This is Laura Diet with the Becker Healthcare
podcast. I'm thrilled today to be joined by
Sunny Goya, Senior Vice President and Head of
diversified businesses at Blue Cross, North Carolina. Sunny
is pleasure to have you on the podcast
today?
Thanks for inviting me here. Really excited to
speak with you.
Absolutely. And I'm looking forward to learning more
about how you're thinking about the future of
Blue Cross North Carolina and some of the
cool things that you're doing within the community.
But before we dive into that discussion, You
tell me a little bit more about yourself
in your background?
Happy too.
As the head of diversified businesses for Blue
cross, North Carolina.
Effectively manage all of our non insurance companies
and resources that advance the company's strategy to
improve
convenient access to quality and affordable care in
our states.
And I lead the team that manages
multi billion dollar portfolio of companies,
partnerships, joint ventures and minority investment.
In addition to those duties I serve as
an advisor on several boards, including Echo Health
venture, Sure health, All solutions at number of
others.
And my background my professional background here is
that I was in investment banking, venture capital,
strategic planning,
and all of that's been driven by my
interest and innovation. It's a big reason why
I'm actually in healthcare
because I think there's a significant need and
a lot of innovation that's actually happening. That
could really drive tangible differences in people's lives
And excited to be here than speak to
you about it.
Excellent. Well, let's dive right in. What are
some of the biggest trends and headwind that
you're following right now?
You know, let me let me start off
with focus on access to care.
With the current labor shortages driven by the
great resignation and by the number of clinical
burnout outs to really looking forward in the
future to with the next decade of our
aging population is.
It's exciting to see a lot of folks
trying see leverage new services and technologies to
expand access to care.
These services are being groomed by a number
of stakeholders from venture capital,
funding early stage organizations to all the way
together Spectrum where to those that are publicly
traded
and the breath of services that we're seeing
that we're tracking,
range for from pure tele solutions, the hybrid
tech and services hub and smoke for rural
communities,
providing access to quality,
affordable healthcare
across the spectrum, it's really, really exciting
even the number of health systems we see,
that are today focused on rebuilding their care
delivery footprints from,
the big inpatient centers to more ambulatory and
income models. That focus on access to care
is a trend that we are tracking close
way.
You know, the the second 1 here is
what I call diversification and collaboration.
We're seeing a lot of increased investments in
partnerships. And organizations that are attempting to diversify
the kind of legacy healthcare model.
And with so much more and collaboration happening
in industry in my opinion that leads to
nothing but good, but we're tracking this closely.
And those activities are kind of widespread, right?
Their
across a number of different types of organizations
mapping against
lots of different
strategies
some of them are just accessing new profit,
others to provide a more holistic set of
services and solutions to their patients and our
members.
Others are really just simply aligning the use
of their capital towards their company's mission and
purpose and making sure that they're creating greatest
impact on healthcare possible.
And then the third trend that I would
say
that we're tracking closely here is
I think we see a lot significant
investments by almost every stakeholder in healthcare care
on technological advancement. Generative Ai is probably 1
of the more exciting ones that everyone's talking
about
and it does feel like Ai and some
of these new pushes and technological advances are
really driving the entire industry forward versus I
think historically, you've seen a lot of select
views that have 1 and you've got from
losers here.
And that's because there's 3 areas that it's
attacking. 1 is reducing administrative burden think about
automating those back office processes and improving billing
processes,
enabling physicians to focus on high quality care
by managing at a du and mutation activities
or even assisting in diagnosis and treatment of
patients.
And as I mentioned earlier, I think it
can also help the spam the work a
person can do right by
simplifying human interactions in the call centers or
even at the nurse level,
suggesting interventions or
gaps in care that they should be tracking
towards or monitoring
remote monitoring data is really kind of an
interesting 1. So I think that's a really,
really exciting
trend that we'll be watching for quite some
time here. In terms of headwind,
couple I'd call out here. First 1 is
just driving cost
continue
to be a challenge and look to be
a challenge in the future.
We're in an affordability crisis where
today, healthcare represents about 17 percent of Gdp.
And there's about 2 20000000000
dollars in medical debt weighing down 15 percent
of household across its country. At staggering,
when you layer on top of that, the
impact of inflation that's driving up the cost
of delivery and health systems
problem is getting worse. And then couple that
with the price of drugs. We have a
really tough road ahead of us.
Prices of existing drugs are increasing dramatically, the
there's an accelerated pace of new cell and
gene therapies. They're being improved groups.
