1 00:00:00,119 --> 00:00:02,261 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,340 --> 00:00:04,245 Becker payer issues podcast. 3 00:00:04,800 --> 00:00:06,942 Thrilled today to be joined by a special 4 00:00:06,942 --> 00:00:07,101 guest. 5 00:00:08,154 --> 00:00:10,974 Win wright is the president of Medicare Advantage 6 00:00:11,035 --> 00:00:13,674 at Blue Cross Blue Shield of Michigan. Krishna, 7 00:00:13,835 --> 00:00:15,514 thanks so much for taking the time to 8 00:00:15,514 --> 00:00:17,288 be with us on the podcast today. Go 9 00:00:17,288 --> 00:00:18,558 ahead have to be here, Jacob. Thank you 10 00:00:18,558 --> 00:00:19,192 for having me. 11 00:00:19,907 --> 00:00:21,811 So K, before, we dive into everything we 12 00:00:21,811 --> 00:00:23,875 wanna talk with you about and and everything 13 00:00:23,875 --> 00:00:25,462 going on in the world of Medicare Advantage. 14 00:00:26,032 --> 00:00:27,458 Can you tell us a little bit more 15 00:00:27,458 --> 00:00:30,312 about yourself, your background in health care and 16 00:00:30,312 --> 00:00:31,818 what it is that you do today at 17 00:00:31,897 --> 00:00:32,848 Bc, Michigan? 18 00:00:33,577 --> 00:00:35,087 Yeah. I sure can pick up. Thank you. 19 00:00:35,644 --> 00:00:37,551 For career background, I've been working in the 20 00:00:37,551 --> 00:00:39,856 health insurance industry for the majority of my 21 00:00:39,856 --> 00:00:40,571 career, although, 22 00:00:41,064 --> 00:00:42,902 I began serving as an act earlier in 23 00:00:42,902 --> 00:00:44,900 my career for a property and casualty carrier, 24 00:00:45,060 --> 00:00:47,218 which I'll get to how that informs the 25 00:00:47,218 --> 00:00:48,816 work that I'm doing today as we go 26 00:00:48,816 --> 00:00:51,145 through the discussion. But, you know, like, many 27 00:00:51,145 --> 00:00:53,058 people that serve in the health insurance industry, 28 00:00:53,854 --> 00:00:56,165 why was attracted to the field my why 29 00:00:56,165 --> 00:00:59,131 is really grounded and... Human experience that centered 30 00:00:59,131 --> 00:01:01,127 around a loved 1, who, of course out 31 00:01:01,127 --> 00:01:03,463 with a severe healthcare care issuer or diagnosis 32 00:01:03,522 --> 00:01:05,437 and despite all the incredible things about our 33 00:01:05,437 --> 00:01:06,236 health care system, 34 00:01:06,968 --> 00:01:08,897 you just learn it's still a very complex 35 00:01:08,953 --> 00:01:09,453 fractured 36 00:01:09,905 --> 00:01:10,858 experience. And so, 37 00:01:11,573 --> 00:01:13,160 I've just been privileged to serve in the 38 00:01:13,160 --> 00:01:16,194 health insurance industry with really a, high. Passion, 39 00:01:16,435 --> 00:01:18,355 maybe maybe even a calling, probably a lot 40 00:01:18,355 --> 00:01:20,275 of people in health would say that for 41 00:01:20,275 --> 00:01:22,435 both the patient and the consumer experience that's 42 00:01:22,435 --> 00:01:23,974 really excellence and affordable 43 00:01:24,450 --> 00:01:25,090 and can, 44 00:01:25,730 --> 00:01:28,689 really bring the best possible outcome. So central 45 00:01:28,689 --> 00:01:30,450 to my career background in health care was 46 00:01:30,450 --> 00:01:32,290 an opportunity to serve for almost 20 years 47 00:01:32,290 --> 00:01:34,620 in an integrated payer provider health care system, 48 00:01:34,779 --> 00:01:36,052 which I thought was really, 49 00:01:36,848 --> 00:01:38,996 just a blessing and a good opportunity to 50 00:01:38,996 --> 00:01:41,383 see how all of the actions of each 51 00:01:41,383 --> 00:01:42,201 of the stakeholders 52 00:01:42,735 --> 00:01:44,023 our contribute to, 53 00:01:44,898 --> 00:01:47,602 really just a better experience. At how the... 54 00:01:47,841 --> 00:01:49,670 That's how he was a human experience that, 55 00:01:49,829 --> 00:01:51,124 and, of course, the government 56 00:01:51,673 --> 00:01:53,893 plays into that with the programs they support, 57 00:01:54,290 --> 00:01:56,431 of which Medicare Advantage is clearly a partner. 