Leaders in the payer space are making changes to simplify members' experiences, improve equity and level-up the way their teams work together.
The 32 leaders featured in this article, part of an ongoing series, are all speaking at Becker's 2024 payer roundtables. This includes our spring Payer Issues Roundtable, which is set for April 8-9, 2024, at the Hyatt Regency in Chicago. Some executives will also speak at our fall Payer Issues Roundtable, which is set for Nov. 4-6, 2024, at the Hyatt Regency in Chicago.
If you work at a health plan and would like to join as a speaker in April or November, contact Randi Haseman at rhaseman@beckershealthcare.com.
Question: What is one change you made in the last two years that had great results?
Abdou Bah. Senior Vice President of Medical Management and Chief Health Equity Officer of EmblemHealth (New York City): EmblemHealth simplified utilization management by eliminating the prior authorization requirement for nearly 20% of services. Streamlining prior authorizations has removed barriers to care and expedited the process for all involved. We did this as part of a complete effort to simplify the healthcare experience for our providers and members. This has allowed providers to spend less time processing prior authorization requests and more time helping their patients and our members get and stay healthy. Simplifying prior authorizations has enhanced operational efficiency and increased satisfaction for our providers, members and our internal team.
Susan Beaton. Vice President of Health Plan Strategy at Wellframe (Boston): Over the past two years, Wellframe has actively worked to impact the overall experience for health plan members. Our research revealed that many members were unfamiliar with care management, so we created marketing campaigns to educate them on the benefits before urging them to onboard the platform. These campaigns have been highly successful, with above-average open and clickthrough rates, as well as increased member engagement on Wellframe.
Danielle Brooks. Director of Quality Health Equity at AmeriHealth Caritas (Philadelphia): In the field of health equity, many concepts and activities have tended to be wrapped in academic terminology. This has made it harder for stakeholders to clearly define the issues and to implement the work that is needed to operationalize health equity initiatives. In the last two years, we have had success in really breaking down that terminology to make concepts more tangible and actionable so the initiatives are more likely to produce positive results.
Neel Butala, MD. Chief Medical Officer of HiLabs and Assistant Professor at the University of Colorado (Aurora): Just last year we expanded our AI engine to cleaning clinical data for health plans, and, in that time, we have already analyzed over 8 billion patient records. It was a logical evolution of our AI engine which has already proven to be a powerful resource in cleaning dirty provider data. This expansion was meaningful for me as a clinician because I know applying AI to clean and enrich clinical data has massive potential for my patients, my fellow providers, and payers. We won't be able to realize the potential of AI for predictive medicine until we address the data quality problem head-on. I find it extremely rewarding to see our technology applied at scale in such an impactful way, a feeling that is galvanized by the reception this solution is experiencing among our health plan partners.
Ceci Connolly. President and CEO of Alliance of Community Health Plans (Washington, D.C.): Nearly two years ago, we began to work with our member companies to brainstorm ways to take Medicare Advantage to the next level. Today, we are tackling barriers and pushing for policy change with a sweeping set of policy proposals called MA for Tomorrow. Our dedication has resulted in quick action. CMS' proposed rule to cap broker fees and ban misleading marketing protects seniors, saves taxpayers money and brings us even closer to our vision for the future of MA.
Rushil Desai. CEO of Aetna Better Health of Illinois (Chicago): Health equity is the foundation of our health plan and continues to drive our mission to implement innovative solutions to drive health outcomes regardless of a member's socioeconomic background. Over the last few years, Aetna Better Health of Illinois expanded the use of data and artificial intelligence to isolate disparities impacting our members, and we built customized initiatives and digital platforms to increase service delivery to the state's most vulnerable populations. We launched several partnerships to expand digital health solutions for prenatal and postpartum women to increase care to moms and babies from birth planning to ongoing, key patient care. We partnered with teams to build digital twinning for Type 2 diabetes patients, 24/7 AI chat bots allowing members to access information from their phone and expanded concordant telehealth solutions offering healthcare providers who look and sound like our members for access to physical and behavioral health services. We continue to expand access to care in a growing digital world to improve health outcomes — the cornerstone of our health plan.
