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 00:00:16,725 --> 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 --> 00:00:28,804 care they need and the personalized experience they 12 00:00:28,804 --> 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 --> 00:00:40,700 providing clinical care and support services that provide 17 00:00:40,700 --> 00:00:44,105 whole person care, we improve health equity, access, 18 00:00:44,105 --> 00:00:46,605 and outcomes for the populations we serve. 19 00:00:47,545 --> 00:00:49,784 This is Gracelyn Keller with the Becker's Healthcare 20 00:00:49,784 --> 00:00:52,524 podcast, and we are live at the 2024 21 00:00:53,625 --> 00:00:54,925 payer issues roundtable. 22 00:00:55,429 --> 00:00:58,070 I am joined currently by doctor Wayne Pan, 23 00:00:58,070 --> 00:01:00,149 who serves as the medical director for San 24 00:01:00,149 --> 00:01:02,710 Francisco Health Plan. So, doctor Pan, thank you 25 00:01:02,710 --> 00:01:04,549 for joining me today. We'd love to have 26 00:01:04,549 --> 00:01:07,349 our conversation start with you briefly introducing yourself 27 00:01:07,349 --> 00:01:08,869 and telling us a little bit more about 28 00:01:08,869 --> 00:01:10,994 your current role. Morning, Grace. My name is 29 00:01:10,994 --> 00:01:13,155 Wayne Pan. I'm a medical director at San 30 00:01:13,155 --> 00:01:15,314 Francisco Health Plan, which is a Medi Cal 31 00:01:15,314 --> 00:01:17,494 managed care plan, based in San Francisco. 32 00:01:18,114 --> 00:01:20,935 We are serving the indigent population, 33 00:01:21,474 --> 00:01:23,795 low income, and also age blind and disabled 34 00:01:23,795 --> 00:01:24,295 populations. 35 00:01:25,010 --> 00:01:27,909 And my current role is, medical director for 36 00:01:28,849 --> 00:01:31,810 as well as for quality improvement appeals and 37 00:01:31,810 --> 00:01:32,310 grievances. 38 00:01:33,409 --> 00:01:35,090 Wonderful. Well, thank you for taking the time 39 00:01:35,090 --> 00:01:37,670 to be here, and let's start our conversation 40 00:01:38,129 --> 00:01:41,665 talking about member experience. So from improving member 41 00:01:41,665 --> 00:01:44,405 experience and expanding value based care to controlling 42 00:01:44,465 --> 00:01:47,905 costs, payer executives have ambitious growth goals for 43 00:01:47,905 --> 00:01:49,665 the rest of the year and the new 44 00:01:49,665 --> 00:01:51,505 year ahead. So in your role, what is 45 00:01:51,505 --> 00:01:53,424 your top priority, and how are you planning 46 00:01:53,424 --> 00:01:54,325 to get there? 47 00:01:54,829 --> 00:01:56,109 Yeah. I think one of the things that 48 00:01:56,109 --> 00:01:57,409 health plan executives 49 00:01:57,790 --> 00:02:00,909 overlook is, grievance and appeals. It's an area 50 00:02:00,909 --> 00:02:04,109 where it's regulatory defined and, you have to 51 00:02:04,109 --> 00:02:04,609 maintain, 52 00:02:05,310 --> 00:02:07,995 records and and follow-up on on cases. But 53 00:02:08,074 --> 00:02:09,675 in fact, it's actually a great way to 54 00:02:09,675 --> 00:02:12,314 understand how your providers are providing services to 55 00:02:12,314 --> 00:02:12,974 your members. 56 00:02:13,275 --> 00:02:16,074 And member satisfaction is, you know, paramount to, 57 00:02:16,395 --> 00:02:18,555 growth in a in a health plan. So, 58 00:02:18,794 --> 00:02:20,235 our top priority is really to make sure 59 00:02:20,235 --> 00:02:22,289 that the grievance and appeals process is actually 60 00:02:22,289 --> 00:02:24,150 working well, and we're taking those insights 61 00:02:24,689 --> 00:02:25,349 and actually, 62 00:02:25,650 --> 00:02:28,610 acting on them to, actively improve the patient 63 00:02:28,610 --> 00:02:29,110 experience. 