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 00:00:16,644 --> 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 00:00:35,020 --> 00:00:37,739 and preventative care services to the home. By 16 00:00:37,739 --> 00:00:40,619 providing clinical care and support services that provide 17 00:00:40,619 --> 00:00:44,185 whole person care, we improve health equity, access, 18 00:00:44,185 --> 00:00:46,605 and outcomes for the populations we serve. 19 00:00:47,865 --> 00:00:49,945 This is Gracelyn Keller with the Becker's healthcare 20 00:00:49,945 --> 00:00:51,965 podcast, and we are live at the 2024 21 00:00:52,344 --> 00:00:54,045 fall pay issues roundtable. 22 00:00:54,829 --> 00:00:57,390 I am joined right now by Angela Perry, 23 00:00:57,390 --> 00:00:59,810 who is the chief Medicare officer at UPMC 24 00:01:00,109 --> 00:01:00,770 Health Plan. 25 00:01:01,149 --> 00:01:02,590 Thank you so much for being here, Angela. 26 00:01:02,590 --> 00:01:03,950 Would love to have you start off by 27 00:01:03,950 --> 00:01:05,790 introducing yourself and telling us a little bit 28 00:01:05,790 --> 00:01:06,765 more about your role. 29 00:01:07,405 --> 00:01:10,604 Sure. Again, I'm Angela Perry. I'm the chief 30 00:01:10,604 --> 00:01:13,745 Medicare officer for UPMC Health Plan and UPMC. 31 00:01:14,444 --> 00:01:16,784 We are a payer provider organization. 32 00:01:17,084 --> 00:01:19,805 So we have both health plan and several 33 00:01:19,805 --> 00:01:21,025 hospitals and physicians. 34 00:01:21,799 --> 00:01:24,439 My role there is I'm responsible for the 35 00:01:24,439 --> 00:01:26,060 Medicare products division. 36 00:01:26,599 --> 00:01:27,739 We have approximately 37 00:01:28,119 --> 00:01:28,619 200 38 00:01:29,159 --> 00:01:30,299 and almost 20,000 39 00:01:30,840 --> 00:01:31,340 members 40 00:01:31,640 --> 00:01:32,780 in Pennsylvania. 41 00:01:33,560 --> 00:01:36,379 We focus on both from a Medicare Advantage 42 00:01:36,439 --> 00:01:36,939 perspective, 43 00:01:37,454 --> 00:01:39,694 non SNP, which is our HMO and PPO 44 00:01:39,694 --> 00:01:42,274 products, as well as our special needs plan, 45 00:01:42,334 --> 00:01:43,634 our D SNP product. 46 00:01:43,935 --> 00:01:45,155 We have about a 140,000 47 00:01:46,174 --> 00:01:48,994 members in our non SNP and about 40,000 48 00:01:49,774 --> 00:01:51,795 numbers in our D SNP product. 49 00:01:52,510 --> 00:01:54,829 Wonderful. Well, thank you for being here. Mhmm. 50 00:01:54,989 --> 00:01:57,629 And let's start our conversation today talking about 51 00:01:57,629 --> 00:02:00,590 growth goals. So from improving member experience and 52 00:02:00,590 --> 00:02:04,525 expanding value based care to controlling costs, Payer 53 00:02:04,525 --> 00:02:06,765 executives have ambitious growth goals for the rest 54 00:02:06,765 --> 00:02:08,705 of the year and looking into 2025. 55 00:02:09,485 --> 00:02:11,164 So in your role, what is your top 56 00:02:11,164 --> 00:02:12,844 priority, and how are you planning to get 57 00:02:12,844 --> 00:02:13,344 there? 