58 00:01:56,907 --> 00:01:59,048 And so that... That's my career background. A 59 00:01:59,048 --> 00:02:00,889 lot of technology and math, but a lot 60 00:02:00,889 --> 00:02:03,216 of business as well as several new programs 61 00:02:03,273 --> 00:02:04,941 launched over the course of my career so 62 00:02:04,941 --> 00:02:07,737 far. And it technology prepared me for my 63 00:02:07,737 --> 00:02:09,962 current role, which is the President of Medicare 64 00:02:10,041 --> 00:02:11,312 Advantage here at blue Cross blue shield of 65 00:02:11,471 --> 00:02:14,109 Michigan. In my role, I have accountability for 66 00:02:14,109 --> 00:02:16,814 the Michigan Medicare Advantage market, which is the 67 00:02:16,814 --> 00:02:19,042 seventh largest Medicare Advantage Plane in the nation 68 00:02:19,042 --> 00:02:21,214 actually with over 650000 69 00:02:21,430 --> 00:02:23,828 for Medicare Advantage members. So it's quite a 70 00:02:23,828 --> 00:02:24,328 sizable, 71 00:02:24,781 --> 00:02:27,562 book of business that we, get the privilege 72 00:02:27,562 --> 00:02:27,800 of, 73 00:02:28,594 --> 00:02:30,759 participating with. In addition, we have fifth with 74 00:02:30,759 --> 00:02:34,035 other blues plan nationally through subsidiary emergent, 75 00:02:34,834 --> 00:02:37,151 where we partner to deliver Medicare Advantage products 76 00:02:37,151 --> 00:02:38,724 as well in other states. So 77 00:02:39,403 --> 00:02:41,000 jacob up as you mentioned, you know, focus... 78 00:02:41,159 --> 00:02:43,714 On Medicare advantage is really my number 1 79 00:02:43,953 --> 00:02:46,268 focus right now both nationally and rachel. So 80 00:02:46,268 --> 00:02:47,306 thanks again for having me. 81 00:02:48,276 --> 00:02:50,102 Fantastic. Well, I appreciate you taking us through 82 00:02:50,102 --> 00:02:52,086 that, and that's a an amazing number, the 83 00:02:52,086 --> 00:02:53,697 seventh largest Medicare Advantage 84 00:02:54,309 --> 00:02:56,372 organization in the country. A lot of unique 85 00:02:56,372 --> 00:02:59,102 needs of those of those senior members. So 86 00:02:59,102 --> 00:03:01,020 let's talk a little bit about that. You 87 00:03:01,020 --> 00:03:01,760 were recently 88 00:03:02,538 --> 00:03:04,696 participating on a panel at A hips 20 89 00:03:04,696 --> 00:03:05,835 24 conference 90 00:03:06,150 --> 00:03:08,629 in Las Vegas last month talking about those 91 00:03:08,629 --> 00:03:09,030 unique needs. 92 00:03:09,989 --> 00:03:11,849 How do we need to be supporting seniors 93 00:03:11,909 --> 00:03:13,849 differently right now from your view 94 00:03:14,243 --> 00:03:15,829 and how do you think the health care 95 00:03:15,829 --> 00:03:18,842 industry more broadly is is aligning with those 96 00:03:18,842 --> 00:03:19,080 needs? 97 00:03:19,873 --> 00:03:21,856 Well, I think it is, what a moment? 98 00:03:22,188 --> 00:03:23,858 In health care and what a moment in 99 00:03:23,938 --> 00:03:26,005 Medicare advantage in general. 100 00:03:26,642 --> 00:03:29,425 And as we discussed at the panel at 101 00:03:29,584 --> 00:03:30,243 A hep 102 00:03:30,871 --> 00:03:32,458 you can't talk about the, 103 00:03:33,093 --> 00:03:35,793 growing needs and changes in unique characteristics of 104 00:03:35,793 --> 00:03:37,778 seniors without also looking at the context in 105 00:03:37,778 --> 00:03:39,151 what you're serving. And 106 00:03:40,096 --> 00:03:40,596 between 107 00:03:40,971 --> 00:03:42,322 utilization increases in Cms, 108 00:03:43,038 --> 00:03:45,526 actions and reimbursement rates and regulatory 109 00:03:45,980 --> 00:03:48,445 of direction. I mean, they're clearly setting up 110 00:03:48,445 --> 00:03:49,184 a context 111 00:03:49,574 --> 00:03:51,481 within which all of those has to be 112 00:03:51,481 --> 00:03:51,798 solved. 113 00:03:52,355 --> 00:03:54,420 But I would definitely say that when you 114 00:03:54,420 --> 00:03:56,168 think about the unique needs of seniors and 115 00:03:56,168 --> 00:03:57,781 how we need to support them differently 116 00:03:58,155 --> 00:03:59,993 within there's a handful of things that are 117 00:03:59,993 --> 00:04:02,316 top of mind that we're working really hard 118 00:04:02,370 --> 00:04:04,193 and labor to address. First of all a 119 00:04:04,193 --> 00:04:04,693 growing 120 00:04:05,065 --> 00:04:05,224 population, 121 00:04:05,874 --> 00:04:07,729 that has increased experience 122 00:04:08,105 --> 00:04:09,858 expectations. Right? We're not in a vacuum. They 123 00:04:09,858 --> 00:04:12,090 don't just experience health care differently than the 124 00:04:12,090 --> 00:04:14,818 rest of their lives and that population is 125 00:04:14,818 --> 00:04:17,375 growing and again so are their expectations and 126 00:04:17,375 --> 00:04:20,411 their needs. We have ongoing challenges to health 127 00:04:20,411 --> 00:04:20,730 equity. 