need to serve? How are we going to serve them in a way that transcends, partizanship, but also policy swings.
So we're able to probably be a little bit more nimble in that space, because we've always expected that in a state where they haven't had that, I could see that being much more challenging. And so what I would say to my team is, you know, we've we've been through this before, but don't let, partisanship or, or politics or the fact that, you know, governments still has to, to do what we're doing, right at the local level in particular, elected officials, they have their values, those values.
Right? Policy. But government staff play a tremendous role in how those things are implemented. Right. So we may not control, the decision of the policy itself, but how it's rolled out. And so, you know, I think we're things feel as when we have a policy that doesn't really crosswalk with the business practices, and the organizational structure.
So what I've always encouraged our team to do in the midst of, you know, these uncertain times is really thinking about how do we layer, how do we avoid layering policy over policy and administration over administration. That only creates more red tape for the Health and Human Services. Space. So really, my advice to them will be, okay, we really need to think about how are we going to mix these decisions that are being made with strategic planning and business re-engineering?
Because, you know, we have to change our practices. We have to look at the impact on our population, and we've got to rally our community and figure out how we're going to respond to those things. And if we don't have enough funding to do all the things we want to do, then how can we do that with others at the table with us?
Collective impact models are a great thing. I think if I were in this space right now, I'd be talking to, our regional partners, my local partners, about some of the health related social needs that communities are facing right now and say, how can you help us solve these problems? You know, as we've seen, like these large scale actions taken in government, fill in the blank.
I won't give you examples, but we've seen political shifts and swings before. I think the question I would be asking my team and, and our policymakers is like, where's the failure? And it seems to always be in the strategy, not the decision that was made, but the how, what it looks like on the ground. And that's how we'd start engaging our partners to figure out how do we solve those problems, in a very collective impact model kind of approach.
Jennifer Colamonico
Well, that takes me to some other questions. And I'll just say, you know, you have a unique background in that you're both a social worker and I believe you have an MBA. So those two, it's almost like the two halves of your brain. Perhaps, or, but but it brings a really interesting point of view on this very question, because and especially when we eat, a lot of what we hear is talking about is waste, fraud and abuse.
We you know, we've had another recent podcast conversation on that. It's a buzzword, but it's also real. Right. And so I'm wondering from your point of view, when you think about that creativity, that collective impact that you're talking about and, you know, kind of the human centered design, right? You know, you have a lot of different agencies that are often serving the same people.
Right? There are a lot of, what you might call inefficiencies in some ways, but, you know, have grown up, because of different ways that agencies have developed and formed and funding streams. Right. We know, and there's a reason for that. But, you know, how do you tackle that at a time where, you know, you it's almost kind of like forced eating the hand around?
Let's simplify some of these processes. Let's, you know, take better care but do more prevention, you know, do all the things that we say we want to do. But we often run into those silos and, and kind of obstacles. You know, what would you be looking for now in terms of, you know, inefficiencies that can now be addressed because they kind of have to if we have fewer funds to go around?
John Eller
Yeah. I think when I think about waste in this space and this isn't the first time this has come up, I mean, being in the health matters space for so many years, I mean, the question always comes up is how much fraud occurs. And, you know, should we be providing these programs and are they giving the right dosage?
And are we doing the right thing? So I think all those questions are still going to be addressed, hopefully by local governments and by states. But also I think it's a I think it's a fair question. And so, you know, as I think about all the debates that occur and, you know, how we would deal with those, you know, it's a broader question to answer, when you think about where the waste exists and what programs should we be doing?
It's also about what are we funded and why. I mean, if you think about, before you even get to the waste part, you know, how do we get to offer these programs? And why are we even doing, and so governments have to wrestle with what are the values of the organization, what do we want to achieve?
How are we going to fund it? And so there's always been this debate about when you figure out the what, you have to figure out, you know, where the funding is going to come from. And it can't all come from the federal government. So this isn't like a new debate, but everything from local tax rates to economic development incentives to I mean, we've seen it in the national news, from public safety to education, you know, health care funding, public assistance fund, you know, and then thinking about this evolving infrastructure that's needed to sustain and support, you know, all the things that we want to do from technology to facilities.