58 00:02:13,645 --> 00:02:14,145 Sure. 59 00:02:14,685 --> 00:02:17,264 So from a goals and a growth 60 00:02:17,760 --> 00:02:18,260 perspective, 61 00:02:18,719 --> 00:02:21,939 every Medicare Advantage Plan is looking to grow. 62 00:02:22,400 --> 00:02:24,159 And the last couple of years in the 63 00:02:24,159 --> 00:02:24,980 post pandemic 64 00:02:25,360 --> 00:02:25,860 era 65 00:02:26,480 --> 00:02:28,819 has been challenging to say the least. 66 00:02:29,199 --> 00:02:30,500 So our goals 67 00:02:31,034 --> 00:02:33,935 continue to be focusing on innovative benefit design. 68 00:02:34,555 --> 00:02:36,414 Again, focusing from a 69 00:02:36,875 --> 00:02:40,155 quality and and a risk adjustment point of 70 00:02:40,155 --> 00:02:40,655 view. 71 00:02:41,034 --> 00:02:43,435 So a lot of the policies from a 72 00:02:43,435 --> 00:02:45,375 government perspective have changed. 73 00:02:45,995 --> 00:02:46,495 And 74 00:02:46,849 --> 00:02:49,090 being able to not just comply with some 75 00:02:49,090 --> 00:02:49,669 of those 76 00:02:50,129 --> 00:02:53,750 changes from quality and stars to risk adjustment, 77 00:02:54,290 --> 00:02:57,010 the health equity index that's a part of 78 00:02:57,010 --> 00:02:59,764 that. All of these things are our goals, 79 00:03:00,064 --> 00:03:02,145 not just to comply with them, but to 80 00:03:02,145 --> 00:03:04,004 really understand how we're gonna 81 00:03:04,544 --> 00:03:07,044 better impact the health of our communities. 82 00:03:07,504 --> 00:03:10,324 We are primarily in Western and Central Pennsylvania. 83 00:03:11,199 --> 00:03:13,840 And so being a regional health plan, we 84 00:03:13,840 --> 00:03:14,340 are 85 00:03:14,639 --> 00:03:17,840 highly engaged in our communities. And our goals 86 00:03:17,840 --> 00:03:20,639 are really to connect people from an access 87 00:03:20,639 --> 00:03:23,379 and affordability and a stability point of view. 88 00:03:24,294 --> 00:03:24,794 Absolutely. 89 00:03:25,094 --> 00:03:27,014 And going off of that at an industry 90 00:03:27,014 --> 00:03:29,814 level, how would you describe the biggest barriers 91 00:03:29,814 --> 00:03:32,074 to effectively serving and engaging members? 92 00:03:32,375 --> 00:03:34,534 What opportunities do you see for large scale 93 00:03:34,534 --> 00:03:36,454 improvements, and how are you applying all this 94 00:03:36,454 --> 00:03:37,594 in your current strategy? 95 00:03:38,669 --> 00:03:40,689 So I think some of the biggest barriers 96 00:03:40,750 --> 00:03:41,889 really come 97 00:03:42,189 --> 00:03:43,569 back to access 98 00:03:44,030 --> 00:03:44,530 overall. 99 00:03:45,069 --> 00:03:48,270 And the pandemic has taught us not only 100 00:03:48,270 --> 00:03:50,530 can we use a myriad way of 101 00:03:51,084 --> 00:03:52,944 engaging members digitally 102 00:03:53,645 --> 00:03:54,465 through telehealth, 103 00:03:54,764 --> 00:03:57,185 but also just your regular brick and mortar. 104 00:03:57,724 --> 00:04:01,104 Primary care is central to overall health. 105 00:04:01,405 --> 00:04:02,864 And our senior population 106 00:04:03,164 --> 00:04:04,465 in Western Pennsylvania 107 00:04:05,319 --> 00:04:07,480 and and Alleghany County, which is where Pittsburgh 108 00:04:07,480 --> 00:04:10,780 is, Alleghany County has the the 2nd highest 109 00:04:11,000 --> 00:04:14,360 aging population behind Miami Dade. So we're number 110 00:04:14,360 --> 00:04:17,019 2 with with our seniors growing older. 