1 00:00:00,240 --> 00:00:02,399 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,399 --> 00:00:04,179 Becker's Pay Your Issues podcast. 3 00:00:04,480 --> 00:00:06,740 Thrilled today to be joined by Mike Jasperson, 4 00:00:06,879 --> 00:00:08,880 who is the senior vice president of provider 5 00:00:08,880 --> 00:00:10,740 network and health plan operations 6 00:00:11,039 --> 00:00:13,404 at Priority Health. Mike, thanks so much for 7 00:00:13,404 --> 00:00:14,764 taking the time to be with me on 8 00:00:14,764 --> 00:00:15,824 the podcast today. 9 00:00:16,524 --> 00:00:18,464 Glad to join you. Thanks for having me. 10 00:00:18,765 --> 00:00:20,285 So, Mike, before we dive into everything we 11 00:00:20,285 --> 00:00:21,804 wanna talk with you about, can you tell 12 00:00:21,804 --> 00:00:24,364 us a little bit more about yourself, your 13 00:00:24,364 --> 00:00:26,925 background in the world of healthcare, and what 14 00:00:26,925 --> 00:00:28,920 it is that you're doing today at Priority 15 00:00:30,260 --> 00:00:31,160 Health. Sure. 16 00:00:31,539 --> 00:00:33,619 So I've been in, health care for the 17 00:00:33,619 --> 00:00:34,020 past, 18 00:00:34,500 --> 00:00:36,439 25 years. I've had, 19 00:00:37,060 --> 00:00:39,859 some stints on the delivery side, so working 20 00:00:39,859 --> 00:00:40,760 for some large, 21 00:00:41,460 --> 00:00:42,280 health systems. 22 00:00:43,204 --> 00:00:45,204 I've also worked in the post acute, 23 00:00:45,524 --> 00:00:48,405 space in hospice and palliative care, and I've 24 00:00:48,405 --> 00:00:48,885 spent, 25 00:00:49,204 --> 00:00:51,125 a great I I suppose the majority of 26 00:00:51,125 --> 00:00:53,304 my career in health insurance, 27 00:00:54,164 --> 00:00:56,484 working for a large, Blues plan as well 28 00:00:56,484 --> 00:00:59,600 as my current role at Priority Health. And 29 00:00:59,600 --> 00:01:02,320 so I'm the senior vice president of our 30 00:01:02,320 --> 00:01:04,099 provider network and health plan, 31 00:01:04,799 --> 00:01:06,979 operations for Priority Health. We're a large, 32 00:01:07,439 --> 00:01:10,420 provider sponsored or provider owned health plan 33 00:01:11,055 --> 00:01:11,555 operating, 34 00:01:12,015 --> 00:01:15,055 in the state of Michigan and, actually, most 35 00:01:15,055 --> 00:01:18,414 recently outside the state of Michigan in expanding 36 00:01:18,414 --> 00:01:19,234 into Indiana 37 00:01:19,694 --> 00:01:20,994 and Ohio as well. 38 00:01:21,534 --> 00:01:22,274 My responsibilities 39 00:01:22,655 --> 00:01:25,234 include, provider network development management, 40 00:01:26,090 --> 00:01:27,549 value based health care. 41 00:01:28,329 --> 00:01:30,750 I'm responsible for member and provider services, 42 00:01:31,769 --> 00:01:34,649 claims, and other key operational areas of the 43 00:01:34,649 --> 00:01:35,149 organization. 44 00:01:35,769 --> 00:01:38,269 And I'm responsible for advancing, you know, automation, 45 00:01:38,649 --> 00:01:39,149 AI, 46 00:01:39,844 --> 00:01:42,405 quality and training within the operations and and 47 00:01:42,405 --> 00:01:44,745 also planning for future business operational, 48 00:01:45,605 --> 00:01:47,864 architectural and application needs. 49 00:01:49,125 --> 00:01:49,625 Fantastic. 50 00:01:49,924 --> 00:01:52,405 So, Mike, let's talk about Priority Health as 51 00:01:52,405 --> 00:01:55,409 you know, being a pioneer within value based 52 00:01:55,570 --> 00:01:57,189 care since the late nineties. 53 00:01:57,490 --> 00:01:59,170 As I understand that the company has saved 54 00:01:59,170 --> 00:01:59,670 over 55 00:02:00,210 --> 00:02:02,790 $100,000,000 through alternative payment methods between 56 00:02:03,090 --> 00:02:04,630 2019 and 2022 57 00:02:05,010 --> 00:02:05,510 alone. 