So as we live in this virtual world, we kind of have the old way of government operating the way it always has. And now this new trend to figure it out post-pandemic, you know, we can do, things a little bit differently. And I think governments are still wrestling with that. You know, as we think about this reliance on federal or state dollars, it's also about how can we do business a little bit different.
And so while we can't always control the policy decisions or the politics behind it, the challenge when we think about, you know, millions and billions and trillions of dollars that, everyone's looking at right now and how to how to balance a federal budget, you know, when you take that down with the state and local, level, you know, we really have to watch that our spending is an outpacing our revenue.
And I think, that's what we're experiencing and hearing at the, at the federal level a lot. And so at the local level, we've experienced recessions before. We've had to tighten up. We've had to cut. Those were hard times. I mean, I remember, programs that we launched that, you know, we spent our heart and souls creating that we had to stop or put a halt on because of the funding that needed to occur.
But I think at the end of the day, the critical question to ask is, and we learned this during the pandemic and nothing else is what is an essential service. And I don't think as a system, we've ever fully solved that question. There's so much debate over what is essential. As a former social worker, I think a lot of things are essential.
Right. But I can tell you that isn't the case. So I think, we got to look at our work, our workflows and our, our, our workforce and, and figure out what do we have to absolutely have to deliver those essential services whenever we define what those things are and I can tell you at the federal level, those terms can change.
At the state level, they can change. And even at the community level, those things change. So I think we got to figure out, before we talk about what to cut or, what to keep, we've got to identify, you know, are we doing it the most efficient way? But what do we value as those essential services to do?
Jennifer Colamonico
So thinking about the problems that were challenged with and how we're solving them, if you had a magic wand, what is the one thing that you would fix that would really, enable this to get on the right track?
John Eller
You know, if I had my magic wand, it would be about really thinking about population health. What things drive population health. So that health for everyone is really what we want to focus on. And I think values are going to drive that in this new uncertain space. But I think as governments, one thing that we struggle with is, you know, how do you measure those things?
How do you show that the things we've always funded are still effective? And if they're not, why are we still funding them? So we can be innovative and creative and test some new things. And I think that's what we're all going to be having to wrestle with here in the next few years. About the prove it, mentality.
And also, why are we continue to find something that perhaps isn't furthering the things that we would consider essential? So, I think it's a it's going to be a drastic shift in the way that local governments operate.
Jennifer Colamonico
If we're if we're being honest with ourselves, you know, regardless of how we might feel about different policies, you know, they're it's always a good idea to stop and reassess where, you know, are we getting what we need out of these programs, like, are we we don't want to be committed to the program. We want to be committed to the outcome that the program is creating, and it's not creating that outcome.
Then, you know, we need to rethink it. So it, you know, it's certainly an opportunity to reassess. I wonder, you know, you've had a lot of experience in Medicaid transformation and managed care expansion. What do you think about serving the most vulnerable populations? What types of things do you feel we should be doing more of that are, you know, getting, maybe there's not the data.
Exactly. Or maybe we don't have consensus that these are most effective. But in your experience, what have been the most effective interventions in really improving population health and particularly in rural and, you know, for vulnerable populations?
John Eller
Yeah, I think that's a great question. You know, I mentioned the health related social needs. North Carolina has a healthy opportunities, Medicaid demonstration pilot that we've been operating. And it's one of the first in the country. I think other states are looking at it now. And at first, you know, like any new initiative, there were skeptics.
I think it's proven that it's worked really well because now we figured out that, you know, housing is health, food is health. You know, insurances help, you know, mental health is health. But so we figured out how to, how to deal with all of these, adjacent issues that sometimes we only were a medicaid payer.
And so I think that's been really important for us to look at and learn. I think many of us in the social work profession have been saying this for years. And, and I'm glad to see, you know, it's picking up some momentum, but I think health related social needs is something that's going to be around to stay.
An example I'll give you is we had a very, a very conservative legislature one year, very conservative governor and very conservative Health and Human Services secretary. And, I remember the analogy that we were talking about one client in particular who kept going to the emergency room over and over and over again. And the right questions weren't being asked.