Erin Drinkwater. Chief of Government Relations and Strategic Partnerships at MetroPlusHealth (New York City): In the past two years, MetroPlusHealth has significantly enhanced our healthcare offerings by bringing behavioral health services in-house. This change has led to notable improvements, particularly in expediting outpatient follow-up care for individuals with substance use disorders. By integrating mental health professionals into substance use disorder facilities, connecting patients with community-based organizations and adopting a peer support model, we've not only surpassed statewide averages but also ensured holistic care for our more than 750,000 members. Our in-house model makes it easier for us to identify, monitor and partner with our members and providers, efficiently enabling us to successfully treat their physical and mental health needs, while also addressing social determinants.
Stacy Edgar. Chief Executive Officer and Founder of Venteur (Berkeley, Calif.): We have been able to analyze and use our growing database of information to better target our customers and serve them with better healthcare options. This use of data has also helped us to trends that you wouldn't expect. For example, we discovered hospitals were ideal customers for us when looking at the size of the opportunity going against some of our original targeting when Venteur first started out.
Paige Franklin. CEO of Aetna Better Health of Kentucky (Louisville): After becoming CEO of our Kentucky Medicaid plan, I took a refreshed approach to strategic planning. I shifted toward a more collaborative model, securing buy-in from leaders across every department — not just the C-suite — through monthly meetings and yearly planning retreats. Each of our teams worked in tandem throughout the year to create directives informed by their expertise. This increased cohesion helped us create, meet and exceed benchmarks that matter to the members we serve.
Hillary Galyean. Vice President of Enterprise Account Management of First Choice Health Network (Seattle): Letting go of perfection and challenging my team to do the same. It is important to have structure and clarity when launching new products/solutions; however, "perfect is the enemy of good." We are participants in the never-ending school of life, whereby continuous improvement is critical, and perfection is impossible. I have relinquished the idea of perfection.
Tom Grote. CEO of Banner | Aetna (Phoenix): Over the last two years, Banner|Aetna has seen great success in the Affordable Care Act marketplace. We created individual and family plan offerings with innovative programs and benefits that have fueled exponential membership growth. When we first entered the marketplace, we had less than 4,000 covered members. Now Banner | Aetna covers 30% of the entire Arizona individual market.
Robert Groves, MD. Executive Vice President and Chief Medical Officer of Banner | Aetna (Phoenix): At Banner|Aetna we are beginning to reimagine care management. We have hired a professional dedicated to developing local, community building, population health strategies. Philip Randall led the development of the highly successful Banner | Aetna kitchen, which we continue to expand to meet the needs of the local communities we serve. This program invites high risk members to a "cooking show-like" experience with members attending a series of hands-on cooking demonstrations. Both a chef and a dietician are there to answer questions and give guidance. The members then take home a bag of ingredients from the lesson to make fully independently at home. Though the actual program has limitations on scaling, the experiential learning is likely to be far more effective than a Power Point didactic. Members love the experience as demonstrated by both the volume and effusiveness of testimonials and the waiting list in spite of ongoing program expansion. We should not underestimate the value of good old fashion "viral" spread of information. In this case the spread is not digital but person to person. Attendees enthusiastically share what they have learned with family and friends. Finally, getting together with others on a shared journey promotes relationships and community. These are the ingredients that give life meaning and purpose. We desperately need this in a post-pandemic world where loneliness and isolation are increasing.
We are expanding the concept this year in what we call an "Eco" — an ecosystem of programs and opportunities for our most vulnerable members. The concept is being extended to include "Banner | Aetna Active," which invites members to get moving with fun walks and outings to nearby attractions along with instructions on how to safely stay active year round. We are partnering with community organizations like the city of Phoenix, Rio Salado College and many other community organizations to serve our members and connect them to the broader community and their fellow members.
Sheri Johnson. Vice President, Billing and Enrollment at UCare (Minneapolis): Over the past two years, the membership billing and enrollment team at UCare incorporated a change that significantly increased engagement. Two years ago, I discovered my leaders had no standard for the cadence and/or the content of 1:1 conversations. I also learned that, in general, employees did not find the 1:1 conversation valuable or a good use of their time. To address this, we implemented a standard 1:1 process with specific topic categories. These categories included: recognition, progress toward goals, current barriers, new ideas and several more. These categories were then put into a framework that added structure while also allowing flexibility for leaders to use their own style in the conversations. The 1:1 became a two-way exchange between the employee and the leader rather than a one-way conversation.
