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Hello, everyone.
This is Jacob Emerson with the Becker's Pay
Your Issues podcast.
Thrilled today to be joined by a special
guest,
Blue Shield of California's Promise Health Plan CEO,
Kristin Cerf. Kristin, thank you so much for
taking the time to be with us on
the podcast today.
Hello. Thank you so much for having me,
Jacob. I'm excited. This will be fun.
Likewise, Kristen. And before we dive into everything
we wanna talk with you about and everything
that's going on at Blue Shield, can you
tell us a little bit more about yourself
in terms of your health care career background
and what it is that you're doing today
at Blue Shield of California?
Alright. So I am currently president and CEO
of Blue Shield of California Promise Health Plan.
Blue Shield of California Promise Health Plan is
a nonprofit health plan that is fully owned
by Blue Shield of California,
also a nonprofit mission oriented health plan here
in California.
And I've been in this role for about
5 years now, and I've had a little
bit of a nontraditional
journey because before I moved into this position,
I was in the legal department. I was
the chief legal officer for Promise Health Plan.
I've had a long legal career, I guess.
At this point, it's over 15 years. I
started with the California
Department of Managed Health Care that regulates managed
care plans in California.
I spent time as outside counsel at Lock
Lord. It's an AM fifty law firm, and
it specialized at the time in deep, payer
issues and did everything from value based contracting
to, you know, disputes to learning how to
implement operational changes, mergers and acquisitions, all kinds
of fun stuff. And I was also at
another health plan and worked deeply in their
Medicaid business for 6 or 7 years as
well prior to coming to Blue Shield. So
it's been a really fun, a little bit
of a different journey, but I think that
lenses are always fun to play with. So,
it's definitely contributed a lot to my career.
Fantastic. Well, I appreciate you taking us through
that, Kristen. And the first thing I wanted
to talk with you about is something that
happened just a few weeks ago, and it
really affected all health plans throughout the country.
But the National Committee For Quality Assurance awarded
a 4 star rating to Blue Shield's Promise
health plan. Really, only a handful of,
health plans around the country achieved 4 stars,
and that number gets even smaller as you
know when we're talking about the Medicaid space.
So talk to us a little bit about
this rating. What goes into something like that,
and what does it mean specifically for Blue
Shield of California?
You know, this rating is a really special
rating because it's all about preventative care, and
it's about whether or not we've been able
to get our members access to and receive
the preventative care services that we need. So
I like to think of this as, like,
blood pressure screening, cervical cancer screenings, childhood immunizations,
adolescent immunizations,
prenatal and postpartum care. Right? So this is
really critical stuff, and so this is not
only a win for us at Promise. It's
a win for all of our members, our
580,000
Medicaid members in Los Angeles and San Diego
County.
And it's really deeply personal for me and
the team. As I mentioned, we're a nonprofit
organization.
Our mission is to ensure that our members
have access to high quality health care that's
worthy of our family and friends.
And we really view ensuring that members have
access to these preventative care services as core
to that mission. And I think in Medicaid,
it's a little bit tricky. Right? Because you're
talking about a low income population. It's a
significant
population as well. You've got about a third
of all Californians
on the Medicaid program
and about half of the children.
And for folks that are listening from other
states, California has combined the Children's Health Insurance
Program with the Medicaid program. So I just
talk about them together.
But it is a very large swath. And
when you think about that and you think
about the challenges that folks living in those
communities
may have, the lack of resources and access
to care that they may have, I I'd
say this is a pretty significant accomplishment and
one that we're very excited about.
Absolutely.
And, you know, that number you mentioned, 580,000
members across the state of California, that rating
means that all of those people are receiving
high quality health care as deemed by the
NCQA.
So, Kristen, what specific innovations took place within
the company, let's say over the last year,
to help achieve this high rating?
You know, it's so funny because we're living
in this age of technology, and I'd say
core and center to all of this is
data. Right? And access to is real time
data as is possible, and that requires really
deep partnership with our providers
to make sure that we know what's going
on and that we have that collaborative relationship.
But the real secret sauce here and where
the rubber meets the road is how do
you influence
someone to come to the table.
Right? How do you influence someone to go
see a doctor? How do you influence a
mom to take time out of her day
who has a job, children, other issues,
and go get a mammogram, which may feel
like something that's a little bit, like, not
as necessary because you feel fine. Right? Life
is going along. You're feeling great. Why do
I need that cervical cancer screening? Why do
I need that mammogram screening? Or, you know,
for men as well, why do I need
that blood pressure or that diabetes screening?
And and so it's hard because it's about
influence. And so what we've done is we've
taken our data. Right? We've continued to evolve
and invest in getting as real time data
as is humanly possible, and that is part
of the work that we're doing at Blue
Shield, and I'm sure you'll be hearing more
about that,
in the coming days,
and working with our providers and our community
based organization partners so that we can really
get out there and build that trust with
our members.
I think that equity and understanding the communities
that we serve, understanding barriers and access to
care, understanding that there may be a need
for alternative
appointment hours, working with providers to ensure that
they understand what's going on in their specific
community, and also listening.
Because so often, so many of our members,
our providers, and our community based organizations
actually tell us exactly what they need. And
so when we understand what we need, we
can actually tailor and build interventions
that are designed to address those needs. So
that's really been the secret sauce, but, you
know, it's not necessarily like a cut and
paste or a one size fits all because
every person is different. Every provider group is
different. Every community that someone lives in is
different. And so, you have to take those
dynamics into account to truly move the needle
and build those trusted relationships and get to
a place where people understand the importance of
taking the time to engage in these important
screenings.
