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This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor Tommy Ibrahim, president and CEO of Sanford
Health Plan. Doctor Ibrahim, it's a pleasure to
have you on the podcast today.
Thanks so much, Laura. It's a pleasure to
be here.
Now, I'm really looking forward to our discussion
because I know you're doing such interesting things
at Sanford and really a lot happening in
the healthcare space in general. So I I'm
looking forward to getting your perspective and especially
how you're thinking about growth and development in
the future. But before we dive into that
discussion, can you tell us a little bit
more about yourself and your background?
Yeah. Sure. Happy to. So I am a
physician, born and raised on the East Coast.
Actually, spent most of my career out there
as well,
internal medicine by background and, largely, you know,
aside from clinical practice, have been in a
variety of successfully larger physician executive roles over
the course the past couple of
decades, mainly on the provider side. So actually
coming over to the,
the health insurance space, the health plan side
has been, you know, a really
exciting, adjustment and change. And then a real
opportunity to be sort of at the intersection,
of a fantastic integrated health healthcare delivery system,
but also with a financing,
division to really help shape, the future of
how we take care of patients in this
country.
You know, to me, it really is all
about impact,
and the ability to sort of be at
the intersection
of those two amazing assets, is to, you
know, have that opportunity to reshape and redesign
how we take care of patients, to look
at alternative care delivery models, to look at
alternative payment models,
and to put in place structures and systems
to really get upstream and and support
health and wellness and and really
begin to move, healthcare,
in the direction this country really needs.
That's really, you know, such a, an important
thing to, be on the forefront of, and
especially as you talked about going from being
on the health system side to now the
health plan side. What was the biggest adjustment
you had to make?
You know, it's definitely a little bit of
a learning curve. Right?
You know, it's a it's a different, it's
a different system. It's a different language,
a different incentive,
you know, mechanisms that are put into place.
But, again, a true opportunity to do something
transformational,
and to partner, you know, with our care
delivery system,
with our integrated healthcare, you know, physician enterprise,
and to, again, sort of put in place
those mechanisms to truly transform how we take
care of patients.
And we service a very wide region. I
mean, the Sanford Health Plan,
as you might know, is a provider owned,
not for profit organization.
We are spread out a pretty you know,
across a pretty wide region, over 250,000
square miles across North Dakota, South Dakota,
Minnesota, Iowa, and now Nebraska as well.
So we have a true opportunity to serve
America's Heartland,
and
and these rural geographies in a different way.
And I'm just super excited to be,
here and have this opportunity.
Absolutely. You know, that's such an important point.
And as an Iowa native, I know how
important to, and sprawling and challenging,
some of those rural communities can be. Now,
from your perspective, what do you see as
being some of the biggest trends and headwinds
that you're following right now?
Well, I think it's no surprise to anybody.
I mean, the economics of our healthcare industry
are definitely driving towards, continued unsustainability.
You know, for appropriate reasons, there's a lot
of measures that are being put into place
to try to control that trend,
overall. But, you know, we're seeing the, you
know, the daily effects, of the, of the
sort of the post pandemic
period,
continued
inflationary pressures on
medical as well as pharmaceutical
claim rates,
and a real need to address
purchasers, both employers, as well as federal and
state governments, to try to reign in medical
costs
and other associated
economic pressures
to really control
that trend overall. So we're obviously spending a
lot of time trying to respond to that.
You know, in addition
and for appropriate reason, you know, we're seeing,
other other measures from the federal government, for
example, around Medicare Advantage, you know, challenges and
and the associated responses in terms of, you
know, stars rating, adjustments and and reimbursement,
adjustments moving into the future. So we're obviously
trying to really step back and prepare,
for that as a Sanford help point.
Yeah. Absolutely. I think that makes a lot
of sense. And, you know, when you think
about, what you're doing today and and where
these trends are headed in the future,
What do you see as being just so
essential that, you know, what you're doing right
now to prepare for the future, in in,
you know, obviously, there's no crystal ball, but,
I just love to get a sense from
you in terms of for for our listeners
and those who are at health systems across
the country, what they should be doing to
make sure that they're ready for some of
these changes, even if you can't predict, you
know, exactly what's gonna happen.