And, when the right question was asked, what we found was, you know, that it could be something as simple as in, in the hot summer, someone with asthma may need a window unit that has an air conditioner. That allows them to breathe better. Right. And so when we start figuring out why do people show, in a recurring way, in the emergency room or at their doctor and present that way?
It could be that the simplest thing could make the biggest difference. And I think that's the shift in health care that we really need to think about. And so when I think of, you know, what are some things that we could be doing right now and what's the path forward with Medicaid transformation, but also, Medicaid expansion?
It's going to have to continue to be there's other things. Trauma impacts people. You know, chronic illness is a real thing. Family history is a real thing. And so when we start figuring out why people are presenting and start helping them with those health related social needs, it'll be a game changer. Housing is always tough.
Transportation is always tough. I mean, these things aren't easy things to do. But the neat thing is, is that we're talking about them now in a very open way in conservative states and, and liberal states alike. And so regardless of your party, I think that's a common thread, that we can talk about is how can we make people healthier in a way that prevents them from having recidivism?
And when I think about population health, in addition to those needs, the last thing I'll say is community health. We have to figure out a way to, like, stop making people come into buildings and find ways to go out in the community that they trust, and meet them where they're at. And we've seen so many cities and counties do this very effectively.
So many nonprofits do this really effectively as well. And so I think that spirit is there to continue that. And so I feel really, really good about that. And so that gives me hope, that we've, we're starting to learn about, health being more than what we just thought about traditionally is a player who pays the bill, but really more about the surrounding factors that, really make up who I am as a person.
Jennifer Colamonico
It doesn't always feel like we've gotten to a better place with, you know, with transforming health. But I do think we've made big progress. And you guys in North Carolina, I mean, you mentioned the healthy opportunities, you know, pilot and you've had other pilots in your state. I mean, you've really, I think, done a lot of innovative piloting, if you will, for things that other states can learn from.
Do you spend a lot of time kind of evangelizing that to other states?
John Eller
Well, we've had some really strong state leadership. Who is help with that? So I definitely won't take credit for that. I mean, I can say over my almost 24 years in government, I was about on every Medicaid expansion and transformation, workgroup you could think of as a social services director. But then also, you know, as a county manager, and I think, we had lots of lots of feedback from our community.
I think the state, did this really well as they thought about, you know, what does transformation look like, you know, as a backdrop, before we even got to expansion. And it was, you know, how do we transform managed care in a way that works, for everyone, regardless of, you know, a payer source? And I think that was a tremendous step forward.
And, you know, then we fast forward and we talked about how do we strengthen our behavioral health space and then how do we integrate physical health and behavioral health. And then, you know, our child and family specialty plan that we just launched, that will launch in December and then, you know, the Healthy Opportunities palette.
So it's like all of these small initiatives are starting to culminate together. And I think what we're seeing is that, you know, other states are paying attention. And I think that's a very good thing because all of these steps are leading to, you know, the next thing of true integration of care and holistic whole person care. And so it is really exciting to be, you know, part of that and to finally see expansion as a result, you know, get over this in a, in a very, you know, conservative environment.
And so, give credit to our elected officials, too, because what they had heard from their constituents was, you know, regardless of what party you belong to, people need health care. And, and, and it's going to help us improve our, our outcomes and our, our, our family, plight when when our not only our children, but us as adults, need support.
So it's been good to come from a place of hearing know for all those years to now just seeing where we are now and again. That gives me great hope that other states, who are kind of where we were several years ago, they can get there as well. So, I'm very excited about the future and hopeful.
Jennifer Colamonico
Well, thank you for being with us today. It was a pleasure to talk to you and give you an opportunity to really talk about the great work that you're doing. And, and, we appreciate you.
John Eller
Thank you. Thanks for having me today. Good to be with you.
Jennifer Colamonico
This episode of Vital Viewpoints on Healthcare is sponsored by 红领巾瓜报 Information Services. 红领巾瓜报IS is a subscription based service that provides state level data on publicly sponsored programs like Medicaid from the latest managed care enrollment, market share, and financial performance data to up to date RFP calendars and state by state overviews, 红领巾瓜报IS has all the information you'll need to power your initiatives to success.
This podcast was produced by myself, Jennifer Colamonico along with Tiffany McKenzie in collaboration with our guests. The content is the property of 红领巾瓜报.