The results were remarkable! The annual engagement survey showed a score of 79%, an increase of five points from the year before. The Direct Leader Category improved 11 points! Within the Direct Leader Category, there was significant improvement on specific questions that tied directly to the new 1:1 framework. Employees gave leaders high marks for setting clear expectations, providing support and freedom for employees to express their opinions, as well as providing valuable feedback year round.
Taking time to review the 1:1 process and making simple changes to make the conversation more effective can have a positive impact on the employee-leader relationship and employee engagement. By increasing employee engagement, you will ultimately drive organizational results.
Edward Juhn, MD. Chief Quality Officer of Inland Empire Health Plan (Rancho Cucamonga, Calif.):
When it comes to fostering real and lasting impact through the improvement of quality outcomes for our 1.5 million members, Inland Empire Health Plan goes "all in." As part of the ongoing pursuit toward IEHP's mission to heal and inspire the human spirit, we increased funding for our 2024 Global Quality Pay For Performance program to $288.9 million. This significant commitment has led to great results, including the ability to:
- Reward clinicians and hospitals who achieve key quality improvement measure goals.
- Motivate those individuals and entities who may not be performing as well.
- Meet the evolving and dynamic needs of our network and members.
As this innovative initiative demonstrates, IEHP puts our money where our mouth is — not only to promote positive change and achieve top-tier quality performance levels, but also because it's just the right thing to do for our members, providers and the expansive Inland Empire community we serve.
Michael Kobernick, MD. Senior Medical Director at Blue Cross Blue Shield of Michigan (Detroit): One change that has great results is the focus on social determinants of health. We know that just because someone has health insurance does not mean they can afford healthcare. Paying attention to social determinants of health allows for interventions that help people get the care they need.
Neil Kulkarni. Vice President of Customer and Clinician Experience Solutions at Highmark Health (Pittsburgh): We've made significant investments and improvements in streamlining and delivering an integrated digital experience over the last two years and just launched a new digital experience called MyHighmark. We've seen strong adoption and engagement from our customers through our new digital channel, and this experience will allow us to better engage customers not only in the core administrative aspects of their health insurance but more holistically in a way that helps them stay healthier and manage their health through various clinical programs as well.
Hossam Mahmoud, MD. Regional Chief Medical Officer of Carelon Behavioral Health (Boston): Over the last two years, Carelon Behavioral Health has enhanced our data analytics and predictive algorithms to support health equity. In order to help address disparities in healthcare outcomes, both qualitatively and quantitatively, we have used enhanced data analysis and algorithms to develop a clearer understanding of the dimensions and factors associated with these inequities. Having such granular data and predictive algorithms is necessary to develop impactful initiatives to tackle these disparities and close the care gap. Our medical directors have played an integral role in the use of such advanced data capabilities, collaborating with the quality, clinical and analytics teams to identify such disparities, understand the contributing factors, and design programs to mitigate them.
Mamata Majmundar, MD. Chief Medical Officer of Evry Health (Texas): We have been working hard on a system that uses technology to look at a lot of information and make personalized care plans for our members. It might take a while before we see results, but the initial indications are positive. These care plans consider each person’s specific needs and situation. By using care plans we are looking to increase member education and engagement about their overall health, and identify emerging health issues sooner. This should also help improve member experience.
Hilary Marden-Resnik. President and CEO of UCare (Minneapolis): UCare continued to evolve our work arrangements to meet employees' post-pandemic expectations and preferences in a way that was aligned with our strong workplace culture. For example, at a time in which many employers began mandating employees return to the office a certain number of days per week, we instead adopted an approach we call "Office for Your Day." This approach allows employees to coordinate with their leaders when they work from the office or home on any given day, depending on the requirements of the day and their personal preference. The approach demonstrates that we trust employees to use their best judgment on what will maximize their effectiveness and personal needs, and acknowledges the personal pressures that many employees are facing. The approach has been wildly successful; it has been one of the many factors that has contributed to UCare retaining employee engagement scores on par with the highest national benchmarks and preventable turnover of only 3.2%. And UCare employee performance has remained high throughout!
Joanne Mizell. Chief Operating Officer of Banner | Aetna (Phoenix): This year we launched a high-touch onboarding experience for newly enrolled Banner | Aetna members that has received excellent feedback. As part of the enhanced approach, we reach out via phone directly to new members to help them understand and get the most out of their benefits. Everyone who took the call (100%) said it was helpful and they appreciated it.
