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This is Gracelyn Keller with the Becker's healthcare
podcast, and we are live at the 2024
fall pay issues roundtable.
I am joined right now by Angela Perry,
who is the chief Medicare officer at UPMC
Health Plan.
Thank you so much for being here, Angela.
Would love to have you start off by
introducing yourself and telling us a little bit
more about your role.
Sure. Again, I'm Angela Perry. I'm the chief
Medicare officer for UPMC Health Plan and UPMC.
We are a payer provider organization.
So we have both health plan and several
hospitals and physicians.
My role there is I'm responsible for the
Medicare products division.
We have approximately
200
and almost 20,000
members
in Pennsylvania.
We focus on both from a Medicare Advantage
perspective,
non SNP, which is our HMO and PPO
products, as well as our special needs plan,
our D SNP product.
We have about a 140,000
members in our non SNP and about 40,000
numbers in our D SNP product.
Wonderful. Well, thank you for being here. Mhmm.
And let's start our conversation today talking about
growth goals. So from improving member experience and
expanding value based care to controlling costs, Payer
executives have ambitious growth goals for the rest
of the year and looking into 2025.
So in your role, what is your top
priority, and how are you planning to get
there?
Sure.
So from a goals and a growth
perspective,
every Medicare Advantage Plan is looking to grow.
And the last couple of years in the
post pandemic
era
has been challenging to say the least.
So our goals
continue to be focusing on innovative benefit design.
Again, focusing from a
quality and and a risk adjustment point of
view.
So a lot of the policies from a
government perspective have changed.
And
being able to not just comply with some
of those
changes from quality and stars to risk adjustment,
the health equity index that's a part of
that. All of these things are our goals,
not just to comply with them, but to
really understand how we're gonna
better impact the health of our communities.
We are primarily in Western and Central Pennsylvania.
And so being a regional health plan, we
are
highly engaged in our communities. And our goals
are really to connect people from an access
and affordability and a stability point of view.
Absolutely.
And going off of that at an industry
level, how would you describe the biggest barriers
to effectively serving and engaging members?
What opportunities do you see for large scale
improvements, and how are you applying all this
in your current strategy?
So I think some of the biggest barriers
really come
back to access
overall.
And the pandemic has taught us not only
can we use a myriad way of
engaging members digitally
through telehealth,
but also just your regular brick and mortar.
Primary care is central to overall health.
And our senior population
in Western Pennsylvania
and and Alleghany County, which is where Pittsburgh
is, Alleghany County has the the 2nd highest
aging population behind Miami Dade. So we're number
2 with with our seniors growing older.
And from a a barriers perspective, what we've
seen in this post pandemic
world is that
things are much more complicated.
And as a result, our our physicians
who still tend to be very fee for
service focused instead of
really in value models. They're just trying to
deal with, enormous volumes and high utilization. And
so that doesn't really lend itself to comprehensive
evaluations for our seniors. It really is much
more episodic
in
nature. And when you're
It really is much more episodic in nature.
And when you're dealing with the kind of
complexity and acuity that we're seeing,
being episodic
versus comprehensive
tends to make things more expensive,
tends to spread things out across the population.
Seniors
get frustrated that they're not they're only being
seen for maybe their diabetes
and not for
their asthma or their COPD. They have to
come back for a second or third visit.
So that creates access issues, which is an
unintended consequence overall.
So how we're addressing these is really engaging
with our physician and provider partners very differently.
Having new conversations,
not just about risk adjustment and quality,
but also
about what their goals are.
Because most physicians, frankly, have been burned out
in this, again, post pandemic world. They're they're
being asked to see huge numbers of people
and that doesn't lend itself to good quality
care either.
So
by coming together and trying to solve in
a more aligned way, these conversations
are the ones that are driving
changes in process and changes in focus
by both the payer and the provider side
of the house at UPMC.
Let's shift gears just slightly toward health equity.
So as health equity becomes increasingly centered in
payer strategies,
how are you addressing health disparities? And can
you share specific examples of measurable successes to
date? Sure.
So at at again,
UPMC,
we are a regional health plan. So we
are very community focused and community engaged.
And one of the things that we've done
for years is not just focus on behavioral
health or social determinants as a kind of
buzzword,
But we understand at the community level, at
the community hospital level,
what's happening
in those different neighborhoods.
There's
rural. There's urban. There's suburban.
There's
cultural
sensitivities that we need to pay attention to
and how people choose to access care.
So our strategies have been about engaging people
where they are.
And not just looking at things like
like language or or
those kinds of barriers. But instead,
looking at at going into churches, we have
something called our faith and wellness challenge. It's
almost like the biggest loser
where different churches, mosques, and synagogues compete
to get healthier over, you know, a period
of time.
We engage with our our local groceries
to have
mobile access to healthier foods going into communities
that have food, you know, that we look
at the deprivation index
and there's food deserts and
and a lot of communities. So we try
to partner with those groceries to bring
literally
mobile trucks that bring in healthy foods. And
then from a benefit design perspective, we have
a healthy foods card that's particularly focused on
our special needs plan.
So our members can
use that card at those those mobile trucks
to buy that healthy food. That's just one
example. I could go into several.
But primarily,
we like to focus on the behavioral aspects,
on the social aspects, on the community aspects,
and make sure that our benefit designs
reflect that sense of values
for putting
people
first.
Have a hashtag grandma and grandpa centered care.
And that means really understanding what the individuals
need
and making sure that our community focus
is central to all that we do from
an operations and a member services execution.
And as we wrap our conversation here, is
there anything else you'd like to share on
the podcast today?
I would just say that, you know, there's
still a a thought that members are,
or seniors or persons with disabilities are not
as digitally focused
as maybe some younger folks.
And I would say at UPMC, we've seen
that not to be the case. That our
seniors engage with our flex card. They engage
with us digitally.
They're very comfortable doing telehealth visits even in
rural communities.
But even they struggle with different things. So
creating
tech guides or or doing things that, you
know, again, meets that individual where they are.
There's so much fear
when it comes to making decisions
in the Medicare space that anything that we
could do as health plans
to better support and engage our members
and make things easy for them, have an
easy button,
that is the way forward.
And our seniors really appreciate that and reward
us with high retention and satisfaction.
Wonderful. Well, Angela, thank you for taking the
time to be here today on the Becker's
Healthcare Podcast. Again, we are live at the
2024 fall payer issues roundtable. Thanks so much.
Thank you.