Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast.
Thrilled today to be joined by Mike Jasperson,
who is the senior vice president of provider
network and health plan operations
at Priority Health. Mike, thanks so much for
taking the time to be with me on
the podcast today.
Glad to join you. Thanks for having me.
So, Mike, before we dive into everything we
wanna talk with you about, can you tell
us a little bit more about yourself, your
background in the world of healthcare, and what
it is that you're doing today at Priority
Health. Sure.
So I've been in, health care for the
past,
25 years. I've had,
some stints on the delivery side, so working
for some large,
health systems.
I've also worked in the post acute,
space in hospice and palliative care, and I've
spent,
a great I I suppose the majority of
my career in health insurance,
working for a large, Blues plan as well
as my current role at Priority Health. And
so I'm the senior vice president of our
provider network and health plan,
operations for Priority Health. We're a large,
provider sponsored or provider owned health plan
operating,
in the state of Michigan and, actually, most
recently outside the state of Michigan in expanding
into Indiana
and Ohio as well.
My responsibilities
include, provider network development management,
value based health care.
I'm responsible for member and provider services,
claims, and other key operational areas of the
organization.
And I'm responsible for advancing, you know, automation,
AI,
quality and training within the operations and and
also planning for future business operational,
architectural and application needs.
Fantastic.
So, Mike, let's talk about Priority Health as
you know, being a pioneer within value based
care since the late nineties.
As I understand that the company has saved
over
$100,000,000 through alternative payment methods between
2019 and 2022
alone.
So what do you attribute these successes to?
And, ultimately, how have the approaches or the
company's strategies evolved over time to stay at
the forefront of what is a rapidly evolving
value based ecosystem?
Oh, great great question. And it's obviously something
that we're really, really proud of. We've been
doing value based care, as you mentioned, for
a long, long time.
So our success in value based care really
stems from
our early adoption
and continuous evolution of alternative payment models or
so called APMs.
So today, over 50% of our members are
cared for by providers who are
what we would call an advanced value based,
arrangements with us.
So over the years, we've developed a robust
framework that really supports providers in delivering high
quality
cost effective care.
And key to that,
to success in that is collaborative partnerships. So
we work really, really closely
with our provider partners to align on goals,
to share resources,
and providing advanced technical and analytical support, and
really having teams that engaged,
to ensure the success
and collaboration
together.
We have
strategic partnerships with
independent physician organizations.
We have them with integrated, you know, large
integrated delivery systems as well, such as our
own,
parent organization, Corwell Health, which really allows us
to implement comprehensive care models that focus
on the whole patient.
For example,
in 2020,
Priority Health and CoreWell Health
began a full risk contract together,
which resulted in positive results for both members
and providers,
including,
over $45,000,000
saved due to optimized
patient care.
So
these savings really come from members health, being
managed through coordinated primary care
and getting their health concerns addressed early
as well as when chronic conditions are managed
and visits to high cost facilities,
ER visits, inpatient stays are avoided.
So these savings mean
premiums and costs for our members and employers
are be able are able to be kept
down because of that collaborative
partnership.
It's really important that we also drive,
data driven decision making. So
we use an, APM readiness assessment to help
us partner with providers who are ready
to really tackle value based care. And our
analysis enable providers to identify opportunities, you know,
really clear opportunities for improvement
and to track performance metrics over time.
We also offer
significant flexibility in our models,
offering multiple levels of risk to kinda meet
the provider where they're at, from a value
based, perspective,
from no risk or limited risk to, you
know, the spectrum across the spectrum to full
risk, allowing providers to engage at a comfortable
pace while progressively taking on more and more
responsibility
over time as their capabilities evolve.
Wow. So clearly
a lot of savings
generated by working more closely with your your
parent health system, Mike. And I and to
follow-up with you on that, how would you
say that Priority Health is is further shaping
its programs,
its products
to better address evolving patient needs and community
health across,
your market and and the landscape that you're
seeing.
Yep.
So today's health care landscape
requires us to be more adaptive and responsive
really than ever, before.
So we're continuously
refining,
programs to meet the evolving needs of patients
and communities through,
many initiatives.
Some,
clear examples
include, you know, patient centric approaches. So our
APM support a holistic treatment model that considers
not only quality and cost of care, but
social determinants of health as well, which we
know have a profound impact
on outcomes and health care costs as well.
We're ensuring
enhanced patient care coordination.
So we focus on improving care coordination across
primary care, specialty care,
post acute care,
which really enhances patient outcomes and reduces costs
overall.
Advanced primary care clinics is one example of
something that we've taken on in partnership with
Corwell Health and with other partners as well.
So these are specifically designed clinics for Medicare
members
with chronic diseases.
These clinics provide longer appointment times,
comprehensive care planning
to address the holistic needs of of Medicare
beneficiaries with significant,
health
needs. Community engagement is important as well. So
programs like,
a community medicine clinic for Medicaid beneficiaries
address specific health care needs and barriers as
well
and, offer tailored support to our multidisciplinary
team,
managing that patient in a holistic way. And
then, of course, innovative tools are important
to drive, those outcomes. So by way of
example,
we have a partnership with an with, Epic
and the Epic pair platform,
and we use also other data sharing tools
as well to help more easily exchange data
with providers while improving care coordination
and also reducing administrative burdens, on on busy
practices as well.
Interesting. Interesting. And I I wanna ask you
a little bit about your provider partnerships,
outside
the CoreWell umbrella.
As priority continues to expand its value based
initiatives,
what are some of the key challenges, Mike,
that you foresee both operationally,
and within your provider relationships
to meet the growing demand
for, what patients are demanding in terms of
more personalized and more efficient
health care? Yep. So some of the challenges
are are operational, you know, as we scale
our programs and seek to maintain quality and
efficiency.
So So it really does require a robust
infrastructure and continuous innovation and care,
delivery models. We do have to meet these
organizations where they're at as well in terms
of their own evolution. So not
every partnership is
built the same way, so we have to
offer that,
flexibility.
Another challenge is is provider interest. So
this is also an opportunity to really educate
providers about,
APMs and ensure that they have access to
tools and resources to help them be,
successful.
Technology
integration is another challenge, you know, leveraging
advanced data analytics and AI to predict patient
needs and to streamline care coordination.
I had mentioned already community partnerships. So I
continue to expand collaborations with
local organizations
to address social determinants of health and the
disparate needs
of these patients and and our members to
treat them holistically.
And then, of course, policy advocacy. So
working with policymakers
to support value based care frameworks and to
incentivize
incentivize providers to continue to move forward and
to evolve.
So, Mike, before we go, what else are
we missing? You've got the ears of a
lot of health plan leaders from all over
the country. What are some last bits of
advice you wanna share with them?
So,
value based care really is a journey that
requires a commitment,
innovation and
collaboration. So
at Priority Health, we're dedicated to transforming healthcare
delivery by prioritizing value
and focusing on the health and the well-being
of our members.
So our successes to date give us confidence
that we can continue
to lead,
in this space with progressive partners,
on the on the care delivery on the
provider side and continue to improve outcomes and
reduce costs for the communities we serve. So
it really is about a partnership. It's about
engagement.
It's about finding,
common ground and being able to move, the
organization forward in the interest of the communities
we,
serve together.
Wonderful. Well, Mike, thank you so much for
taking the time to sit down with me
and for sharing your insights with our audience.
We really appreciate it. My pleasure. Thank you,
Jacob. If you'd like to listen to more
podcasts from Becker's Healthcare, you can visit beckers
hospital review
dotcom.