111 00:04:17,675 --> 00:04:20,875 And from a a barriers perspective, what we've 112 00:04:20,875 --> 00:04:22,254 seen in this post pandemic 113 00:04:22,955 --> 00:04:24,095 world is that 114 00:04:24,475 --> 00:04:26,014 things are much more complicated. 115 00:04:26,555 --> 00:04:28,814 And as a result, our our physicians 116 00:04:29,675 --> 00:04:32,074 who still tend to be very fee for 117 00:04:32,074 --> 00:04:33,909 service focused instead of 118 00:04:34,449 --> 00:04:35,569 really in value models. They're just trying to 119 00:04:35,569 --> 00:04:36,689 deal with, enormous volumes and high utilization. And 120 00:04:36,689 --> 00:04:39,349 so that doesn't really lend itself to comprehensive 121 00:04:39,569 --> 00:04:42,050 evaluations for our seniors. It really is much 122 00:04:42,050 --> 00:04:43,110 more episodic 123 00:04:44,009 --> 00:04:44,509 in 124 00:04:45,409 --> 00:04:46,870 nature. And when you're 125 00:04:47,845 --> 00:04:50,665 It really is much more episodic in nature. 126 00:04:50,884 --> 00:04:52,564 And when you're dealing with the kind of 127 00:04:52,564 --> 00:04:54,904 complexity and acuity that we're seeing, 128 00:04:55,365 --> 00:04:56,425 being episodic 129 00:04:56,805 --> 00:04:57,865 versus comprehensive 130 00:04:58,884 --> 00:05:01,144 tends to make things more expensive, 131 00:05:01,620 --> 00:05:04,680 tends to spread things out across the population. 132 00:05:05,459 --> 00:05:05,959 Seniors 133 00:05:06,259 --> 00:05:09,379 get frustrated that they're not they're only being 134 00:05:09,379 --> 00:05:11,000 seen for maybe their diabetes 135 00:05:11,300 --> 00:05:12,279 and not for 136 00:05:12,580 --> 00:05:14,899 their asthma or their COPD. They have to 137 00:05:14,899 --> 00:05:17,080 come back for a second or third visit. 138 00:05:17,595 --> 00:05:20,714 So that creates access issues, which is an 139 00:05:20,714 --> 00:05:22,654 unintended consequence overall. 140 00:05:23,115 --> 00:05:26,014 So how we're addressing these is really engaging 141 00:05:26,074 --> 00:05:29,454 with our physician and provider partners very differently. 142 00:05:30,089 --> 00:05:31,310 Having new conversations, 143 00:05:31,930 --> 00:05:34,189 not just about risk adjustment and quality, 144 00:05:34,649 --> 00:05:35,389 but also 145 00:05:35,770 --> 00:05:37,310 about what their goals are. 146 00:05:37,610 --> 00:05:40,569 Because most physicians, frankly, have been burned out 147 00:05:40,569 --> 00:05:43,785 in this, again, post pandemic world. They're they're 148 00:05:43,785 --> 00:05:46,365 being asked to see huge numbers of people 149 00:05:46,824 --> 00:05:49,625 and that doesn't lend itself to good quality 150 00:05:49,625 --> 00:05:50,524 care either. 151 00:05:50,985 --> 00:05:51,485 So 152 00:05:51,785 --> 00:05:54,824 by coming together and trying to solve in 153 00:05:54,824 --> 00:05:57,485 a more aligned way, these conversations 154 00:05:58,170 --> 00:05:59,870 are the ones that are driving 155 00:06:00,410 --> 00:06:03,150 changes in process and changes in focus 156 00:06:03,529 --> 00:06:05,850 by both the payer and the provider side 157 00:06:05,850 --> 00:06:07,069 of the house at UPMC. 158 00:06:08,970 --> 00:06:12,170 Let's shift gears just slightly toward health equity. 