Hello, everyone. This is Jacob Emerson with the
Becker payer issues podcast.
Thrilled today to be joined by a special
guest.
Win wright is the president of Medicare Advantage
at Blue Cross Blue Shield of Michigan. Krishna,
thanks so much for taking the time to
be with us on the podcast today. Go
ahead have to be here, Jacob. Thank you
for having me.
So K, before, we dive into everything we
wanna talk with you about and and everything
going on in the world of Medicare Advantage.
Can you tell us a little bit more
about yourself, your background in health care and
what it is that you do today at
Bc, Michigan?
Yeah. I sure can pick up. Thank you.
For career background, I've been working in the
health insurance industry for the majority of my
career, although,
I began serving as an act earlier in
my career for a property and casualty carrier,
which I'll get to how that informs the
work that I'm doing today as we go
through the discussion. But, you know, like, many
people that serve in the health insurance industry,
why was attracted to the field my why
is really grounded and... Human experience that centered
around a loved 1, who, of course out
with a severe healthcare care issuer or diagnosis
and despite all the incredible things about our
health care system,
you just learn it's still a very complex
fractured
experience. And so,
I've just been privileged to serve in the
health insurance industry with really a, high. Passion,
maybe maybe even a calling, probably a lot
of people in health would say that for
both the patient and the consumer experience that's
really excellence and affordable
and can,
really bring the best possible outcome. So central
to my career background in health care was
an opportunity to serve for almost 20 years
in an integrated payer provider health care system,
which I thought was really,
just a blessing and a good opportunity to
see how all of the actions of each
of the stakeholders
our contribute to,
really just a better experience. At how the...
That's how he was a human experience that,
and, of course, the government
plays into that with the programs they support,
of which Medicare Advantage is clearly a partner.
And so that... That's my career background. A
lot of technology and math, but a lot
of business as well as several new programs
launched over the course of my career so
far. And it technology prepared me for my
current role, which is the President of Medicare
Advantage here at blue Cross blue shield of
Michigan. In my role, I have accountability for
the Michigan Medicare Advantage market, which is the
seventh largest Medicare Advantage Plane in the nation
actually with over 650000
for Medicare Advantage members. So it's quite a
sizable,
book of business that we, get the privilege
of,
participating with. In addition, we have fifth with
other blues plan nationally through subsidiary emergent,
where we partner to deliver Medicare Advantage products
as well in other states. So
jacob up as you mentioned, you know, focus...
On Medicare advantage is really my number 1
focus right now both nationally and rachel. So
thanks again for having me.
Fantastic. Well, I appreciate you taking us through
that, and that's a an amazing number, the
seventh largest Medicare Advantage
organization in the country. A lot of unique
needs of those of those senior members. So
let's talk a little bit about that. You
were recently
participating on a panel at A hips 20
24 conference
in Las Vegas last month talking about those
unique needs.
How do we need to be supporting seniors
differently right now from your view
and how do you think the health care
industry more broadly is is aligning with those
needs?
Well, I think it is, what a moment?
In health care and what a moment in
Medicare advantage in general.
And as we discussed at the panel at
A hep
you can't talk about the,
growing needs and changes in unique characteristics of
seniors without also looking at the context in
what you're serving. And
between
utilization increases in Cms,
actions and reimbursement rates and regulatory
of direction. I mean, they're clearly setting up
a context
within which all of those has to be
solved.
But I would definitely say that when you
think about the unique needs of seniors and
how we need to support them differently
within there's a handful of things that are
top of mind that we're working really hard
and labor to address. First of all a
growing
population,
that has increased experience
expectations. Right? We're not in a vacuum. They
don't just experience health care differently than the
rest of their lives and that population is
growing and again so are their expectations and
their needs. We have ongoing challenges to health
equity.
And by that, we would lump in any
in an equity in health care, whether that
be, social determinants, whether it be social economic
status, whether that be your disease burden itself,
whether that be access to care in your
region, whether that, I mean, that could be
a plethora of things, but there's challenges to
health equity today still.
The overall health of the population,
Obviously, we want to focus on preventive care,
but people are also living longer, which is
a great thing, but they're living longer with
chronic disease.
And there's also a lot of very promising
medications and and drugs that are
hitting the market and able to hit the
market through new technology and new innovation. That's...
Great, but it also needs to be, affordable
for health care,
participants, comp... Affordable for seniors.
Or or the entirety of their lifespan is
those things obviously are changing
on an ongoing basis. And then...
Off, also, they they need to be supported.
They're continuing to navigate a complicated a complicated
health care system, and that 1 Would have
we participate wanna make it better. Wanna make
it easier for seniors to get the care
that they need. And so it's really those
things that we discussed on that the panel
was really do you do that within the
context that we are dealing with post pandemic
right now and in the wake of the
utilization changes? And
the overall government program of Medicare Advantage.
Absolutely. And I wanna dive into some of
those headwind in a bit. But before we
do, you you just mentioned, some of those
increased
expectations by health plan members nowadays. It doesn't
matter the age. It seems that everyone is
g more towards digital solutions and and they
want that from their health plan.