Yeah. So I think if we focus on
some of the challenges that we're seeing in
Medicare Advantage, for example, you know, think, the
Sanford Health Plan and other provider led health
plans,
sort of get lumped into a broader conversation
about,
maybe some of the tactics and practices out
there, that have contributed to, some of the,
you know, problems that have been identified, whether
it's around prior authorization, whether it's around
prior authorization, whether it's around excessive denial rates.
And, you know, as a sort of a
a distinct and differentiated
provider led,
health plan as a not for profit,
that is, you know, locally owned and operated,
really, sort of mission focused in in serving
the community.
You know, we, I think, unfairly, to some
degree, get lumped into that broader,
conversation. So,
you know, this is an area that I
think, I am certainly focused on. I think
other CEOs and provider led health plans are
definitely trying to address to to really help
reshape that narrative.
I think if you just look at it
from a pure factual and data perspective,
we have done a tremendous amount to ensure
that we are reducing abrasion and friction for
our members,
for our providers.
We have incredibly low prior authorization rates,
and in some cases where prior authorization is
necessary,
ensure that we turn things around, to have
a response both back to our providers and
our members within less than 24 hours
and have, you know, very successfully been able
to demonstrate,
our performance there with greater than 90%
turnaround times less than 24 hours. So that's
a key data point where I think it's
it's really important to differentiate.
Similarly,
you know, when it comes to denials,
we really,
perform
incredibly well, much, much better on a national
average basis,
than some of the larger plans.
And I think take a lot pride in
our performance here and and and really think
that as further disruption happens within the Medicare
Advantage space, that we have a great opportunity
to to really capitalize and continue to grow
organically,
on some of the challenges that, members might
be facing with different plans.
That's fascinating to hear and especially on the
Medicare Advantage Point. I know that's,
certainly
Medicare Advantage Plans across the board have, a
lot of, you know, different opinions on how,
you know, what they do currently and how
they can grow and continue to evolve. And
so it's just been really fascinating to see
them,
as part of our larger health care ecosystem.
Now from your perspective, how are you you
thinking about growth and development for the future?
Yeah. So we think think about it in
really 2, you know, important buckets, buckets.
You know, I would say organically,
we're constantly focused on our direct markets,
evaluating which product lines, have opportunity both in
the commercial as well as the governmental space
to continue to expand. I think one of
the challenges that we run into there obviously
is just limited by population and,
by
specific market dynamics that might limit how far
we can really go from an organic growth
perspective. Having said that, we're really stepping back
and trying to differentiate ourselves around the member
experience, making sure that we're trying to be
as high touch as possible to serve clients
and employers and and individual,
you know, members to the best,
to the best of our abilities and to
and to truly meet their unique and specific
needs. And I think by taking a very
high touch experience, by focusing on the fact
that we are,
an integrated healthcare delivery system, and work very
closely,
with a very large base of, physicians and
and other advanced providers.
We have an ability to to really,
cultivate a seamless and frictionless process, and,
you know,
patient journey, a member journey, if you will,
through our entire
healthcare delivery system. So we really try to
emphasize that,
to, you know, attract and retain,
and grow our our health plan, you know,
through that integrated and and differentiated process.
You know, aside from that, we're always thinking
about how we expand beyond our broader region.
So as I mentioned, you know, we're across,
5 states today. The predominant,
I think, member population for us exists in
South Dakota and North Dakota.
But we are always thinking about how sort
of a broader regional presence might play out,
even a broader national presence might play out,
and always evaluating inorganic opportunities as well. So
how can we partner with other potential regional
health plans that are also not for profit,
sort of,
assimilated the same exact way, kind of a
similar vision and and mission focus.
But also thinking about how we could partner
with other,
medical groups, for example, or other health care
delivery systems that might be interested,
potentially
in, you know, not not necessarily launching their
own health plan, but tapping into,
health plan capabilities to potentially launch products within
their respective markets. That's an area that we've
seen some interest in, and one that we're
actually
actively chasing. Particularly with our niche around rural
healthcare,
We think our strength there gives us an
advantage, a competitive advantage,
just given our depth, given our expertise, and
our understanding of the challenges of those markets.