58 00:02:06,130 --> 00:02:08,685 So what do you attribute these successes to? 59 00:02:08,685 --> 00:02:11,884 And, ultimately, how have the approaches or the 60 00:02:11,884 --> 00:02:15,004 company's strategies evolved over time to stay at 61 00:02:15,004 --> 00:02:17,264 the forefront of what is a rapidly evolving 62 00:02:17,724 --> 00:02:19,264 value based ecosystem? 63 00:02:19,724 --> 00:02:22,229 Oh, great great question. And it's obviously something 64 00:02:22,229 --> 00:02:24,150 that we're really, really proud of. We've been 65 00:02:24,150 --> 00:02:26,150 doing value based care, as you mentioned, for 66 00:02:26,150 --> 00:02:27,209 a long, long time. 67 00:02:27,590 --> 00:02:29,750 So our success in value based care really 68 00:02:29,750 --> 00:02:30,650 stems from 69 00:02:31,030 --> 00:02:32,090 our early adoption 70 00:02:32,549 --> 00:02:36,389 and continuous evolution of alternative payment models or 71 00:02:36,389 --> 00:02:37,414 so called APMs. 72 00:02:38,275 --> 00:02:41,794 So today, over 50% of our members are 73 00:02:41,794 --> 00:02:43,974 cared for by providers who are 74 00:02:44,275 --> 00:02:46,754 what we would call an advanced value based, 75 00:02:47,074 --> 00:02:48,454 arrangements with us. 76 00:02:48,834 --> 00:02:51,094 So over the years, we've developed a robust 77 00:02:51,419 --> 00:02:54,539 framework that really supports providers in delivering high 78 00:02:54,539 --> 00:02:55,039 quality 79 00:02:55,340 --> 00:02:56,719 cost effective care. 80 00:02:57,259 --> 00:02:58,319 And key to that, 81 00:02:59,340 --> 00:03:02,219 to success in that is collaborative partnerships. So 82 00:03:02,219 --> 00:03:03,599 we work really, really closely 83 00:03:04,055 --> 00:03:06,395 with our provider partners to align on goals, 84 00:03:06,455 --> 00:03:07,514 to share resources, 85 00:03:08,615 --> 00:03:11,814 and providing advanced technical and analytical support, and 86 00:03:11,814 --> 00:03:13,754 really having teams that engaged, 87 00:03:14,455 --> 00:03:15,835 to ensure the success 88 00:03:16,135 --> 00:03:16,875 and collaboration 89 00:03:17,175 --> 00:03:17,675 together. 90 00:03:18,135 --> 00:03:18,955 We have 91 00:03:19,680 --> 00:03:21,300 strategic partnerships with 92 00:03:21,840 --> 00:03:23,620 independent physician organizations. 93 00:03:24,000 --> 00:03:26,240 We have them with integrated, you know, large 94 00:03:26,240 --> 00:03:29,120 integrated delivery systems as well, such as our 95 00:03:29,120 --> 00:03:29,620 own, 96 00:03:30,000 --> 00:03:33,224 parent organization, Corwell Health, which really allows us 97 00:03:33,224 --> 00:03:35,805 to implement comprehensive care models that focus 98 00:03:36,185 --> 00:03:37,324 on the whole patient. 99 00:03:38,025 --> 00:03:38,844 For example, 100 00:03:39,465 --> 00:03:40,364 in 2020, 101 00:03:40,824 --> 00:03:42,685 Priority Health and CoreWell Health 102 00:03:42,985 --> 00:03:45,540 began a full risk contract together, 103 00:03:45,919 --> 00:03:49,060 which resulted in positive results for both members 104 00:03:49,199 --> 00:03:50,099 and providers, 105 00:03:50,560 --> 00:03:51,060 including, 106 00:03:51,840 --> 00:03:52,740 over $45,000,000 107 00:03:53,520 --> 00:03:55,139 saved due to optimized 108 00:03:55,439 --> 00:03:56,175 patient care. 109 00:03:56,895 --> 00:03:57,395 So 110 00:03:58,014 --> 00:04:01,455 these savings really come from members health, being 111 00:04:01,455 --> 00:04:03,794 managed through coordinated primary care 112 00:04:04,254 --> 00:04:06,675 and getting their health concerns addressed early 113 00:04:06,974 --> 00:04:09,375 as well as when chronic conditions are managed 114 00:04:09,375 --> 00:04:11,155 and visits to high cost facilities, 115 00:04:12,159 --> 00:04:14,979 ER visits, inpatient stays are avoided. 