128 00:04:21,464 --> 00:04:24,042 And by that, we would lump in any 129 00:04:24,341 --> 00:04:26,418 in an equity in health care, whether that 130 00:04:26,418 --> 00:04:29,946 be, social determinants, whether it be social economic 131 00:04:29,946 --> 00:04:32,575 status, whether that be your disease burden itself, 132 00:04:32,735 --> 00:04:34,886 whether that be access to care in your 133 00:04:34,886 --> 00:04:36,400 region, whether that, I mean, that could be 134 00:04:36,400 --> 00:04:38,808 a plethora of things, but there's challenges to 135 00:04:38,808 --> 00:04:40,244 health equity today still. 136 00:04:41,202 --> 00:04:43,356 The overall health of the population, 137 00:04:44,168 --> 00:04:46,399 Obviously, we want to focus on preventive care, 138 00:04:46,559 --> 00:04:48,551 but people are also living longer, which is 139 00:04:48,551 --> 00:04:50,224 a great thing, but they're living longer with 140 00:04:50,224 --> 00:04:50,941 chronic disease. 141 00:04:51,593 --> 00:04:53,999 And there's also a lot of very promising 142 00:04:54,770 --> 00:04:56,541 medications and and drugs that are 143 00:04:56,914 --> 00:04:58,344 hitting the market and able to hit the 144 00:04:58,344 --> 00:05:00,806 market through new technology and new innovation. That's... 145 00:05:01,858 --> 00:05:04,495 Great, but it also needs to be, affordable 146 00:05:04,495 --> 00:05:05,134 for health care, 147 00:05:06,253 --> 00:05:08,410 participants, comp... Affordable for seniors. 148 00:05:09,143 --> 00:05:11,283 Or or the entirety of their lifespan is 149 00:05:11,283 --> 00:05:12,892 those things obviously are changing 150 00:05:13,897 --> 00:05:15,640 on an ongoing basis. And then... 151 00:05:16,449 --> 00:05:18,923 Off, also, they they need to be supported. 152 00:05:19,083 --> 00:05:22,057 They're continuing to navigate a complicated a complicated 153 00:05:22,275 --> 00:05:24,644 health care system, and that 1 Would have 154 00:05:24,924 --> 00:05:27,156 we participate wanna make it better. Wanna make 155 00:05:27,156 --> 00:05:29,389 it easier for seniors to get the care 156 00:05:29,389 --> 00:05:31,382 that they need. And so it's really those 157 00:05:31,382 --> 00:05:33,056 things that we discussed on that the panel 158 00:05:33,056 --> 00:05:34,986 was really do you do that within the 159 00:05:34,986 --> 00:05:37,619 context that we are dealing with post pandemic 160 00:05:37,619 --> 00:05:39,635 right now and in the wake of the 161 00:05:39,853 --> 00:05:41,231 utilization changes? And 162 00:05:41,704 --> 00:05:44,022 the overall government program of Medicare Advantage. 163 00:05:45,061 --> 00:05:46,739 Absolutely. And I wanna dive into some of 164 00:05:46,739 --> 00:05:48,897 those headwind in a bit. But before we 165 00:05:48,897 --> 00:05:51,269 do, you you just mentioned, some of those 166 00:05:51,788 --> 00:05:52,288 increased 167 00:05:52,986 --> 00:05:56,099 expectations by health plan members nowadays. It doesn't 168 00:05:56,099 --> 00:05:58,094 matter the age. It seems that everyone is 169 00:05:58,094 --> 00:06:01,463 g more towards digital solutions and and they 170 00:06:01,463 --> 00:06:02,981 want that from their health plan. 171 00:06:03,780 --> 00:06:05,618 What are you seeing among seniors? Are they 172 00:06:05,618 --> 00:06:09,485 g toward these digital solutions as the industry 173 00:06:09,541 --> 00:06:10,573 originally predicted they would. 174 00:06:11,367 --> 00:06:12,638 Yeah and sure are And in fact, 175 00:06:13,511 --> 00:06:15,020 you know, when you... When you look ahead, 176 00:06:15,179 --> 00:06:17,085 you think that it's not changing as quickly 177 00:06:17,085 --> 00:06:19,091 as you... As you wish, and then you 178 00:06:19,091 --> 00:06:20,446 look back and you say, wow it was 179 00:06:20,446 --> 00:06:22,201 changed. I'll give you a few stats, 180 00:06:23,477 --> 00:06:23,977 recently, 181 00:06:24,355 --> 00:06:26,349 Prince Water house Cooper did this study, and 182 00:06:26,349 --> 00:06:27,759 we've are finding the same thing in our 183 00:06:28,039 --> 00:06:30,777 population. So it feels real to us that 184 00:06:31,156 --> 00:06:34,112 82 percent are open to new traditional ways 185 00:06:34,112 --> 00:06:35,891 of getting medical attention 186 00:06:36,763 --> 00:06:39,478 74 percent or open to virtual doctor visits. 