What are you seeing among seniors? Are they
g toward these digital solutions as the industry
originally predicted they would.
Yeah and sure are And in fact,
you know, when you... When you look ahead,
you think that it's not changing as quickly
as you... As you wish, and then you
look back and you say, wow it was
changed. I'll give you a few stats,
recently,
Prince Water house Cooper did this study, and
we've are finding the same thing in our
population. So it feels real to us that
82 percent are open to new traditional ways
of getting medical attention
74 percent or open to virtual doctor visits.
43 percent wanna shop for health care. 55
percent, trust the Internet more than a doctor
and those are
startling to many of us who maybe 10
years ago,
saw
environment in which those things were at the
case, they're shifting and they're shifting very, very
quickly And what that means for us is
that it changes
how you look at
how do you look at the solutions you
bring to market, it changes, how you how
strongly you partner? First of all, we'll talk
about? Our partnership with providers because they are
our hallmark in a and a really key
going to the strategy is as you indicate
we're gonna talk about in a minute, those
headwind and utilization etcetera. Of course, without a...
Doubt, our providers are really central to that.
But we're also looking at new ways. To
partner an innovative ways to partner to tackle
the challenges. But meet seniors where they are
in light of those new
those new care patterns and the stats I
just mentioned. 1 of the examples of that,
you may have seen recently we partnered with
Me and a new... Retail partnership. And the
reason we did that is exactly those those
shifts. Like seniors,
we wanna meet them where they want to
be
and we have an ability to do that
partnering with a,
different type of partnership and into retail consumers
environment. Helps us do that, meet our members
where they wanna be, make the most of
the resources they're already using,
lowering their out of pocket costs in the
process.
But then, of course, it's incumbent upon us
as a participant to also loop that back
into the care,
flow that they are receiving with their pro
provider. So it's it's all of that. They
are changing their digital
profile. They're changing their
openness to new types of innovative innovative solutions
to get care, and we wanna be able
to be a part of that and help
guide them to really high quality locations to
get that
Sure. And it's so timely that you bring
up that partnership with My,
all over the country. We're seeing Medicare Advantage
plans
partner with with grocery stores with retail pharmacies
on these on these kinds of products.
Has the market responded well to this new
offering between between you and Me, and what's
what's the future plans for this partnership?
Yes. Yeah. It sure have. I mean, we
really exceeded our growth
expectations for our initial launch of that, so
it resonated very strongly in our market. And
we're still uncovering ways in which
that, you know, why was that the case?
While we were where they wanted to be,
number 1, not in a different off to
the side, shopping system,
not that agents aren't part of that solution
they clearly. Are because they understand the complexities
of the health care, but seniors are often
and about. They they want to have a
conversation often. They want to
understand more than anything who can they trust
and trusted brands like Me and Blue Cross,
Blue Shield of Michigan.
We found a really good
synergy between that, to be a trusted voice
in the market, for seniors when they're looking
for that type of information. So we we
definitely see that But we also see that
there's other,
deeper use cases that we need to solve
for together. You know, if it were...
Easy and turnkey. It probably already would have
been, you know, core practice right now across
the nation. You're seeing those spring up because
of that. There's a lot of
new
opportunities that we have to be able to
unlock real value for seniors in ways that
they wanna consume it. I think that our
history is brought with just as a health
care industry may making
assumptions about how seniors want that care and
that typically hasn't yielded the best unlocks, as
we, you know, look past fast back at
decades of
population health management and the real,
the glimmer, the the diamonds that we pick
out of this end up being where you
have a win win win between the provider
and the clinical care system, the payer who
can bring the analytics together and help
get that member to the best possible solutions,
but then also do that in a way
that consumers really wanna use it, and and
we see it just a
fantastic
opportunity to do that with Me.
That's really great to hear. And everything you
just said, K really plays into some of
those earlier numbers you were talking about that.
82 percent of your members are open to
receiving health care in new ways. So really
cool to hear how how your members are
responding to this new partnership.
I think though, Krishna, my next question for
you. We we have to talk about some
some major upheaval that a major story that's
been going on within Medicare Advantage over the
last month or so.
As you know, Cms recently
rec
Medicare Advantage star ratings
across many health plans
after some some court challenges to to methodologies.
Can you talk a little bit about what
the that's looked like for for Bc cbs,
Michigan, what that's looked like for your team?
And and how does that ultimately impact your
strategy going into next year?
Well, you know, the good news is we
have,
enjoyed
strong star performance, both 4 and 4 and
a half for our Ppo and Hmo products
for sub years. And so that high rating
represents our commitment to ongoing quality, make sure
the seniors have access to it. The recent
bump in performance really provided with us an
opportunity to invest additional monies in the last
minute for 20 25 5 in the benefit
programs for our H hmo plan in 20
25 in particular. So I wouldn't call it
a big strategic shift as much as I
would just say it was a nice fine
tuning that were able... We were able to
deliver for, the market in 20 25. I
think, obviously, we had to re rebuild, like
the rest the industry did and did that
very quickly.