And I think we're anticipating about 55
by 20 27 that Are got costs so
under 2000000 dollars on average.
And Gl,
I've a friends around Gl and it's driving
up the cost of care,
and I think by 2030, we're projecting about
30000000 Americans we'll be using Gl lps
and that's a staggering number,
even within our own datasets sets, we're seeing
prescription drugs from 20 22 to 20 23
growing up 5 percent,
mostly driven by specialty drugs, which was almost
at 9 percent trees there. But we're seeing
these the rising costs hitting us everywhere.
The second headwind provider shortages and labor costs,
9 I mentioned this is 1 of the
most critical areas
is our workforce shortages.
Today, about hundred million Americans Live in an
area with a primary care shortage.
As effectively 30 percent of our population living
in an area without adequate primary care coverage
to make that work
to make that come even more real 166000000
people live in an area with mental health
shortages.
So when you look forward here
over the next decade,
we're anticipating and projecting somewhere in about 124000
position shortage in the U. S. That is
staggering.
And there is such a critical need to
continue to develop and leverage technology and find
alternative ways to deliver care to start to
address this headwind, but it is a day
that's impacting everybody.
Technology
So those would be the the 2 headwind
that I would call out.
Well, that's fascinating. And, you know, you really
covered a lot of ground in terms of
seeing so many different...
Areas where you really... There's opportunities for growth
and development continue to
provide clearance, bridge some of those gaps, and
it fascinating too to hear about how you're
thinking on some of the rising costs of
new drugs, inflation,
especially some of those innovative,
solutions and treatments,
therapies as well that could be really beneficial
for certain patients, how to navigate that and
make sure there's access to care when it
will make a big difference.
So, you know, I just... Feel like there's
so many things happening right now as you
said,
and so the opportunities to really
continue to grow and develop. I'm wondering how
you're thinking about growth for the future. What
does that look like for...
Blue Cross of North Carolina?
Yeah.
Great question. You know, I'm I'm really bullish
on the growth for insurers and in transforming
healthcare. And I think that's the really important
statement of transforming healthcare. Because I think there
will be some
insurance companies who will focus on
what they have done over the past
10/20/4080
years of their existence.
But I think we need to be transforming
and meeting the needs of
what our stakeholders are our members our patients
are looking for. And so I'm excited about
maybe 3 categories here of growth for us.
I see a lot of opportunities for payers
that seek out new partners
for every investment we make, there must be
a measurable
health outcome for our members
and those outcomes will vary but they're always
present. I'll give you some examples here at
North Carolina.
We a few years ago partnered,
and founded a company called All Solutions.
Did this in partnership with a private equity
firm.
The intention was to build
a company that could support independent primary care
across our states.
Today only a few years later, we are
managing 36 locations across our
our triangle and Charlotte regions providing high quality
primary care that has integrated of health psychiatry
nutrition, chronic care management
and a number of other services that you
can see in person and virtually.
Another partnership we partnered with Mar Group to
provide Medicaid services in our states
we now are the largest plan and manage
just about 600000
lives across our states ensuring that
those of the media population have access to
high quality carriers to improve their lives.
I think there's a lot of other opportunities
to partner as we think about the future
and so those platforms I think are going
to hit in categories like better member engagement
to provide our members
and our consumers, the answers are seeking
and to be able to help support the
decisions to improve their health turning.
Another area that we are exploring here is
expanding
clinical data interoperability and decision sports to effectively
share our data and enable physicians and providers
to be able to guide their patients to
make better more informed decisions.
We think that be really critical.
And so there's a number of other
categories
that we have
expanded into, like dispatch health getting into income
care.
We've been partnering with health systems to think
about new payer and
care management type solutions. So I think partnership
is going to be a big category and
it's a big category of for our success,
but also success as we look forward,
The second category I'd takes talked about is
the health, what we call the front door
healthcare.
We think there is a large
opportunity and helping our patients and our members
navigate the care they need. But there's been
a lot of dollars
spent into navigation and transparency solutions,
range rewards, platforms and many other types of
platforms
and network
The solutions have been successful, but there's so
much more opportunity here. The reality is our
members and our patients they need so much
more from us.
So we are,
really focused on partnering and creating a seamless
high quality care delivery footprint. That will be
more integrated with our services
to create amazing experiences for all North Carolina.