187 00:06:40,675 --> 00:06:43,810 43 percent wanna shop for health care. 55 188 00:06:43,869 --> 00:06:46,079 percent, trust the Internet more than a doctor 189 00:06:46,279 --> 00:06:47,259 and those are 190 00:06:48,037 --> 00:06:50,913 startling to many of us who maybe 10 191 00:06:50,913 --> 00:06:51,473 years ago, 192 00:06:52,351 --> 00:06:52,831 saw 193 00:06:54,202 --> 00:06:55,870 environment in which those things were at the 194 00:06:55,870 --> 00:06:57,777 case, they're shifting and they're shifting very, very 195 00:06:57,777 --> 00:06:59,683 quickly And what that means for us is 196 00:06:59,683 --> 00:07:00,739 that it changes 197 00:07:01,113 --> 00:07:02,249 how you look at 198 00:07:03,198 --> 00:07:04,317 how do you look at the solutions you 199 00:07:04,317 --> 00:07:06,633 bring to market, it changes, how you how 200 00:07:06,633 --> 00:07:09,030 strongly you partner? First of all, we'll talk 201 00:07:09,030 --> 00:07:11,517 about? Our partnership with providers because they are 202 00:07:11,517 --> 00:07:13,930 our hallmark in a and a really key 203 00:07:14,228 --> 00:07:16,539 going to the strategy is as you indicate 204 00:07:16,539 --> 00:07:18,387 we're gonna talk about in a minute, those 205 00:07:18,387 --> 00:07:20,616 headwind and utilization etcetera. Of course, without a... 206 00:07:20,934 --> 00:07:22,844 Doubt, our providers are really central to that. 207 00:07:23,003 --> 00:07:26,202 But we're also looking at new ways. To 208 00:07:26,202 --> 00:07:28,854 partner an innovative ways to partner to tackle 209 00:07:29,789 --> 00:07:31,781 the challenges. But meet seniors where they are 210 00:07:31,781 --> 00:07:33,136 in light of those new 211 00:07:33,708 --> 00:07:35,929 those new care patterns and the stats I 212 00:07:35,929 --> 00:07:37,834 just mentioned. 1 of the examples of that, 213 00:07:38,706 --> 00:07:40,690 you may have seen recently we partnered with 214 00:07:40,848 --> 00:07:43,085 Me and a new... Retail partnership. And the 215 00:07:43,085 --> 00:07:45,545 reason we did that is exactly those those 216 00:07:45,545 --> 00:07:46,497 shifts. Like seniors, 217 00:07:47,052 --> 00:07:48,639 we wanna meet them where they want to 218 00:07:48,639 --> 00:07:49,139 be 219 00:07:49,448 --> 00:07:51,751 and we have an ability to do that 220 00:07:51,751 --> 00:07:53,259 partnering with a, 221 00:07:54,212 --> 00:07:56,618 different type of partnership and into retail consumers 222 00:07:56,753 --> 00:07:58,764 environment. Helps us do that, meet our members 223 00:07:58,764 --> 00:08:00,125 where they wanna be, make the most of 224 00:08:00,125 --> 00:08:01,644 the resources they're already using, 225 00:08:02,444 --> 00:08:04,125 lowering their out of pocket costs in the 226 00:08:04,125 --> 00:08:04,605 process. 227 00:08:05,100 --> 00:08:07,500 But then, of course, it's incumbent upon us 228 00:08:07,500 --> 00:08:09,979 as a participant to also loop that back 229 00:08:09,979 --> 00:08:10,459 into the care, 230 00:08:11,339 --> 00:08:12,995 flow that they are receiving with their pro 231 00:08:13,114 --> 00:08:15,503 provider. So it's it's all of that. They 232 00:08:15,503 --> 00:08:17,516 are changing their digital 233 00:08:18,052 --> 00:08:19,667 profile. They're changing their 234 00:08:20,043 --> 00:08:22,449 openness to new types of innovative innovative solutions 235 00:08:22,449 --> 00:08:24,446 to get care, and we wanna be able 236 00:08:24,446 --> 00:08:25,905 to be a part of that and help 237 00:08:25,964 --> 00:08:28,681 guide them to really high quality locations to 238 00:08:28,681 --> 00:08:29,420 get that 239 00:08:30,448 --> 00:08:32,192 Sure. And it's so timely that you bring 240 00:08:32,192 --> 00:08:33,936 up that partnership with My, 241 00:08:34,570 --> 00:08:36,869 all over the country. We're seeing Medicare Advantage 242 00:08:36,869 --> 00:08:37,369 plans 243 00:08:37,759 --> 00:08:40,740 partner with with grocery stores with retail pharmacies 244 00:08:41,279 --> 00:08:42,800 on these on these kinds of products. 245 00:08:44,559 --> 00:08:46,653 Has the market responded well to this new 246 00:08:46,653 --> 00:08:50,004 offering between between you and Me, and what's 247 00:08:50,004 --> 00:08:52,318 what's the future plans for this partnership? 248 00:08:53,195 --> 00:08:55,364 Yes. Yeah. It sure have. I mean, we 249 00:08:55,364 --> 00:08:57,459 really exceeded our growth 250 00:08:57,836 --> 00:09:00,389 expectations for our initial launch of that, so 251 00:09:00,389 --> 00:09:03,122 it resonated very strongly in our market. And 252 00:09:03,912 --> 00:09:06,400 we're still uncovering ways in which 253 00:09:06,775 --> 00:09:08,446 that, you know, why was that the case? 254 00:09:08,684 --> 00:09:10,409 While we were where they wanted to be, 255 00:09:11,164 --> 00:09:13,386 number 1, not in a different off to 256 00:09:13,386 --> 00:09:15,316 the side, shopping system, 257 00:09:16,324 --> 00:09:18,643 not that agents aren't part of that solution 258 00:09:18,643 --> 00:09:20,952 they clearly. Are because they understand the complexities 259 00:09:20,952 --> 00:09:22,944 of the health care, but seniors are often 260 00:09:22,944 --> 00:09:25,811 and about. They they want to have a 261 00:09:25,811 --> 00:09:27,347 conversation often. They want to 262 00:09:27,816 --> 00:09:29,720 understand more than anything who can they trust 263 00:09:29,720 --> 00:09:31,861 and trusted brands like Me and Blue Cross, 264 00:09:32,020 --> 00:09:33,210 Blue Shield of Michigan. 