1 00:00:00,160 --> 00:00:02,899 Evernorth brings the power of wonder and relentless 2 00:00:02,960 --> 00:00:05,919 innovation to create world class pharmacy care and 3 00:00:05,919 --> 00:00:09,199 benefit solutions. Our connected health services make the 4 00:00:09,199 --> 00:00:12,080 treatment, prediction, and prevention of health care's most 5 00:00:12,080 --> 00:00:13,059 complex conditions 6 00:00:13,605 --> 00:00:16,344 easier and more accessible as we drive organizations 7 00:00:16,725 --> 00:00:19,524 and people forward. Ever North Home Based Care 8 00:00:19,524 --> 00:00:22,004 provides value based care that helps patients with 9 00:00:22,004 --> 00:00:23,384 multiple chronic conditions 10 00:00:23,844 --> 00:00:26,085 and social determinant of health barriers get the 11 00:00:26,085 --> 00:00:28,884 care they need and the personalized experience they 12 00:00:28,884 --> 00:00:31,660 deserve. We serve patients who struggle to navigate 13 00:00:31,660 --> 00:00:34,060 the health care system by bringing high quality 14 00:00:34,060 --> 00:00:34,560 primary 15 00:00:34,939 --> 00:00:37,739 and preventative care services to the home. By 16 00:00:37,739 --> 00:00:40,700 providing clinical care and support services that provide 17 00:00:40,700 --> 00:00:43,439 whole person care, we improve health equity, 18 00:00:43,925 --> 00:00:46,585 access, and outcomes for the populations we serve. 19 00:00:48,005 --> 00:00:50,164 This is Gracelyn Keller with the Becker's Healthcare 20 00:00:50,164 --> 00:00:52,265 podcast, and we are live at the 2024 21 00:00:52,565 --> 00:00:53,784 payer issues roundtable. 22 00:00:54,245 --> 00:00:56,725 I'm joined currently by Jeremy Wigginton, who is 23 00:00:56,725 --> 00:00:59,130 the chief medical officer at Capital Blue Cross. 24 00:00:59,450 --> 00:01:00,890 Thanks so much for being here, and let's 25 00:01:00,890 --> 00:01:03,049 start our conversation today by having you introduce 26 00:01:03,049 --> 00:01:04,409 yourself and tell us a little bit more 27 00:01:04,409 --> 00:01:05,230 about your role. 28 00:01:05,609 --> 00:01:08,090 Thank you. Yes. Doctor Jeremy Wigginton, the chief 29 00:01:08,090 --> 00:01:10,010 medical officer for Capital Blue Cross out of 30 00:01:10,010 --> 00:01:11,069 Harrisburg, Pennsylvania. 31 00:01:11,525 --> 00:01:12,965 And in my current role, I lead all 32 00:01:12,965 --> 00:01:15,864 of our health plans clinical operations, including utilization 33 00:01:16,084 --> 00:01:16,584 management, 34 00:01:16,965 --> 00:01:20,245 care management, our behavioral health, clinical programs and 35 00:01:20,245 --> 00:01:20,745 strategies, 36 00:01:21,125 --> 00:01:23,125 all of our clinical data reporting, our total 37 00:01:23,125 --> 00:01:25,765 cost of care, and our clinical strategic alignment 38 00:01:25,765 --> 00:01:26,744 across the enterprise. 39 00:01:27,640 --> 00:01:29,799 Wonderful. Well, thanks for being here. And let's 40 00:01:29,799 --> 00:01:30,780 start our conversation 41 00:01:31,799 --> 00:01:34,759 talking about growth goals. So from improving member 42 00:01:34,759 --> 00:01:37,420 experience, expanding value based care, 43 00:01:37,719 --> 00:01:41,015 and controlling costs, payer executives have ambitious growth 44 00:01:41,015 --> 00:01:42,614 goals for the rest of this year and 45 00:01:42,614 --> 00:01:44,775 the new year looking ahead. In your role, 46 00:01:44,775 --> 00:01:46,375 what is your top priority and how are 47 00:01:46,375 --> 00:01:48,295 you planning to get there? That's a great 48 00:01:48,295 --> 00:01:49,594 question. And there 49 00:01:50,055 --> 00:01:52,295 actually are a lot of ambitious growth goals 50 00:01:52,295 --> 00:01:54,649 and plans. And so my top priority is 51 00:01:54,649 --> 00:01:57,849 really identifying our population's really the the top 52 00:01:57,849 --> 00:02:00,409 greatest needs, and then working with our provider 53 00:02:00,409 --> 00:02:02,729 partners to help deliver solutions to those needs. 