159 00:06:12,170 --> 00:06:14,834 So as health equity becomes increasingly centered in 160 00:06:14,834 --> 00:06:15,654 payer strategies, 161 00:06:16,194 --> 00:06:18,595 how are you addressing health disparities? And can 162 00:06:18,595 --> 00:06:21,954 you share specific examples of measurable successes to 163 00:06:21,954 --> 00:06:23,254 date? Sure. 164 00:06:23,634 --> 00:06:25,175 So at at again, 165 00:06:25,680 --> 00:06:26,180 UPMC, 166 00:06:26,480 --> 00:06:28,560 we are a regional health plan. So we 167 00:06:28,560 --> 00:06:31,620 are very community focused and community engaged. 168 00:06:32,240 --> 00:06:34,080 And one of the things that we've done 169 00:06:34,080 --> 00:06:36,660 for years is not just focus on behavioral 170 00:06:36,720 --> 00:06:39,120 health or social determinants as a kind of 171 00:06:39,120 --> 00:06:39,620 buzzword, 172 00:06:39,995 --> 00:06:42,235 But we understand at the community level, at 173 00:06:42,235 --> 00:06:43,935 the community hospital level, 174 00:06:44,475 --> 00:06:45,375 what's happening 175 00:06:45,675 --> 00:06:46,975 in those different neighborhoods. 176 00:06:47,355 --> 00:06:47,855 There's 177 00:06:48,314 --> 00:06:50,495 rural. There's urban. There's suburban. 178 00:06:51,035 --> 00:06:51,535 There's 179 00:06:52,074 --> 00:06:52,574 cultural 180 00:06:53,110 --> 00:06:55,270 sensitivities that we need to pay attention to 181 00:06:55,270 --> 00:06:57,370 and how people choose to access care. 182 00:06:57,750 --> 00:07:00,790 So our strategies have been about engaging people 183 00:07:00,790 --> 00:07:01,610 where they are. 184 00:07:02,069 --> 00:07:05,129 And not just looking at things like 185 00:07:05,430 --> 00:07:07,449 like language or or 186 00:07:07,915 --> 00:07:10,175 those kinds of barriers. But instead, 187 00:07:10,795 --> 00:07:13,514 looking at at going into churches, we have 188 00:07:13,514 --> 00:07:16,475 something called our faith and wellness challenge. It's 189 00:07:16,475 --> 00:07:18,175 almost like the biggest loser 190 00:07:18,555 --> 00:07:21,855 where different churches, mosques, and synagogues compete 191 00:07:22,199 --> 00:07:24,439 to get healthier over, you know, a period 192 00:07:24,439 --> 00:07:25,019 of time. 193 00:07:25,560 --> 00:07:28,620 We engage with our our local groceries 194 00:07:29,000 --> 00:07:29,740 to have 195 00:07:30,120 --> 00:07:33,419 mobile access to healthier foods going into communities 196 00:07:33,560 --> 00:07:35,959 that have food, you know, that we look 197 00:07:35,959 --> 00:07:37,214 at the deprivation index 198 00:07:37,694 --> 00:07:39,475 and there's food deserts and 199 00:07:39,935 --> 00:07:42,574 and a lot of communities. So we try 200 00:07:42,574 --> 00:07:44,995 to partner with those groceries to bring 201 00:07:45,535 --> 00:07:46,035 literally 202 00:07:46,574 --> 00:07:49,500 mobile trucks that bring in healthy foods. And 203 00:07:49,500 --> 00:07:51,980 then from a benefit design perspective, we have 204 00:07:51,980 --> 00:07:55,740 a healthy foods card that's particularly focused on 205 00:07:55,740 --> 00:07:57,120 our special needs plan. 206 00:07:57,420 --> 00:07:59,120 So our members can 207 00:07:59,500 --> 00:08:02,904 use that card at those those mobile trucks 208 00:08:02,904 --> 00:08:04,904 to buy that healthy food. That's just one 209 00:08:04,904 --> 00:08:06,764 example. I could go into several. 