But we were just tickle that they had
made that change and were able to
stand by the program as as they had
rolled it out, and we are,
continually committed.
As they raise the bar in performance
expectations around quality and performance to to reach
those stars measures,
we're committed to clearing them. And that was
just a nice win for, I think the
the market and for seniors. I mean, the
seniors are the ones that are gonna benefit
from those changes in 20 25.
Yeah. Absolutely. I believe it's 40 plans that
are seeing upgrades, to their star ratings, and
of course, as, you know, Krishna, the all
the funds that come along with that.
If we're saying on the topic of of
20 25 strategy,
payers are kind of all over the place
right now in terms of planning. For Medicare
Advantage, how they're how they're pricing their products.
A lot of headwind right now in the
industry in terms of rising utilization rates and
and reduced reimbursement
from Cms.
So how is how is Blue Cross navigating
these headwind
that we're really seeing industry wide?
Well, you know what, 1 of the things
that I will say, which, you know, obviously,
my background,
you probably imagine that this was coming to
some that just because of the emphasis that
I already placed on,
partnerships with providers, but that's really central to
what Blue Cross is and what we stand
for is strong. Mean we have a deep
not only respectful for a partnership with providers
and really are leaning into that as it's
what it's gonna take strong for everyone to
be successful in a Medicare Advantage program.
We also have strong relationships with employers in
our market, of course, given our participation with
group Medicare Advantage plans.
And and 1 of the things that I
would say is
we're all,
aligned in our passion about solving for affordability
and access to excellent health care I mean,
all of these trends that you mentioned, whether
it's utilization,
patterns post pandemic, whether it's the Cms funding,
changes and reimbursement. Like, that affects all of
us, not not just a payer it affects
the providers it affects seniors it affects employers
in our market, and
we wanna solve that in our act working
towards solving that together. We might reach the
different aspects of the problem, but
we're all committed to being here for seniors
and the products that they want, which clearly,
you know, they're voting with their feed its
Medicare advantage.
So we see the utilization rates being up
that Cms is reduction and reimbursement to the
industry overall just really signaling a market theft
to correction
that the work that we've been doing to
meet the needs of the,
the population and as they've reached toward Medicare
Advantage
did drive a lot of competition reits and
benefits, and now they're correcting
the funding to make sure that it's sustainable
for the long term and that we continue
to double down in the things that we
need to change to be successful in Medicare
advantage. So
really our best work right now is being
done side by side with our partners. I'll
give you 1 example, the work that we're
doing with providers that participate in our boot
blueprint for... Affordability,
currently more than 50 percent of our total
attributed Blue Cross Commercial Medicare Advantage, Michigan membership
is covered by physicians participating in that shared
payment model. That's a total Jacob of 22
physician organizations that have signed on to a
blueprint shared brisk program. It it really makes
it 1 of the largest payment models of
its kind nationally. And that
represent work that acknowledges that you can't solve
for this level of change alone and that
we all need to evolve together to make
the program work in the best way that,
at
Cms, you know, the centers for medicare care
and medicaid services have laid out
and be successful and sustainable for seniors
to do that. And so I would answer
that in terms of partnerships. I mean, I
mentioned new partnerships and innovative ones that we're
working on with with companies like Me we'll
continue to do that. But it's also incumbent
upon us to
clear any confusion out of the way for
seniors that we would be aligned with their
physician as we solve for that together. That's
what they want, that's what we're hearing from
seniors. They they don't want conflicting messages. They
want to know what care to get and
the best care.
Cms provides the overall road map for that
in terms of their,
star program and quality. And
so we have work to do to make
sure that we're partnering.
At the hipaa of providers to do that,
and I would say that that's probably the
number 1 critical
success factor that we're leaning into right now.
Fantastic. Well, what else are we missing? You
you have the year right now of a
lot of health plan colleagues and and leaders
from all over the country. What would your
concluding thoughts be for them?
Well, I would say, you know, it's it's
a it's a pattern. It hard work.
Obviously,
us send many others who would be listening
for this are working really, really hard. New
environment that we're all dedicated to
succeed in.
Obviously, advanced analytics is gonna help us as
industry,
to understand that. The good news is at
the time
analytics are advancing that can help us meet
those challenges. So that's all great. But in
terms of what I would wanna, offer industry
colleagues, it's just it's time to get really
clear on our intent and our mission and
then make our decisions in alignment with that,
You know, when the going gets tough like
this, it's real. Easy to shift off of
that and make short term,
trade offs that may or may not align
with other our long term mission, and we've
just chosen to just re anchor ourselves be
re committed more than ever, and and that's
what we're doing. Blue Cross blue Shield and
Michigan, and we're committed to providing seniors.
Access to high quality affordable health care, and
that's what we're focused on being able to
do in our market through these changes,
So I I think that's probably my best
closing remark is, be rec committed to your
mission and,
show up every day willing to do the
hard work to make that happen.
Wonderful. I think that's a great parting message,
So, Thank you so much for taking the
time to sit down with us. And for
sharing your insights with our listeners, we truly
appreciate it. Thank you so much, Jacob.
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