265 00:09:34,082 --> 00:09:35,455 We found a really good 266 00:09:35,763 --> 00:09:38,463 synergy between that, to be a trusted voice 267 00:09:38,463 --> 00:09:40,686 in the market, for seniors when they're looking 268 00:09:40,686 --> 00:09:42,513 for that type of information. So we we 269 00:09:42,513 --> 00:09:44,832 definitely see that But we also see that 270 00:09:44,832 --> 00:09:45,389 there's other, 271 00:09:46,105 --> 00:09:48,810 deeper use cases that we need to solve 272 00:09:48,810 --> 00:09:50,401 for together. You know, if it were... 273 00:09:51,053 --> 00:09:54,003 Easy and turnkey. It probably already would have 274 00:09:54,003 --> 00:09:56,076 been, you know, core practice right now across 275 00:09:56,076 --> 00:09:57,750 the nation. You're seeing those spring up because 276 00:09:57,750 --> 00:09:59,207 of that. There's a lot of 277 00:10:00,077 --> 00:10:00,577 new 278 00:10:01,274 --> 00:10:03,348 opportunities that we have to be able to 279 00:10:03,348 --> 00:10:05,661 unlock real value for seniors in ways that 280 00:10:05,661 --> 00:10:07,974 they wanna consume it. I think that our 281 00:10:07,974 --> 00:10:10,218 history is brought with just as a health 282 00:10:10,218 --> 00:10:12,464 care industry may making 283 00:10:13,234 --> 00:10:15,298 assumptions about how seniors want that care and 284 00:10:15,298 --> 00:10:18,648 that typically hasn't yielded the best unlocks, as 285 00:10:18,648 --> 00:10:20,799 we, you know, look past fast back at 286 00:10:20,799 --> 00:10:21,697 decades of 287 00:10:22,153 --> 00:10:23,667 population health management and the real, 288 00:10:24,623 --> 00:10:27,172 the glimmer, the the diamonds that we pick 289 00:10:27,172 --> 00:10:28,859 out of this end up being where you 290 00:10:28,859 --> 00:10:31,588 have a win win win between the provider 291 00:10:31,645 --> 00:10:33,954 and the clinical care system, the payer who 292 00:10:33,954 --> 00:10:35,919 can bring the analytics together and help 293 00:10:36,437 --> 00:10:38,987 get that member to the best possible solutions, 294 00:10:39,067 --> 00:10:40,422 but then also do that in a way 295 00:10:40,422 --> 00:10:42,653 that consumers really wanna use it, and and 296 00:10:42,653 --> 00:10:43,504 we see it just a 297 00:10:44,101 --> 00:10:44,601 fantastic 298 00:10:45,216 --> 00:10:46,648 opportunity to do that with Me. 299 00:10:47,524 --> 00:10:49,434 That's really great to hear. And everything you 300 00:10:49,434 --> 00:10:51,185 just said, K really plays into some of 301 00:10:51,185 --> 00:10:53,096 those earlier numbers you were talking about that. 302 00:10:53,509 --> 00:10:55,830 82 percent of your members are open to 303 00:10:55,830 --> 00:10:58,549 receiving health care in new ways. So really 304 00:10:58,549 --> 00:11:00,389 cool to hear how how your members are 305 00:11:00,389 --> 00:11:01,750 responding to this new partnership. 306 00:11:03,042 --> 00:11:05,189 I think though, Krishna, my next question for 307 00:11:05,189 --> 00:11:06,779 you. We we have to talk about some 308 00:11:06,779 --> 00:11:08,767 some major upheaval that a major story that's 309 00:11:08,767 --> 00:11:11,232 been going on within Medicare Advantage over the 310 00:11:11,232 --> 00:11:12,187 last month or so. 311 00:11:13,157 --> 00:11:15,010 As you know, Cms recently 312 00:11:15,386 --> 00:11:15,886 rec 313 00:11:16,421 --> 00:11:18,035 Medicare Advantage star ratings 314 00:11:18,968 --> 00:11:20,662 across many health plans 315 00:11:21,371 --> 00:11:24,235 after some some court challenges to to methodologies. 