116 00:04:15,680 --> 00:04:17,139 So these savings mean 117 00:04:17,519 --> 00:04:19,759 premiums and costs for our members and employers 118 00:04:19,759 --> 00:04:21,519 are be able are able to be kept 119 00:04:21,519 --> 00:04:23,459 down because of that collaborative 120 00:04:24,365 --> 00:04:24,865 partnership. 121 00:04:25,485 --> 00:04:27,665 It's really important that we also drive, 122 00:04:28,125 --> 00:04:30,225 data driven decision making. So 123 00:04:30,525 --> 00:04:34,045 we use an, APM readiness assessment to help 124 00:04:34,045 --> 00:04:36,060 us partner with providers who are ready 125 00:04:36,540 --> 00:04:39,180 to really tackle value based care. And our 126 00:04:39,180 --> 00:04:42,300 analysis enable providers to identify opportunities, you know, 127 00:04:42,300 --> 00:04:44,079 really clear opportunities for improvement 128 00:04:44,459 --> 00:04:46,800 and to track performance metrics over time. 129 00:04:47,500 --> 00:04:48,720 We also offer 130 00:04:49,675 --> 00:04:51,454 significant flexibility in our models, 131 00:04:51,834 --> 00:04:54,154 offering multiple levels of risk to kinda meet 132 00:04:54,154 --> 00:04:56,314 the provider where they're at, from a value 133 00:04:56,314 --> 00:04:57,615 based, perspective, 134 00:04:58,555 --> 00:05:01,274 from no risk or limited risk to, you 135 00:05:01,274 --> 00:05:03,830 know, the spectrum across the spectrum to full 136 00:05:03,830 --> 00:05:06,730 risk, allowing providers to engage at a comfortable 137 00:05:07,189 --> 00:05:10,069 pace while progressively taking on more and more 138 00:05:10,069 --> 00:05:10,569 responsibility 139 00:05:11,350 --> 00:05:13,770 over time as their capabilities evolve. 140 00:05:14,870 --> 00:05:15,930 Wow. So clearly 141 00:05:16,230 --> 00:05:17,290 a lot of savings 142 00:05:17,654 --> 00:05:20,295 generated by working more closely with your your 143 00:05:20,295 --> 00:05:22,774 parent health system, Mike. And I and to 144 00:05:22,774 --> 00:05:24,855 follow-up with you on that, how would you 145 00:05:24,855 --> 00:05:27,415 say that Priority Health is is further shaping 146 00:05:27,415 --> 00:05:28,154 its programs, 147 00:05:28,455 --> 00:05:29,274 its products 148 00:05:29,829 --> 00:05:33,430 to better address evolving patient needs and community 149 00:05:33,430 --> 00:05:34,569 health across, 150 00:05:34,949 --> 00:05:37,110 your market and and the landscape that you're 151 00:05:37,110 --> 00:05:37,610 seeing. 152 00:05:37,990 --> 00:05:38,490 Yep. 153 00:05:39,110 --> 00:05:41,209 So today's health care landscape 154 00:05:42,035 --> 00:05:44,694 requires us to be more adaptive and responsive 155 00:05:44,754 --> 00:05:46,454 really than ever, before. 156 00:05:47,074 --> 00:05:48,214 So we're continuously 157 00:05:48,595 --> 00:05:49,095 refining, 158 00:05:49,714 --> 00:05:52,115 programs to meet the evolving needs of patients 159 00:05:52,115 --> 00:05:53,415 and communities through, 160 00:05:54,354 --> 00:05:55,254 many initiatives. 161 00:05:55,879 --> 00:05:56,379 Some, 162 00:05:56,839 --> 00:05:57,740 clear examples 163 00:05:58,040 --> 00:06:01,800 include, you know, patient centric approaches. So our 164 00:06:01,800 --> 00:06:05,100 APM support a holistic treatment model that considers 165 00:06:05,160 --> 00:06:07,560 not only quality and cost of care, but 166 00:06:07,560 --> 00:06:09,639 social determinants of health as well, which we 167 00:06:09,639 --> 00:06:11,175 know have a profound impact 168 00:06:11,574 --> 00:06:13,995 on outcomes and health care costs as well. 169 00:06:14,854 --> 00:06:15,914 We're ensuring 170 00:06:16,214 --> 00:06:18,154 enhanced patient care coordination. 171 00:06:18,694 --> 00:06:21,095 So we focus on improving care coordination across 172 00:06:21,095 --> 00:06:22,954 primary care, specialty care, 173 00:06:23,654 --> 00:06:24,954 post acute care, 174 00:06:25,819 --> 00:06:29,100 which really enhances patient outcomes and reduces costs 175 00:06:29,100 --> 00:06:29,600 overall. 