But work very closely with other health care
organizations
nationally,
that, have a similar mission focus on rural,
which is really exciting. And I think, you
know, given
given the underserved
nature of those markets,
given,
how, for example, Medicare Advantage penetration rates are
very low, in rural geography, we think that's
a really interesting area to expand within.
That's fascinating to hear. You know, and certainly,
as you talked about having that focus on
rural healthcare, being able to understand what patients
need and how to improve access, and troubleshoot
some of those big challenges,
really makes a big difference. And, you know,
when you think about that Medicare Advantage,
penetration and and seeing that as a potential
opportunity.
Are are you, you know, looking at ways
to continue to engage, the larger population? Have
you, I guess, heard any feedback in in
terms of willingness to, you know, participate in
some of those plans or an eagerness
to have additional participation there? Yeah.
You know, I think we're seeing some really
encouraging trends in terms of where,
Medicare Advantage is going. You know, for the
first time ever,
Medicare Advantage penetration rates nationally have crossed,
that 51%
mark. So that, basically, what that means is,
more Medicare beneficiary,
eligible enrollees are opting to move into an
MA product,
as opposed to traditional Medicare. And there's really
good reason for that. It's, you know, it's
it's a it's a nice sort of bundled
one stop shop kind of,
approach to health insurance.
And in most cases, it's also the most
affordable with most plans offering up to, you
know, 0 premium,
you know, payments, in terms of a a
cost share model for, these beneficiaries. So I
think more and more
members or beneficiaries will elect to move into
this direction.
And as it pertains to
rural markets,
the numbers are very different.
I think if you study sort of our
region, we're seeing penetration rates sometimes less than
20%. And
that could be related to,
just various different factors associated with referral patterns
or physicians making recommendations to
their patients about whether or not to opt
for an MA product,
challenges around access, for example, potential network adequacy.
All of those, I think, come into play
when, you know, sort of evaluating whether or
not it makes sense
for a patient or a member in those
markets to to make a change. But, I
think that's where we add some strength and
where we can actually,
you know, begin to move that paradigm.
That's great to hear. And thank you so
much for digging a little bit deeper into
that question as well. Now, before we wrap
up our conversation, I'm wondering, could you tell
me about a project or initiative from the
last year or so that yielded the best
results?
Yeah. That's a really good question. I mean,
I think the first thing that comes to
mind is some of the great work that
we're doing around virtual care.
You know, as it, again, sort of pertains
to to rural health care, we think that
telehealth and virtual capabilities are essential,
to reaching members and patients within rural geographies
that might otherwise have challenges with transportation,
or just access in general.
So Sanford, through the incredible generosity of, Denny
Sanford, has a tremendous,
initiative underway to build out a $350,000,000
virtual
care center. And as part of that,
we're actually launching, and have launched a
patient care virtual center, that's predominantly focused on
our ACA, as well as Medicare Advantage population.
And and working very closely with those, patients,
we're able to really identify,
care gaps. We're able to to really reach
out to those folks,
who are considered high risk, and to ensure
that we're bundling services and and benefits around
them, to,
try to optimize their health as best as
possible. And we've been able to really demonstrate,
some excellent success there. 16% of our virtual
visits,
with our MA members have actually led to
an internal referral. And really, what that means
is we're identifying gaps in care. We're making
sure that those patients get seen
by the appropriate specialists where they need to.
And, that ultimately leads to to better outcomes,
and reduces, outcomes and reduces, healthcare costs downstream.
And I think that's the way, really healthcare
should be, you know, delivered and working.
That's a really, really,
strong perspective there and, you know, great to
hear those results. Thank you so much, doctor
Ibrahim, for joining us on the podcast today.
I really appreciate the opportunity to connect with
you and share some of the cool things
you're doing at Sanford with our broader audience.
I look forward to connecting with you in
the future as well.
Likewise, Laura. Thanks for the opportunity.