316 00:11:24,951 --> 00:11:26,860 Can you talk a little bit about what 317 00:11:26,860 --> 00:11:29,023 the that's looked like for for Bc cbs, 318 00:11:29,342 --> 00:11:31,173 Michigan, what that's looked like for your team? 319 00:11:31,571 --> 00:11:33,481 And and how does that ultimately impact your 320 00:11:33,481 --> 00:11:35,073 strategy going into next year? 321 00:11:36,204 --> 00:11:37,722 Well, you know, the good news is we 322 00:11:37,722 --> 00:11:38,042 have, 323 00:11:39,481 --> 00:11:39,981 enjoyed 324 00:11:40,360 --> 00:11:42,358 strong star performance, both 4 and 4 and 325 00:11:42,358 --> 00:11:45,075 a half for our Ppo and Hmo products 326 00:11:45,075 --> 00:11:48,057 for sub years. And so that high rating 327 00:11:48,592 --> 00:11:51,455 represents our commitment to ongoing quality, make sure 328 00:11:51,455 --> 00:11:53,625 the seniors have access to it. The recent 329 00:11:53,625 --> 00:11:55,785 bump in performance really provided with us an 330 00:11:55,785 --> 00:11:58,585 opportunity to invest additional monies in the last 331 00:11:58,585 --> 00:12:01,557 minute for 20 25 5 in the benefit 332 00:12:01,557 --> 00:12:03,792 programs for our H hmo plan in 20 333 00:12:03,792 --> 00:12:06,905 25 in particular. So I wouldn't call it 334 00:12:06,905 --> 00:12:09,060 a big strategic shift as much as I 335 00:12:09,060 --> 00:12:10,742 would just say it was a nice fine 336 00:12:10,742 --> 00:12:13,441 tuning that were able... We were able to 337 00:12:13,441 --> 00:12:16,378 deliver for, the market in 20 25. I 338 00:12:16,378 --> 00:12:17,727 think, obviously, we had to re rebuild, like 339 00:12:17,727 --> 00:12:20,059 the rest the industry did and did that 340 00:12:20,059 --> 00:12:20,699 very quickly. 341 00:12:21,419 --> 00:12:23,500 But we were just tickle that they had 342 00:12:23,500 --> 00:12:25,440 made that change and were able to 343 00:12:26,150 --> 00:12:28,613 stand by the program as as they had 344 00:12:28,613 --> 00:12:30,622 rolled it out, and we are, 345 00:12:31,393 --> 00:12:32,267 continually committed. 346 00:12:32,839 --> 00:12:35,017 As they raise the bar in performance 347 00:12:35,476 --> 00:12:38,273 expectations around quality and performance to to reach 348 00:12:38,273 --> 00:12:39,232 those stars measures, 349 00:12:39,872 --> 00:12:42,682 we're committed to clearing them. And that was 350 00:12:42,682 --> 00:12:44,676 just a nice win for, I think the 351 00:12:44,676 --> 00:12:46,750 the market and for seniors. I mean, the 352 00:12:46,750 --> 00:12:48,446 seniors are the ones that are gonna benefit 353 00:12:49,063 --> 00:12:51,296 from those changes in 20 25. 354 00:12:52,189 --> 00:12:54,586 Yeah. Absolutely. I believe it's 40 plans that 355 00:12:54,586 --> 00:12:56,504 are seeing upgrades, to their star ratings, and 356 00:12:56,504 --> 00:12:58,502 of course, as, you know, Krishna, the all 357 00:12:58,502 --> 00:13:00,180 the funds that come along with that. 358 00:13:01,073 --> 00:13:02,669 If we're saying on the topic of of 359 00:13:02,669 --> 00:13:04,265 20 25 strategy, 360 00:13:05,302 --> 00:13:06,659 payers are kind of all over the place 361 00:13:06,659 --> 00:13:08,905 right now in terms of planning. For Medicare 362 00:13:08,984 --> 00:13:11,287 Advantage, how they're how they're pricing their products. 363 00:13:12,399 --> 00:13:14,147 A lot of headwind right now in the 364 00:13:14,147 --> 00:13:17,023 industry in terms of rising utilization rates and 365 00:13:17,023 --> 00:13:18,400 and reduced reimbursement 366 00:13:19,017 --> 00:13:19,735 from Cms. 367 00:13:20,293 --> 00:13:23,106 So how is how is Blue Cross navigating 368 00:13:23,164 --> 00:13:23,824 these headwind 369 00:13:24,441 --> 00:13:26,195 that we're really seeing industry wide? 370 00:13:27,245 --> 00:13:28,517 Well, you know what, 1 of the things 371 00:13:28,517 --> 00:13:30,425 that I will say, which, you know, obviously, 372 00:13:30,584 --> 00:13:31,618 my background, 373 00:13:32,015 --> 00:13:34,242 you probably imagine that this was coming to 374 00:13:34,242 --> 00:13:36,321 some that just because of the emphasis that 375 00:13:36,400 --> 00:13:37,353 I already placed on, 376 00:13:38,385 --> 00:13:41,401 partnerships with providers, but that's really central to 377 00:13:41,401 --> 00:13:43,068 what Blue Cross is and what we stand 378 00:13:43,068 --> 00:13:45,625 for is strong. Mean we have a deep 379 00:13:45,625 --> 00:13:48,111 not only respectful for a partnership with providers 380 00:13:48,644 --> 00:13:51,266 and really are leaning into that as it's 381 00:13:51,266 --> 00:13:53,192 what it's gonna take strong for everyone to 382 00:13:53,192 --> 00:13:55,425 be successful in a Medicare Advantage program. 