210 00:08:07,144 --> 00:08:08,205 But primarily, 211 00:08:08,584 --> 00:08:11,564 we like to focus on the behavioral aspects, 212 00:08:11,625 --> 00:08:14,365 on the social aspects, on the community aspects, 213 00:08:14,665 --> 00:08:16,685 and make sure that our benefit designs 214 00:08:17,330 --> 00:08:19,750 reflect that sense of values 215 00:08:20,610 --> 00:08:21,350 for putting 216 00:08:21,889 --> 00:08:22,389 people 217 00:08:22,850 --> 00:08:23,350 first. 218 00:08:23,650 --> 00:08:26,550 Have a hashtag grandma and grandpa centered care. 219 00:08:27,250 --> 00:08:30,790 And that means really understanding what the individuals 220 00:08:30,930 --> 00:08:31,430 need 221 00:08:32,065 --> 00:08:35,044 and making sure that our community focus 222 00:08:35,424 --> 00:08:37,424 is central to all that we do from 223 00:08:37,424 --> 00:08:39,924 an operations and a member services execution. 224 00:08:41,504 --> 00:08:43,664 And as we wrap our conversation here, is 225 00:08:43,664 --> 00:08:45,105 there anything else you'd like to share on 226 00:08:45,105 --> 00:08:46,164 the podcast today? 227 00:08:46,799 --> 00:08:48,639 I would just say that, you know, there's 228 00:08:48,639 --> 00:08:51,539 still a a thought that members are, 229 00:08:52,000 --> 00:08:54,559 or seniors or persons with disabilities are not 230 00:08:54,559 --> 00:08:55,940 as digitally focused 231 00:08:56,399 --> 00:08:58,580 as maybe some younger folks. 232 00:08:59,144 --> 00:09:01,625 And I would say at UPMC, we've seen 233 00:09:01,625 --> 00:09:04,425 that not to be the case. That our 234 00:09:04,425 --> 00:09:07,384 seniors engage with our flex card. They engage 235 00:09:07,384 --> 00:09:08,365 with us digitally. 236 00:09:08,825 --> 00:09:12,024 They're very comfortable doing telehealth visits even in 237 00:09:12,024 --> 00:09:12,925 rural communities. 238 00:09:13,889 --> 00:09:16,129 But even they struggle with different things. So 239 00:09:16,129 --> 00:09:16,629 creating 240 00:09:17,250 --> 00:09:20,690 tech guides or or doing things that, you 241 00:09:20,690 --> 00:09:23,190 know, again, meets that individual where they are. 242 00:09:23,490 --> 00:09:24,790 There's so much fear 243 00:09:25,170 --> 00:09:27,269 when it comes to making decisions 244 00:09:27,674 --> 00:09:30,475 in the Medicare space that anything that we 245 00:09:30,475 --> 00:09:31,774 could do as health plans 246 00:09:32,154 --> 00:09:34,495 to better support and engage our members 247 00:09:34,875 --> 00:09:36,794 and make things easy for them, have an 248 00:09:36,794 --> 00:09:37,534 easy button, 249 00:09:38,154 --> 00:09:39,615 that is the way forward. 250 00:09:39,940 --> 00:09:42,580 And our seniors really appreciate that and reward 251 00:09:42,580 --> 00:09:44,600 us with high retention and satisfaction. 252 00:09:45,779 --> 00:09:47,779 Wonderful. Well, Angela, thank you for taking the 253 00:09:47,779 --> 00:09:49,300 time to be here today on the Becker's 254 00:09:49,300 --> 00:09:51,620 Healthcare Podcast. Again, we are live at the 255 00:09:51,620 --> 00:09:55,220 2024 fall payer issues roundtable. Thanks so much. 256 00:09:55,220 --> 00:09:55,754 Thank you.