176 00:06:30,779 --> 00:06:33,100 Advanced primary care clinics is one example of 177 00:06:33,100 --> 00:06:35,180 something that we've taken on in partnership with 178 00:06:35,180 --> 00:06:37,439 Corwell Health and with other partners as well. 179 00:06:37,654 --> 00:06:41,014 So these are specifically designed clinics for Medicare 180 00:06:41,014 --> 00:06:41,514 members 181 00:06:41,895 --> 00:06:43,115 with chronic diseases. 182 00:06:43,495 --> 00:06:45,915 These clinics provide longer appointment times, 183 00:06:46,295 --> 00:06:47,835 comprehensive care planning 184 00:06:48,295 --> 00:06:51,330 to address the holistic needs of of Medicare 185 00:06:51,389 --> 00:06:52,769 beneficiaries with significant, 186 00:06:53,149 --> 00:06:53,649 health 187 00:06:54,110 --> 00:06:57,009 needs. Community engagement is important as well. So 188 00:06:57,389 --> 00:06:58,269 programs like, 189 00:06:59,149 --> 00:07:01,730 a community medicine clinic for Medicaid beneficiaries 190 00:07:02,350 --> 00:07:04,670 address specific health care needs and barriers as 191 00:07:04,670 --> 00:07:05,170 well 192 00:07:05,665 --> 00:07:08,564 and, offer tailored support to our multidisciplinary 193 00:07:09,105 --> 00:07:09,605 team, 194 00:07:09,985 --> 00:07:12,705 managing that patient in a holistic way. And 195 00:07:12,705 --> 00:07:14,884 then, of course, innovative tools are important 196 00:07:15,425 --> 00:07:17,985 to drive, those outcomes. So by way of 197 00:07:17,985 --> 00:07:18,485 example, 198 00:07:19,879 --> 00:07:22,459 we have a partnership with an with, Epic 199 00:07:22,839 --> 00:07:24,459 and the Epic pair platform, 200 00:07:24,919 --> 00:07:27,000 and we use also other data sharing tools 201 00:07:27,000 --> 00:07:29,579 as well to help more easily exchange data 202 00:07:29,800 --> 00:07:32,379 with providers while improving care coordination 203 00:07:33,264 --> 00:07:36,705 and also reducing administrative burdens, on on busy 204 00:07:36,705 --> 00:07:37,925 practices as well. 205 00:07:38,865 --> 00:07:41,264 Interesting. Interesting. And I I wanna ask you 206 00:07:41,264 --> 00:07:43,365 a little bit about your provider partnerships, 207 00:07:43,985 --> 00:07:44,485 outside 208 00:07:44,865 --> 00:07:46,165 the CoreWell umbrella. 209 00:07:46,830 --> 00:07:49,970 As priority continues to expand its value based 210 00:07:50,029 --> 00:07:50,529 initiatives, 211 00:07:50,830 --> 00:07:52,430 what are some of the key challenges, Mike, 212 00:07:52,430 --> 00:07:54,770 that you foresee both operationally, 213 00:07:55,709 --> 00:07:57,490 and within your provider relationships 214 00:07:57,870 --> 00:07:59,345 to meet the growing demand 215 00:08:00,125 --> 00:08:02,125 for, what patients are demanding in terms of 216 00:08:02,125 --> 00:08:04,144 more personalized and more efficient 217 00:08:04,524 --> 00:08:07,584 health care? Yep. So some of the challenges 218 00:08:07,644 --> 00:08:10,044 are are operational, you know, as we scale 219 00:08:10,044 --> 00:08:13,164 our programs and seek to maintain quality and 220 00:08:13,164 --> 00:08:13,664 efficiency. 221 00:08:14,204 --> 00:08:16,089 So So it really does require a robust 222 00:08:16,149 --> 00:08:19,129 infrastructure and continuous innovation and care, 223 00:08:19,829 --> 00:08:21,910 delivery models. We do have to meet these 224 00:08:21,910 --> 00:08:24,629 organizations where they're at as well in terms 225 00:08:24,629 --> 00:08:26,490 of their own evolution. So not 226 00:08:27,014 --> 00:08:27,675 every partnership is 227 00:08:27,975 --> 00:08:29,415 built the same way, so we have to 228 00:08:29,415 --> 00:08:30,154 offer that, 229 00:08:30,694 --> 00:08:31,194 flexibility. 