54 00:02:02,729 --> 00:02:04,189 And those things include 55 00:02:04,569 --> 00:02:05,549 areas of overutilization, 56 00:02:06,090 --> 00:02:08,814 such as emergency room care, but also areas 57 00:02:08,814 --> 00:02:09,854 of poor health outcome 58 00:02:10,574 --> 00:02:12,514 health outcomes, such as things like sepsis 59 00:02:12,814 --> 00:02:15,294 or even inpatient surgical infection rates, those things 60 00:02:15,294 --> 00:02:17,375 that are really driving the worst outcomes but 61 00:02:17,375 --> 00:02:18,514 for the highest cost. 62 00:02:18,814 --> 00:02:20,094 And I really think by looking at the 63 00:02:20,094 --> 00:02:22,479 intersection of those costs and outcomes, we can 64 00:02:22,479 --> 00:02:24,639 start to drive those more meaningful discussions with 65 00:02:24,639 --> 00:02:26,639 our provider partners about the ways that we 66 00:02:26,639 --> 00:02:27,780 can partner together 67 00:02:28,080 --> 00:02:30,580 to really find real solutions to those problems, 68 00:02:31,120 --> 00:02:33,040 and how to align incentives to bring those 69 00:02:33,040 --> 00:02:35,219 solution those solutions to fruition. 70 00:02:36,014 --> 00:02:36,754 A 100%. 71 00:02:37,294 --> 00:02:39,294 And at an industry level, how would you 72 00:02:39,294 --> 00:02:41,854 describe the biggest barriers to effectively serving and 73 00:02:41,854 --> 00:02:44,655 engaging members? And what opportunities do you see 74 00:02:44,655 --> 00:02:46,655 for large scale improvements? And how are you 75 00:02:46,655 --> 00:02:48,194 applying this in your current strategy? 76 00:02:48,655 --> 00:02:50,280 It's It's a great question as well. Well, 77 00:02:50,280 --> 00:02:52,379 one of the biggest barriers to effectively 78 00:02:52,680 --> 00:02:55,159 serving and engaging our members, in health care 79 00:02:55,159 --> 00:02:57,800 in general is really navigating the complexity of 80 00:02:57,800 --> 00:02:58,939 the health care system. 81 00:02:59,319 --> 00:03:01,500 Members face daily challenges, 82 00:03:02,039 --> 00:03:03,259 and with health literacy, 83 00:03:04,360 --> 00:03:07,055 and really understanding their own health conditions, their 84 00:03:07,055 --> 00:03:08,895 care plans, what they need to do to 85 00:03:08,895 --> 00:03:11,055 improve their own health. So really, there's a 86 00:03:11,055 --> 00:03:13,775 lot of opportunity there around members' self, you 87 00:03:13,775 --> 00:03:16,034 know, self awareness and their own health literacy. 88 00:03:16,735 --> 00:03:20,060 They're faced with extremely complex financial and logistical 89 00:03:20,200 --> 00:03:22,540 challenges around finding the right health care providers, 90 00:03:23,000 --> 00:03:25,800 getting the necessary preventative care and really knowing 91 00:03:25,800 --> 00:03:27,960 what resources are available to them under their 92 00:03:27,960 --> 00:03:29,960 health plan when they need them. So I 93 00:03:29,960 --> 00:03:31,819 see really significant opportunities 94 00:03:32,425 --> 00:03:34,905 for large scale improvements and strategies on how 95 00:03:34,905 --> 00:03:36,604 we approach care navigation 96 00:03:37,064 --> 00:03:40,444 and individualized member support, so advocacy programs. 97 00:03:40,905 --> 00:03:43,224 And I think by helping individual members really 98 00:03:43,224 --> 00:03:45,245 understand and navigate these complexities, 99 00:03:45,849 --> 00:03:47,930 we can really start to serve their needs 100 00:03:47,930 --> 00:03:49,770 better and help them to achieve better health 101 00:03:49,770 --> 00:03:50,669 outcomes together. 102 00:03:51,530 --> 00:03:54,409 Absolutely. And shifting gears just a little bit 103 00:03:54,409 --> 00:03:54,909 toward, 104 00:03:55,210 --> 00:03:56,189 growing leadership. 