Britta Orr. Chief Medicare Officer at Allina Health | Aetna (St. Louis Park, Minn.): Over the past two years, our team at Allina Health | Aetna built and deployed a new local service model to improve member understanding of benefits and increase satisfaction. This consumer-focused approach allows members to talk to member advocates by phone, email or in person at our local office. The plan added nine new positions that report to the local office, growing our dedicated Medicare staff from 16 to 25 and focusing on member advocate support and community engagement. Member Advocates took and resolved over 1,400 appointments in 2023 to help members navigate their Medicare Advantage plans. In its first phase, the model achieved a 16% reduction in calls to customer service and a 23% reduction in repeat calls.
Stephen Parodi, MD. Executive Vice President of the Permanente Federation and the Permanente Medical Group (Oakland, Calif.): Kaiser Permanente's advanced care at home program has had tremendous results, with fewer hospital readmissions and higher patient satisfaction. In addition, patients are less likely to experience delirium and healthcare-acquired conditions that can complicate a person's recovery. This program aligns with our "whole person" approach to healthcare because it invites us into our patients' homes, where we can gain tremendous insights into their lives. For example, we see the medications on their tables, enabling better medication reconciliation. We gain true insights into the social determinants of health, understanding whether they have transportation needs and food insecurity. These insights enable us to address the underlying causes for what ails our patients and the nation to address both acute and chronic disease.
Ria Paul, MD. Chief Medical Officer; Executive Medical Director, Value Based Care Program, Associate Chief Quality Officer, Population Health and Ambulatory Quality at Stanford Health Care Alliance; Stanford (Calif.) University School of Medicine: In the last two years the major change that was done at Stanford was to integrate health plan clinical activities with the healthcare delivery system. Prior to this integration, the health plan case managers worked in a silo and had limited connectivity with the delivery side. The removing of silo enabled the health plan case managers to perform care coordination activities in tandem with the inpatient and outpatient clinical staff and support the member across the care continuum
EHR accessibility together with periodic touch points between health plan and care delivery staff enabled better care for the member and also addressed the needs of the patient in a timely fashion with a reduction in readmissions/ER visits and better patient and provider satisfaction.
Raven Ryan Solon. Chief Compliance & Regulatory Officer at MetroPlusHealth (New York City): We had a strong 2023, hitting peak membership at 760K. As we continue to grow, having a solid infrastructure is key to maintaining a seamless process. In the past couple years, we've restructured the compliance and regulatory teams at MetroPlusHealth as we scale the business. We've utilized available technology such as SharePoint, Service Now and QuickBase to use the resources available more effectively and efficiently. For example, by leveraging one of our workflow management tools, we were able to process over 100 company P&Ps in less than six weeks. Without the tool, it would have taken a couple of months to do that volume of work. This, in turn, has allowed our teams to cover more ground thoroughly and quickly.
Ted Regalia. Vice President of Pharmacy Benefits at Network Health (Menasha, Wis.): Two years ago, we as an organization decided to stop chasing rebates and instead, focus on lowest ingredient cost. Our adoption of biosimilars has been successful for a couple reasons. First, we watched ASP prices come down on both biosimilar and originator products as utilization of biosimilars engages market forces. Second, I can sleep better at night since many of these drugs are priced as a percent of cost, therefore our members will have lower costs. Third, in some cases, we are actually getting drug manufacturer rebates on biosimilars in addition to the lower cost.
If we are going to lower healthcare costs, competitive market forces appear to be one such option.
Barry Streit. Senior Vice President of Growth at Essence Healthcare (Maryland Heights, Mo.): Over the last two years, one impactful change at Essence Healthcare has been our focus on listening to the needs of the generation entering the Medicare space.These late-stage boomers are more technologically inclined than their predecessors, which means their digital expectations aren't necessarily aligned with what's currently being offered by many health plans. We have prioritized improvements to our online experience, including things like better shopping and price comparison tools, easier enrollment processes, and more robust, relevant digital communications. Delivering a five-star member experience means we must continue working every day to find new ways to better meet the evolving needs of healthcare consumers, and this approach has paid off. Not only has Essence experienced increased enrollment rates and member satisfaction, but there is a real excitement within our own team members as they see the response from both our members and those in the market.