230 00:08:32,054 --> 00:08:34,714 Another challenge is is provider interest. So 231 00:08:35,095 --> 00:08:37,274 this is also an opportunity to really educate 232 00:08:37,414 --> 00:08:38,475 providers about, 233 00:08:39,414 --> 00:08:41,414 APMs and ensure that they have access to 234 00:08:41,414 --> 00:08:44,070 tools and resources to help them be, 235 00:08:44,610 --> 00:08:45,110 successful. 236 00:08:46,049 --> 00:08:46,549 Technology 237 00:08:46,850 --> 00:08:49,429 integration is another challenge, you know, leveraging 238 00:08:49,970 --> 00:08:53,169 advanced data analytics and AI to predict patient 239 00:08:53,169 --> 00:08:55,350 needs and to streamline care coordination. 240 00:08:56,274 --> 00:08:58,834 I had mentioned already community partnerships. So I 241 00:08:58,834 --> 00:09:01,095 continue to expand collaborations with 242 00:09:01,394 --> 00:09:02,375 local organizations 243 00:09:02,834 --> 00:09:05,154 to address social determinants of health and the 244 00:09:05,154 --> 00:09:06,134 disparate needs 245 00:09:06,754 --> 00:09:08,914 of these patients and and our members to 246 00:09:08,914 --> 00:09:09,815 treat them holistically. 247 00:09:10,250 --> 00:09:12,509 And then, of course, policy advocacy. So 248 00:09:13,049 --> 00:09:14,269 working with policymakers 249 00:09:14,570 --> 00:09:17,209 to support value based care frameworks and to 250 00:09:17,209 --> 00:09:17,709 incentivize 251 00:09:18,329 --> 00:09:21,370 incentivize providers to continue to move forward and 252 00:09:21,370 --> 00:09:22,029 to evolve. 253 00:09:22,904 --> 00:09:25,065 So, Mike, before we go, what else are 254 00:09:25,065 --> 00:09:26,904 we missing? You've got the ears of a 255 00:09:26,904 --> 00:09:28,825 lot of health plan leaders from all over 256 00:09:28,825 --> 00:09:31,705 the country. What are some last bits of 257 00:09:31,705 --> 00:09:33,404 advice you wanna share with them? 258 00:09:33,784 --> 00:09:34,105 So, 259 00:09:35,319 --> 00:09:37,159 value based care really is a journey that 260 00:09:37,159 --> 00:09:38,299 requires a commitment, 261 00:09:39,000 --> 00:09:40,299 innovation and 262 00:09:40,759 --> 00:09:41,980 collaboration. So 263 00:09:42,360 --> 00:09:45,559 at Priority Health, we're dedicated to transforming healthcare 264 00:09:45,559 --> 00:09:47,659 delivery by prioritizing value 265 00:09:48,039 --> 00:09:50,120 and focusing on the health and the well-being 266 00:09:50,120 --> 00:09:50,940 of our members. 267 00:09:51,254 --> 00:09:53,495 So our successes to date give us confidence 268 00:09:53,495 --> 00:09:54,475 that we can continue 269 00:09:54,934 --> 00:09:55,514 to lead, 270 00:09:56,535 --> 00:09:58,795 in this space with progressive partners, 271 00:09:59,174 --> 00:10:00,615 on the on the care delivery on the 272 00:10:00,615 --> 00:10:03,415 provider side and continue to improve outcomes and 273 00:10:03,415 --> 00:10:05,674 reduce costs for the communities we serve. So 274 00:10:05,779 --> 00:10:08,600 it really is about a partnership. It's about 275 00:10:08,660 --> 00:10:09,160 engagement. 276 00:10:09,620 --> 00:10:10,840 It's about finding, 277 00:10:11,379 --> 00:10:14,100 common ground and being able to move, the 278 00:10:14,100 --> 00:10:16,500 organization forward in the interest of the communities 279 00:10:16,500 --> 00:10:17,000 we, 280 00:10:17,460 --> 00:10:18,200 serve together. 281 00:10:19,434 --> 00:10:21,674 Wonderful. Well, Mike, thank you so much for 282 00:10:21,674 --> 00:10:23,514 taking the time to sit down with me 283 00:10:23,514 --> 00:10:25,674 and for sharing your insights with our audience. 284 00:10:25,674 --> 00:10:28,075 We really appreciate it. My pleasure. Thank you, 285 00:10:28,075 --> 00:10:30,154 Jacob. If you'd like to listen to more 286 00:10:30,154 --> 00:10:32,794 podcasts from Becker's Healthcare, you can visit beckers 287 00:10:32,794 --> 00:10:33,774 hospital review 288 00:10:37,610 --> 00:10:38,110 dotcom.