105 00:03:56,729 --> 00:03:59,264 Keeping pace in today's dynamic health care landscape 106 00:03:59,405 --> 00:04:01,564 is very challenging. So what is a piece 107 00:04:01,564 --> 00:04:03,805 of advice you'd share with peer leaders to 108 00:04:03,805 --> 00:04:05,965 grow their businesses while keeping members top of 109 00:04:05,965 --> 00:04:06,465 mind? 110 00:04:07,085 --> 00:04:09,485 My advice as a physician leader is to 111 00:04:09,485 --> 00:04:12,784 continue to focus on and investing in providing 112 00:04:13,319 --> 00:04:16,199 benefits for whole person care and integrated care. 113 00:04:16,199 --> 00:04:19,259 And this includes investments in people, processes, technology, 114 00:04:19,800 --> 00:04:23,639 to really further integrate members' behavioral, emotional and 115 00:04:23,639 --> 00:04:26,040 social needs into clinical programs. So I really 116 00:04:26,040 --> 00:04:27,980 think we've got to continue to really focus 117 00:04:28,154 --> 00:04:29,615 on the whole person health. 118 00:04:29,915 --> 00:04:32,014 And by approaching our members' needs holistically, 119 00:04:32,954 --> 00:04:34,654 we will be able to provide more impactful 120 00:04:34,714 --> 00:04:37,355 and personalized support. So, for example, in my 121 00:04:37,355 --> 00:04:39,294 own health plan, starting 1onetwenty 122 00:04:40,490 --> 00:04:42,490 5, Capital Blue Cross is gonna have a 123 00:04:42,490 --> 00:04:45,050 completely in source and integrated model of care 124 00:04:45,050 --> 00:04:47,150 that's gonna cross all of our plan functions, 125 00:04:47,529 --> 00:04:51,370 including customer service, utilization management, care management, provider 126 00:04:51,370 --> 00:04:51,870 partnerships. 127 00:04:52,425 --> 00:04:54,105 So I think these types of investments are 128 00:04:54,105 --> 00:04:56,584 really gonna help members lead those happier, healthier 129 00:04:56,584 --> 00:04:59,225 lives with access to more resources and really 130 00:04:59,225 --> 00:05:02,264 a stronger relationship with their care team across 131 00:05:02,264 --> 00:05:04,024 the health care ecosystem. And so I think 132 00:05:04,024 --> 00:05:05,084 investing in that, 133 00:05:05,944 --> 00:05:07,805 whole person model is really critical. 134 00:05:08,720 --> 00:05:11,199 Absolutely. And as we wrap our conversation, I'd 135 00:05:11,199 --> 00:05:13,360 love to dive into technology just a little 136 00:05:13,360 --> 00:05:15,839 bit. So what role is technology playing in 137 00:05:15,839 --> 00:05:18,319 your organization's growth strategies? And I would love 138 00:05:18,319 --> 00:05:20,899 to hear a specific example. Sure. Well, technology 139 00:05:20,959 --> 00:05:22,420 actually plays a really critical 140 00:05:22,774 --> 00:05:24,955 role in our growth and retention strategies. 141 00:05:25,574 --> 00:05:28,375 Members and clients want information and service when 142 00:05:28,375 --> 00:05:30,214 it's convenient for them, and we know that 143 00:05:30,214 --> 00:05:32,694 employer groups want the same on demand access 144 00:05:32,694 --> 00:05:34,475 and support for their plan and membership. 145 00:05:35,040 --> 00:05:36,639 So a prime example of this is through 146 00:05:36,639 --> 00:05:38,899 the creation of a digital front door. So 147 00:05:39,199 --> 00:05:41,759 that allows access to benefits and services, as 148 00:05:41,759 --> 00:05:44,000 well as claims and financial data. And then 149 00:05:44,000 --> 00:05:46,240 by overlaying things like a digital front door 150 00:05:46,240 --> 00:05:47,939 with supplemental AI, 151 00:05:48,615 --> 00:05:50,154 you know, large language models, 152 00:05:50,855 --> 00:05:53,574 we can really offer 20 fourseven access to 153 00:05:53,574 --> 00:05:57,175 needed resources. So by offering that consolidated view 154 00:05:57,175 --> 00:05:59,495 of the most important information to our members 155 00:05:59,495 --> 00:06:01,415 and clients, we can really help to both 156 00:06:01,415 --> 00:06:02,314 grow and retain, 157 00:06:02,629 --> 00:06:04,729 but also, again, improve those health outcomes. 158 00:06:05,430 --> 00:06:07,349 Wonderful. Well, Jeremy, thank you so much for 159 00:06:07,349 --> 00:06:09,430 sharing your insights today on the Becker's HealthCare 160 00:06:09,430 --> 00:06:11,610 podcast. Again, we are live at the 2024 161 00:06:11,829 --> 00:06:12,970 Payer Issues Roundtable. 162 00:06:13,430 --> 00:06:14,169 Thank you.