64 00:02:30,289 --> 00:02:32,370 And going off of that, at an industry 65 00:02:32,370 --> 00:02:34,870 level, how would you describe the biggest barriers 66 00:02:34,930 --> 00:02:37,669 to effectively serving and engaging members? And what 67 00:02:37,944 --> 00:02:40,764 opportunities do you see for large scale improvements, 68 00:02:40,824 --> 00:02:42,425 and how are you applying this at your 69 00:02:42,425 --> 00:02:43,324 current strategy? 70 00:02:44,264 --> 00:02:46,105 I think the hardest part right now is, 71 00:02:46,344 --> 00:02:47,805 care management, care coordination. 72 00:02:48,185 --> 00:02:49,784 A lot of providers are saddled with that 73 00:02:49,784 --> 00:02:53,004 responsibility, but they don't actually have the resources 74 00:02:53,064 --> 00:02:53,759 within their 75 00:02:54,319 --> 00:02:56,560 offices or clinics, to be able to carry 76 00:02:56,560 --> 00:02:58,819 out effective care management and care coordination. 77 00:02:59,120 --> 00:03:00,479 So that's where the health plans really need 78 00:03:00,479 --> 00:03:02,239 to step up so that when they hear 79 00:03:02,239 --> 00:03:04,159 about these issues, that they're actually able to 80 00:03:04,159 --> 00:03:06,000 solve the problem so that members get the 81 00:03:06,000 --> 00:03:08,099 access to the care that they need. 82 00:03:08,935 --> 00:03:11,254 And shifting gears to speak to our up 83 00:03:11,254 --> 00:03:13,034 and coming leaders out there, 84 00:03:13,415 --> 00:03:16,235 keeping pace in today's dynamic health care landscape 85 00:03:16,294 --> 00:03:16,955 is challenging. 86 00:03:17,495 --> 00:03:19,175 And so what's one piece of advice you'd 87 00:03:19,175 --> 00:03:21,175 share with peer leaders to grow their businesses 88 00:03:21,175 --> 00:03:23,034 while keeping members top of mind? 89 00:03:23,415 --> 00:03:25,150 Yeah. I think one of the things, that 90 00:03:25,150 --> 00:03:27,229 health plans need to understand is that being 91 00:03:27,229 --> 00:03:29,870 in silos really makes it difficult to solve 92 00:03:29,870 --> 00:03:30,370 problems. 93 00:03:30,750 --> 00:03:32,830 And so what we see is that making 94 00:03:32,830 --> 00:03:36,050 sure that provider relations as well as, contracting, 95 00:03:36,764 --> 00:03:37,644 grievance and appeals, 96 00:03:38,044 --> 00:03:40,465 all work together to be able to address 97 00:03:40,525 --> 00:03:43,564 issues that are typically across departments. And the 98 00:03:43,564 --> 00:03:45,004 more that a health plan is able to 99 00:03:45,004 --> 00:03:47,324 do that and keeping the patient at the 100 00:03:47,324 --> 00:03:49,564 center, the easier it is to solve the 101 00:03:49,564 --> 00:03:51,664 problems and and provide a better patient experience. 102 00:03:52,569 --> 00:03:54,569 And as we wrap our conversation today, is 103 00:03:54,569 --> 00:03:56,330 there anything else you'd like to share as 104 00:03:56,330 --> 00:03:57,790 closing remarks on the podcast? 105 00:03:58,490 --> 00:04:00,409 So I think in the health care space, 106 00:04:00,409 --> 00:04:02,969 particularly for payers, value based care as well 107 00:04:02,969 --> 00:04:05,230 as risk adjustment are gonna be tied together. 108 00:04:05,745 --> 00:04:08,064 And to be able to have a process, 109 00:04:08,305 --> 00:04:09,985 as patient centered would be the best way 110 00:04:09,985 --> 00:04:11,605 to be able to adjust, 111 00:04:11,985 --> 00:04:14,325 the internal processes as well as external processes 112 00:04:14,465 --> 00:04:15,044 so that, 113 00:04:15,344 --> 00:04:17,584 patients and payers and and providers can all 114 00:04:17,584 --> 00:04:19,925 work together, to achieve the best results. 115 00:04:20,729 --> 00:04:22,810 Wonderful. Well, doctor Pan, thank you for joining 116 00:04:22,810 --> 00:04:25,050 me today on the Becker's healthcare podcast. Again, 117 00:04:25,050 --> 00:04:26,509 we're live at the 2024 118 00:04:27,129 --> 00:04:28,349 payer issues roundtable. 119 00:04:28,810 --> 00:04:29,949 Alright. Thanks, Grace.