Kelli Tice, MD. Vice President of Medical Affairs and Chief Health Equity Officer at GuideWell and Florida Blue (Jacksonville): At GuideWell and Florida Blue, we take our role as a health solutions company seriously and see efforts to eliminate health disparities as a core component of our broader mission to help people and communities achieve better health.
Health equity cannot be an initiative that one person or one team can own. At GuideWell everyone is empowered to serve as a champion for health equity. In fact, it's a core tenet of our strategy.
But this work is only meaningful if it is sustained, and over the last couple of years we made a concerted effort to ensure that health equity concepts are deeply embedded in all aspects of our business operations.
To do this, we made health equity training core to our professional development. We invested in training our board of directors, leadership teams, clinical team members, and provider partners to regard health equity as a business imperative. These trainings have supported strategic planning at every level, all of which now include a deliberate consideration of how to address or enhance health equity.
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): I decided earlier this year to invest in a very small time commitment at the beginning and end of each day using "The Three Question Journal" by Dr. Rangan Chatterjee. The book asks three questions of you in the morning and three at night. All of the questions are designed to help you be more mindful and to achieve a place of calm through morning reflections and evening reflections. The results of spending a small amount of time in the morning reflecting on what I want to achieve for the day and in the evening on what I accomplished, and what I could do differently the next day, has continued to pay dividends in terms of my focus and ensuring I am spending time on the right things at the right time, not only at work, but also in my personal life.
Jennifer Shermo. Chief Growth Officer of Security Health Plan of Wisconsin (Marshfield): In the last two years, we've re-energized our sales team and strategies leaning into relationship-based selling, aligned incentives and increased distribution channels. By focusing on understanding customers' needs and preferences, our sales team was able to tailor their approach to offer personalized solutions, enhancing customer satisfaction and loyalty. Strong relationships drive sustained growth by transforming customers into advocates. Since its implementation, these new strategies have earned Security Health Plan 4% to 5% net growth for two consecutive years, following several years of negative growth. But most importantly, our team morale and engagement has reached an all-time high.
Don Stiffler. Chief Revenue and Growth Officer at Commonwealth Care Alliance (Boston): Commonwealth Care Alliance is known for serving individuals with the most significant needs, including complex clinical and behavioral health diagnoses, substance abuse and SDOH issues. Over the past two years I have helped lead our organization — specifically our products — to become more responsive to the unique needs of our members.
Tailoring product design to address SDOH needs, including food and housing insecurity, and access to transportation; leaning into the unique needs of dual-eligible members with chronic conditions; and launching innovative programs to address non-traditional social needs like loneliness or legal assistance.
In 2024, our membership is nearly double what it was in 2021. A significant portion of our growth can be attributed to our focus on developing products that are closely aligned to our mission to improve the health and well-being of people with the most significant needs by innovating, coordinating, and providing the highest-quality, individualized care — resulting in a higher degree of member satisfaction.
Natasha VanWright, RN. Senior Vice President of Clinical Operations at Belong Health (Philadelphia): For us, automation and artificial intelligence are exciting because it frees up more time for human-to-human clinical engagement. We've really been able to leverage cutting-edge AI tools to streamline care management. A lot of efficiency came from centralizing the data into a format that makes sense and making it securely available across our infrastructure. But we also gain efficiencies by using AI to translate the data into things that are specifically meaningful to the end user. AI allowed us to reduce the cognitive stepping stones between raw data and action. This has led to reduced administrative burdens, enhanced both the member experience and clinical engagement, all leading to better healthcare outcomes.
Troy Williams. Vice President of Hospital Partnerships at First Choice Health Network (Seattle): One change that I've made in the last two years is to be more intentional about relationships in which the majority of our interactions occur through virtual means. This is particularly the case for new relationships where I've had little or no time to spend face-to-face building trust, alignment and collaboration.
Michael Weber. Vice President of Sales, Client and Health Promotion Services at Dean Health Plan by Medica (Madison, Wis.): As we emerged from the pandemic, virtual meetings and remote work became the norm. And for good reason. The world changed because of COVID-19 and the workplace needed to adjust, too. However, I recognized the importance of preserving personal connections. To that end, I prioritized in-person opportunities, even if they were occasional and complemented by virtual meetings. These face-to-face interactions have proven invaluable in building relationships, fostering trust and gaining benefits from personal, business and community perspectives.