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This is Gracelyn Keller with the Becker's Healthcare
podcast, and we are live at the 2024
payer issues roundtable.
I'm joined currently by Jeremy Wigginton, who is
the chief medical officer at Capital Blue Cross.
Thanks so much for being here, and let's
start our conversation today by having you introduce
yourself and tell us a little bit more
about your role.
Thank you. Yes. Doctor Jeremy Wigginton, the chief
medical officer for Capital Blue Cross out of
Harrisburg, Pennsylvania.
And in my current role, I lead all
of our health plans clinical operations, including utilization
management,
care management, our behavioral health, clinical programs and
strategies,
all of our clinical data reporting, our total
cost of care, and our clinical strategic alignment
across the enterprise.
Wonderful. Well, thanks for being here. And let's
start our conversation
talking about growth goals. So from improving member
experience, expanding value based care,
and controlling costs, payer executives have ambitious growth
goals for the rest of this year and
the new year looking ahead. In your role,
what is your top priority and how are
you planning to get there? That's a great
question. And there
actually are a lot of ambitious growth goals
and plans. And so my top priority is
really identifying our population's really the the top
greatest needs, and then working with our provider
partners to help deliver solutions to those needs.
And those things include
areas of overutilization,
such as emergency room care, but also areas
of poor health outcome
health outcomes, such as things like sepsis
or even inpatient surgical infection rates, those things
that are really driving the worst outcomes but
for the highest cost.
And I really think by looking at the
intersection of those costs and outcomes, we can
start to drive those more meaningful discussions with
our provider partners about the ways that we
can partner together
to really find real solutions to those problems,
and how to align incentives to bring those
solution those solutions to fruition.
A 100%.
And at an industry level, how would you
describe the biggest barriers to effectively serving and
engaging members? And what opportunities do you see
for large scale improvements? And how are you
applying this in your current strategy?
It's It's a great question as well. Well,
one of the biggest barriers to effectively
serving and engaging our members, in health care
in general is really navigating the complexity of
the health care system.
Members face daily challenges,
and with health literacy,
and really understanding their own health conditions, their
care plans, what they need to do to
improve their own health. So really, there's a
lot of opportunity there around members' self, you
know, self awareness and their own health literacy.
They're faced with extremely complex financial and logistical
challenges around finding the right health care providers,
getting the necessary preventative care and really knowing
what resources are available to them under their
health plan when they need them. So I
see really significant opportunities
for large scale improvements and strategies on how
we approach care navigation
and individualized member support, so advocacy programs.
And I think by helping individual members really
understand and navigate these complexities,
we can really start to serve their needs
better and help them to achieve better health
outcomes together.
Absolutely. And shifting gears just a little bit
toward,
growing leadership.
Keeping pace in today's dynamic health care landscape
is very challenging. So what is a piece
of advice you'd share with peer leaders to
grow their businesses while keeping members top of
mind?
My advice as a physician leader is to
continue to focus on and investing in providing
benefits for whole person care and integrated care.
And this includes investments in people, processes, technology,
to really further integrate members' behavioral, emotional and
social needs into clinical programs. So I really
think we've got to continue to really focus
on the whole person health.
And by approaching our members' needs holistically,
we will be able to provide more impactful
and personalized support. So, for example, in my
own health plan, starting 1onetwenty
5, Capital Blue Cross is gonna have a
completely in source and integrated model of care
that's gonna cross all of our plan functions,
including customer service, utilization management, care management, provider
partnerships.
So I think these types of investments are
really gonna help members lead those happier, healthier
lives with access to more resources and really
a stronger relationship with their care team across
the health care ecosystem. And so I think
investing in that,
whole person model is really critical.
Absolutely. And as we wrap our conversation, I'd
love to dive into technology just a little
bit. So what role is technology playing in
your organization's growth strategies? And I would love
to hear a specific example. Sure. Well, technology
actually plays a really critical
role in our growth and retention strategies.
Members and clients want information and service when
it's convenient for them, and we know that
employer groups want the same on demand access
and support for their plan and membership.
So a prime example of this is through
the creation of a digital front door. So
that allows access to benefits and services, as
well as claims and financial data. And then
by overlaying things like a digital front door
with supplemental AI,
you know, large language models,
we can really offer 20 fourseven access to
needed resources. So by offering that consolidated view
of the most important information to our members
and clients, we can really help to both
grow and retain,
but also, again, improve those health outcomes.
Wonderful. Well, Jeremy, thank you so much for
sharing your insights today on the Becker's HealthCare
podcast. Again, we are live at the 2024
Payer Issues Roundtable.
Thank you.