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This is Gracelyn Keller with the Becker's Healthcare
podcast, and we are live at the 2024
payer issues roundtable.
I am joined currently by doctor Wayne Pan,
who serves as the medical director for San
Francisco Health Plan. So, doctor Pan, thank you
for joining me today. We'd love to have
our conversation start with you briefly introducing yourself
and telling us a little bit more about
your current role. Morning, Grace. My name is
Wayne Pan. I'm a medical director at San
Francisco Health Plan, which is a Medi Cal
managed care plan, based in San Francisco.
We are serving the indigent population,
low income, and also age blind and disabled
populations.
And my current role is, medical director for
as well as for quality improvement appeals and
grievances.
Wonderful. Well, thank you for taking the time
to be here, and let's start our conversation
talking about member experience. 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 the new
year ahead. So in your role, what is
your top priority, and how are you planning
to get there?
Yeah. I think one of the things that
health plan executives
overlook is, grievance and appeals. It's an area
where it's regulatory defined and, you have to
maintain,
records and and follow-up on on cases. But
in fact, it's actually a great way to
understand how your providers are providing services to
your members.
And member satisfaction is, you know, paramount to,
growth in a in a health plan. So,
our top priority is really to make sure
that the grievance and appeals process is actually
working well, and we're taking those insights
and actually,
acting on them to, actively improve the patient
experience.
And going off of that, at an industry
level, how would you describe the biggest barriers
to effectively serving and engaging members? And what
opportunities do you see for large scale improvements,
and how are you applying this at your
current strategy?
I think the hardest part right now is,
care management, care coordination.
A lot of providers are saddled with that
responsibility, but they don't actually have the resources
within their
offices or clinics, to be able to carry
out effective care management and care coordination.
So that's where the health plans really need
to step up so that when they hear
about these issues, that they're actually able to
solve the problem so that members get the
access to the care that they need.
And shifting gears to speak to our up
and coming leaders out there,
keeping pace in today's dynamic health care landscape
is challenging.
And so what's one piece of advice you'd
share with peer leaders to grow their businesses
while keeping members top of mind?
Yeah. I think one of the things, that
health plans need to understand is that being
in silos really makes it difficult to solve
problems.
And so what we see is that making
sure that provider relations as well as, contracting,
grievance and appeals,
all work together to be able to address
issues that are typically across departments. And the
more that a health plan is able to
do that and keeping the patient at the
center, the easier it is to solve the
problems and and provide a better patient experience.
And as we wrap our conversation today, is
there anything else you'd like to share as
closing remarks on the podcast?
So I think in the health care space,
particularly for payers, value based care as well
as risk adjustment are gonna be tied together.
And to be able to have a process,
as patient centered would be the best way
to be able to adjust,
the internal processes as well as external processes
so that,
patients and payers and and providers can all
work together, to achieve the best results.
Wonderful. Well, doctor Pan, thank you for joining
me today on the Becker's healthcare podcast. Again,
we're live at the 2024
payer issues roundtable.
Alright. Thanks, Grace.