383 00:13:55,904 --> 00:13:58,057 We also have strong relationships with employers in 384 00:13:58,057 --> 00:14:00,689 our market, of course, given our participation with 385 00:14:00,689 --> 00:14:02,045 group Medicare Advantage plans. 386 00:14:02,619 --> 00:14:04,058 And and 1 of the things that I 387 00:14:04,058 --> 00:14:05,037 would say is 388 00:14:05,656 --> 00:14:06,295 we're all, 389 00:14:06,855 --> 00:14:09,113 aligned in our passion about solving for affordability 390 00:14:09,252 --> 00:14:10,851 and access to excellent health care I mean, 391 00:14:11,090 --> 00:14:13,730 all of these trends that you mentioned, whether 392 00:14:13,730 --> 00:14:14,683 it's utilization, 393 00:14:15,477 --> 00:14:18,572 patterns post pandemic, whether it's the Cms funding, 394 00:14:18,969 --> 00:14:21,287 changes and reimbursement. Like, that affects all of 395 00:14:21,287 --> 00:14:23,591 us, not not just a payer it affects 396 00:14:23,591 --> 00:14:26,055 the providers it affects seniors it affects employers 397 00:14:26,055 --> 00:14:27,429 in our market, and 398 00:14:27,803 --> 00:14:30,600 we wanna solve that in our act working 399 00:14:30,600 --> 00:14:32,587 towards solving that together. We might reach the 400 00:14:32,587 --> 00:14:34,597 different aspects of the problem, but 401 00:14:34,972 --> 00:14:37,118 we're all committed to being here for seniors 402 00:14:37,118 --> 00:14:38,808 and the products that they want, which clearly, 403 00:14:38,968 --> 00:14:40,246 you know, they're voting with their feed its 404 00:14:40,326 --> 00:14:41,306 Medicare advantage. 405 00:14:42,643 --> 00:14:45,680 So we see the utilization rates being up 406 00:14:45,680 --> 00:14:48,398 that Cms is reduction and reimbursement to the 407 00:14:48,398 --> 00:14:50,941 industry overall just really signaling a market theft 408 00:14:50,941 --> 00:14:51,918 to correction 409 00:14:52,372 --> 00:14:54,121 that the work that we've been doing to 410 00:14:54,121 --> 00:14:55,155 meet the needs of the, 411 00:14:55,809 --> 00:14:57,889 the population and as they've reached toward Medicare 412 00:14:58,050 --> 00:14:58,550 Advantage 413 00:14:59,009 --> 00:15:00,929 did drive a lot of competition reits and 414 00:15:00,929 --> 00:15:02,710 benefits, and now they're correcting 415 00:15:03,423 --> 00:15:05,733 the funding to make sure that it's sustainable 416 00:15:05,733 --> 00:15:07,964 for the long term and that we continue 417 00:15:07,964 --> 00:15:09,318 to double down in the things that we 418 00:15:09,318 --> 00:15:11,331 need to change to be successful in Medicare 419 00:15:11,389 --> 00:15:12,367 advantage. So 420 00:15:12,679 --> 00:15:14,670 really our best work right now is being 421 00:15:14,670 --> 00:15:17,378 done side by side with our partners. I'll 422 00:15:17,378 --> 00:15:18,891 give you 1 example, the work that we're 423 00:15:18,891 --> 00:15:21,281 doing with providers that participate in our boot 424 00:15:21,281 --> 00:15:22,274 blueprint for... Affordability, 425 00:15:23,603 --> 00:15:26,068 currently more than 50 percent of our total 426 00:15:26,068 --> 00:15:29,408 attributed Blue Cross Commercial Medicare Advantage, Michigan membership 427 00:15:29,408 --> 00:15:32,214 is covered by physicians participating in that shared 428 00:15:32,214 --> 00:15:35,825 payment model. That's a total Jacob of 22 429 00:15:35,884 --> 00:15:39,482 physician organizations that have signed on to a 430 00:15:39,482 --> 00:15:42,184 blueprint shared brisk program. It it really makes 431 00:15:42,184 --> 00:15:43,774 it 1 of the largest payment models of 432 00:15:43,774 --> 00:15:45,340 its kind nationally. And that 433 00:15:46,018 --> 00:15:49,071 represent work that acknowledges that you can't solve 434 00:15:49,210 --> 00:15:51,604 for this level of change alone and that 435 00:15:51,604 --> 00:15:53,692 we all need to evolve together to make 436 00:15:53,692 --> 00:15:55,601 the program work in the best way that, 437 00:15:55,760 --> 00:15:56,260 at 438 00:15:56,635 --> 00:15:58,226 Cms, you know, the centers for medicare care 439 00:15:58,226 --> 00:16:00,078 and medicaid services have laid out 440 00:16:00,469 --> 00:16:03,920 and be successful and sustainable for seniors 441 00:16:04,696 --> 00:16:07,088 to do that. And so I would answer 442 00:16:07,088 --> 00:16:09,321 that in terms of partnerships. I mean, I 443 00:16:09,321 --> 00:16:11,801 mentioned new partnerships and innovative ones that we're 444 00:16:11,801 --> 00:16:14,264 working on with with companies like Me we'll 445 00:16:14,264 --> 00:16:17,284 continue to do that. But it's also incumbent 446 00:16:17,284 --> 00:16:18,500 upon us to 447 00:16:18,969 --> 00:16:21,599 clear any confusion out of the way for 448 00:16:21,599 --> 00:16:24,868 seniors that we would be aligned with their 449 00:16:24,868 --> 00:16:26,541 physician as we solve for that together. That's 450 00:16:26,541 --> 00:16:28,463 what they want, that's what we're hearing from 451 00:16:28,463 --> 00:16:31,318 seniors. They they don't want conflicting messages. They 452 00:16:31,318 --> 00:16:32,984 want to know what care to get and 453 00:16:32,984 --> 00:16:33,698 the best care. 454 00:16:34,349 --> 00:16:36,584 Cms provides the overall road map for that 455 00:16:36,584 --> 00:16:37,462 in terms of their, 456 00:16:38,021 --> 00:16:39,878 star program and quality. And 457 00:16:40,415 --> 00:16:42,092 so we have work to do to make 458 00:16:42,092 --> 00:16:42,890 sure that we're partnering. 459 00:16:43,462 --> 00:16:44,814 At the hipaa of providers to do that, 460 00:16:44,973 --> 00:16:47,120 and I would say that that's probably the 461 00:16:47,120 --> 00:16:48,177 number 1 critical 462 00:16:48,711 --> 00:16:50,619 success factor that we're leaning into right now. 463 00:16:52,145 --> 00:16:54,690 Fantastic. Well, what else are we missing? You 464 00:16:54,690 --> 00:16:56,042 you have the year right now of a 465 00:16:56,042 --> 00:16:58,588 lot of health plan colleagues and and leaders 466 00:16:58,588 --> 00:17:00,912 from all over the country. What would your 467 00:17:00,912 --> 00:17:02,269 concluding thoughts be for them? 468 00:17:03,067 --> 00:17:04,663 Well, I would say, you know, it's it's 469 00:17:04,663 --> 00:17:06,498 a it's a pattern. It hard work. 470 00:17:07,376 --> 00:17:07,695 Obviously, 471 00:17:08,188 --> 00:17:10,411 us send many others who would be listening 472 00:17:10,411 --> 00:17:13,509 for this are working really, really hard. New 473 00:17:13,509 --> 00:17:15,994 environment that we're all dedicated to 474 00:17:17,345 --> 00:17:17,664 succeed in. 475 00:17:18,384 --> 00:17:21,105 Obviously, advanced analytics is gonna help us as 476 00:17:21,745 --> 00:17:22,065 industry, 477 00:17:22,705 --> 00:17:24,865 to understand that. The good news is at 478 00:17:24,865 --> 00:17:25,684 the time 479 00:17:26,157 --> 00:17:27,988 analytics are advancing that can help us meet 480 00:17:27,988 --> 00:17:30,375 those challenges. So that's all great. But in 481 00:17:30,375 --> 00:17:32,604 terms of what I would wanna, offer industry 482 00:17:32,604 --> 00:17:34,844 colleagues, it's just it's time to get really 483 00:17:34,844 --> 00:17:36,829 clear on our intent and our mission and 484 00:17:36,829 --> 00:17:38,735 then make our decisions in alignment with that, 485 00:17:38,894 --> 00:17:40,561 You know, when the going gets tough like 486 00:17:40,561 --> 00:17:42,723 this, it's real. Easy to shift off of 487 00:17:42,723 --> 00:17:44,179 that and make short term, 488 00:17:44,714 --> 00:17:46,545 trade offs that may or may not align 489 00:17:46,545 --> 00:17:48,535 with other our long term mission, and we've 490 00:17:48,535 --> 00:17:51,494 just chosen to just re anchor ourselves be 491 00:17:51,494 --> 00:17:54,437 re committed more than ever, and and that's 492 00:17:54,437 --> 00:17:55,948 what we're doing. Blue Cross blue Shield and 493 00:17:56,107 --> 00:17:57,778 Michigan, and we're committed to providing seniors. 494 00:17:58,667 --> 00:18:01,445 Access to high quality affordable health care, and 495 00:18:01,445 --> 00:18:03,668 that's what we're focused on being able to 496 00:18:03,668 --> 00:18:05,732 do in our market through these changes, 497 00:18:06,543 --> 00:18:08,636 So I I think that's probably my best 498 00:18:08,773 --> 00:18:11,800 closing remark is, be rec committed to your 499 00:18:11,800 --> 00:18:12,676 mission and, 500 00:18:13,314 --> 00:18:14,987 show up every day willing to do the 501 00:18:14,987 --> 00:18:16,038 hard work to make that happen. 502 00:18:17,233 --> 00:18:19,385 Wonderful. I think that's a great parting message, 503 00:18:19,624 --> 00:18:22,254 So, Thank you so much for taking the 504 00:18:22,254 --> 00:18:23,862 time to sit down with us. And for 505 00:18:23,862 --> 00:18:26,672 sharing your insights with our listeners, we truly 506 00:18:26,729 --> 00:18:28,561 appreciate it. Thank you so much, Jacob. 507 00:18:29,437 --> 00:18:31,269 If you'd like to listen to more podcasts 508 00:18:31,269 --> 00:18:33,516 from Becker Healthcare care You can visit Becker 509 00:18:33,516 --> 00:18:34,952 hospital review dot com.