And that front door of healthcare
really shouldn't just consist of tech solutions
should should incorporate human supports, how do we
actually leverage the things. But also
a network across the state of all of
those front door assets of urgent care is
primary care, ambulatory surgery centers, women's health health
telehealth solutions. How can we create that integrated
bridge with all those good people join
sorry, enter into their healthcare journey on very
different spots.
I think back to recent announcements here where
the number of retailers who kind of wanted
into this and brick and mortar was the
O gateway here,
but healthcare is complex.
And what works with people to pick up
a pan, It's not the exact same thing
as to pick up and actually get their
health care needs served.
You really have to think about a synthetic
or a real integration approach to insurance
and the care delivery
actually makes this successful. That's what we believe
the value comes from ip payer and a
provider creating an integrated front door
at collaboration that's going to be really successful.
It's going to drive better value based care.
Better referral management improves member and patient experience,
etcetera. So that's a second. And then the
last 1 is a big area for carolina.
We're really excited about the growth in value
based care and all the models surrounding it.
I think in January,
Be estimated that about 90000000 lives will be
in value based care models and contracts by
20 27,
more than double where we were in 20
22, which is about 43000000
lives.
A lot of this is because value based
care focuses on aligning the incentives between providers,
payers and consumers. And and we see these
value based care models expanding
beyond where they've started in primary care
into hospital care and into specialties like oncology
orthopedic ne,
behavioral health and so many more.
I'm proud of the work that we have
done at North Carolina because we've launched our
own blue premier model which is our value
based care
construct and 20 19. And we've already shared
at and sorry earned about 500000000.0 dollars in
savings,
that's to last year.
And a lot of that shared with the
community with our health systems.
And that's critical. So coming back to I
said earlier right. This is all about aligning
incentives between providers payers and consumers.
To us, this is the best way to
improve access to improve quality and to improve
affordability, which is 1 of the biggest challenges
in our space.
That's amazing to hear. You know, and really
impressive all the different projects you have going
on in the different ways you're using technology
to improve the access to care and allow
for patients and members to connect with you
in a variety of different ways. And your
last, you know, statements on value based Care
too is just, really, it seems like cutting
edge and on the 4 forefront of how
health care is moving where the transformation is
and truly,
can make a big difference in terms of
changing the way that how care. Resources are
used in the community and certainly the outcomes
that come along with them too. Now before
we I wrap up here, I'm wondering, could
you tell me about up project or initiative
from the last year that yielded the best
results?
Yeah. Happy to.
We've been on a mission to expand Behavioral
health across our states. And I know many
other,
but insurance companies as well as Health systems
have been doing this. But I think we've
taken a very different approach. I'm really proud
of what we've accomplished.
As I mentioned earlier, is the lack of
access to these services in a timely fashion
just creates significant concern for us in the
entire industry.
In light of that a few years ago,
we partnered with an organization called Ava care
to catapult that service inside our states.
Last here we grew that partnership by hiring
over 90 therapists and psychiatrists,
integrating them into primary care practices across the
state here and we managed about 90000
visits
inside of those clinics as well as virtually,
which is really exciting for us because
effectively,
that capacity didn't exist,
but we've really been pushing hard to increase
capacity
by enabling this partnership.
It hasn't been an easy hunch.
But the Fortunate part is
there are so many people that just are
demanding and looking for this kind of help,
finding the actual patients to get to the
services isn't the hard part. The harder part
really been about integrating those services
into their care journey into the primary care.
But we've seen some really immediate results
we have expanded access that I mentioned to
90000 visits
last year and that fort our ability to
offer affordable convenient care folks.
The primary care physicians are raving about this.
They love the integration and it helps them
provide more holistic care to their patients.
And we've actually seen significant amount of impact
from those practices in the shared savings piece
where in their value contracts. They've actually earned
significant savings.
So it's paying off for the positions as
well.
So you uganda end up and it's really
this great win win win scenario,
where the members are getting more access, physicians
are getting paid more for higher quality work.
And as a plan, we know that our
members are getting the quality care that they
need.
I'm really excited about that. We have a
lot of work in front of us to
continue to expand this.
We're not done. We need to continue to
so Build upon this footprint and help support
more and more of our members across the
states.
That's amazing here. You know, and really impressive
to think about all the different opportunities that
you can continue to work on and I...
I'm sure
people that... This will affect in the future.
Sunny, thank you so much for joining us
on the podcast today. This has been a
really fun and interesting discussion, and I look
forward to connecting with you again soon.
Yes, thank you for having me. It's a
pleasure. Look forward to seeing you.