Sure. Absolutely. So a lot of data driven
processes here along with a lot of provider
collaboration, it sounds like, that led to this
high rating.
And as you know, Kristen, there's a member
survey that goes into this rating as well
from the NCQA,
that the that the organization administers itself. Blue
Shield has no input in terms of how
what kind of data comes back from your
members. So were there other areas within the
member experience that the company has placed emphasis
on in the past couple of years that
then led to where we are now with
with that high rating for your Medicaid plan?
Yeah. I'd say one of the things that
we've invested in is actually a joint partnership
with LA Care Health Plan down in Los
Angeles. They're
a local initiative health plan. We're a nonprofit.
We have a heck of a lot in
common.
We put a $149,000,000,
collaboratively
together into the pot to build 14 community
resource centers.
Right? And so this is also taking us
back to the days of brick and mortar,
but creating a place that is welcoming,
and designed to meet community needs, the needs
that I spoke about earlier.
Also incredibly data driven intended to serve very
high volume of both of our membership that
live within 3 miles of each center across
Los Angeles County
and really designed to address
lifestyle issues, right, that can contribute
to health
outcomes. So are you cooking and eating well?
Do you have the skills and tools to
understand how to do that? We offer family
cooking classes. I think that's so great just
to get even kids to the table and
start folks early on what it means to
to live a healthy lifestyle, exercise classes, financial
classes so that people can understand
how to build a credit score. Right? Things
like that. And then as a lever point,
we're able to use them as a place
where we can bring in some screening services.
So everyone's aware we have mammogram vans. Everybody
does. We have provider partners that do that.
We're able to bring those vans to those
sites based on what the community has told
us or or times and needs that will
serve them best.
Well, it's a fantastic example, and I I
really appreciate you sharing that with us, Kristin,
in terms of payers collaborating together for better
health outcomes.
In that vein, any other notable innovations or
community outreach programs that the company wants to
build upon
from this past year or moving forward?
Yeah. Well, before we hit that, if that's
okay, I'd love to just discuss a few
data points that I neglected to mention earlier.
Yeah. So at our community resource centers, we're
actually starting to see our data. We started
this journey about 5 years ago. Sure you
can imagine COVID had an impact, but most
importantly,
we're seeing that these centers are actually supporting
the members. So if we all start at
the top that social needs drive 80% of
health care spending. Right? So we all know
how expensive it is, and we all know
that we need to address it.
And then we bring in interventions like a
resource center to support our members.
We have seen a 36%
decrease in in patient admissions,
a 32%
decrease in urgent care visits, and most excitingly
when we're talking about quality and we're talking
about interventions,
we've seen a 21%
increase in primary care visits from the members
that access these sites. So this is really
exciting stuff and something that I really want
to encourage people to think about.
The stuff that you're gonna see as we
head towards the future that's really exciting, I
think, for us and for everyone at Promise.
You're gonna see deeper partnership. You're gonna see
a focus on equity, which is part of
the work that I think so many states,
including California, are doing.
Again, that is core to our mission, so
we're very excited in that. I think that
we're a little bit ahead of the curve
on that and truly understanding our members, the
populations that we serve, and tailoring,
to address their specific needs.
We've also launched an incredibly exciting program in
partnership with GED Works to support our members
and understanding that
every single member, right, that may need access
to,
getting their high school diploma or GED, general
education degree equivalent,
can do that. And it's completely free to
them because there has been a really deep
correlation shown in studies between
having that high school level education and their
overall health and well-being outcomes. So, we're really
excited to get some data on that as
well and see where we we go. Our
first group has already gone through GED Works,
and they're in the middle of testing and
getting those very exciting,
degrees.
And then our second group is up and
starting right now. So just really exciting, wonderful
stuff to see and also just great to
see how when you listen to the community,
you understand the needs of the folks that
are in that community and you bring to
the table and offer things,
people do take you up on it. And
I think that that is the most meaningful
part of all the work that we're doing.
Absolutely. And clearly so much impactful work going
on at Blue Shield. But before we go,
Kristen, what else are we missing? Any final
thoughts or final bits of advice you'd like
to offer while you have the ears of
a lot of health plan leaders all over
the country?
I am just gonna say, and I've been
saying this for years, partnership,
partnership, partnership. Whether it's partnership with your providers,
your community based organizations,
your members, or even other payers.
These are tremendous challenges, right, that we're all
facing. We all have
extremely,
you know, big audacious goals because they're the
right things to do.
And as we work together, I think that
we're able to have significantly more impact. So,
our future is so bright.
We're seeing Medicaid programs not only in California
through California Advancing and Innovating in Medi Cal
but other states
really headed around and focused on such key
important components of people having the highest and
best opportunity
at an overall, like, great health outcome. Right?
We're focused on equity. We're focused on population
health. We're focused on whole person care. It
doesn't get much better than that. Really understanding
social needs and and delivering on those, I
think, are the key to unlocking highest and
best optimal health outcomes for everyone. So I
always say if it works in Medicaid, it's
gonna work everywhere else too.
And it's working here, it's working now, and
I'm really excited for what that means for
the future.
Wonderful. Well, Kristen, 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, Jacob.
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