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 00:00:23,765 --> 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 00:00:34,939 --> 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 --> 00:00:44,185 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 00:00:47,704 --> 00:00:49,784 This is Gracelyn Keller with the Buckers Healthcare 20 00:00:49,784 --> 00:00:51,804 Podcast, and we are live with the 2024 21 00:00:52,185 --> 00:00:53,405 payer issues roundtable. 22 00:00:54,050 --> 00:00:56,149 I am joined right now by Scott Schweiger, 23 00:00:56,210 --> 00:00:58,210 who is the vice president at the clinic 24 00:00:58,210 --> 00:01:00,609 by Cleveland Clinic. Scott, thank you for being 25 00:01:00,609 --> 00:01:02,289 here, and let's start off by having you 26 00:01:02,289 --> 00:01:03,969 introduce yourself and telling us a little bit 27 00:01:03,969 --> 00:01:05,969 more about your current role. Sure. Thank you 28 00:01:05,969 --> 00:01:08,709 for the opportunity to, chat with Becker's. 29 00:01:09,064 --> 00:01:10,525 Scott Schweiger vice president 30 00:01:10,905 --> 00:01:13,064 at the Clinic by Cleveland Clinic. We provide 31 00:01:13,064 --> 00:01:14,365 virtual second opinions 32 00:01:14,984 --> 00:01:18,365 across accessing our 35 100 specialists and 550 33 00:01:19,385 --> 00:01:21,245 subspecialists at the Cleveland Clinic. 34 00:01:21,820 --> 00:01:23,980 Wonderful. Well, thank you for being here. And 35 00:01:23,980 --> 00:01:25,120 let's talk about 36 00:01:25,420 --> 00:01:28,219 member engagement to start our conversation here. So 37 00:01:28,219 --> 00:01:30,140 at an industry level, how would you describe 38 00:01:30,140 --> 00:01:32,780 the biggest barriers to effectively serving and engaging 39 00:01:32,780 --> 00:01:35,260 members? And what opportunities do you see for 40 00:01:35,260 --> 00:01:37,340 large scale improvements, and how are you applying 41 00:01:37,340 --> 00:01:40,135 this your current strategy? Sure. Thank you. So 42 00:01:40,435 --> 00:01:42,515 there's a couple of a couple of viewpoints 43 00:01:42,515 --> 00:01:45,234 here. So in terms of barriers, if you 44 00:01:45,234 --> 00:01:46,215 look at the payers, 45 00:01:46,915 --> 00:01:49,555 there are thousands of digital health solutions to 46 00:01:49,555 --> 00:01:50,855 navigate from, from 47 00:01:51,250 --> 00:01:52,310 telehealth platforms 48 00:01:52,689 --> 00:01:55,989 to advocacy and navigation solutions, which would include 49 00:01:56,369 --> 00:01:58,310 everything from diabetes, cardiometabolic, 50 00:01:59,009 --> 00:01:59,509 oncology, 51 00:02:01,810 --> 00:02:03,429 neuro, GI, etcetera. 52 00:02:04,444 --> 00:02:07,165 And payers face a patchwork of all these 53 00:02:07,165 --> 00:02:08,144 disparate tools, 54 00:02:08,685 --> 00:02:11,185 right? One report identified over 1400 55 00:02:11,965 --> 00:02:13,745 digital health ventures worldwide. 56 00:02:14,205 --> 00:02:15,824 Another reported more than 57 00:02:16,205 --> 00:02:16,705 350,000 58 00:02:17,860 --> 00:02:20,039 mobile health apps and there are 11,000 59 00:02:20,500 --> 00:02:22,819 point solutions in the market which payers have 60 00:02:22,819 --> 00:02:23,560 access to. 61 00:02:24,259 --> 00:02:27,539 From a member perspective, they're equally frustrated, feeling 62 00:02:27,539 --> 00:02:30,340 confused about their plans' offerings, and even facing 63 00:02:30,340 --> 00:02:32,519 delays in care as a result. 64 00:02:32,979 --> 00:02:34,495 So this, you know, we kind of call 65 00:02:34,495 --> 00:02:37,135 that member abrasion. From a payer perspective, it 66 00:02:37,135 --> 00:02:39,855 could be argued there's point solution fatigue in 67 00:02:39,855 --> 00:02:41,215 the market and how do you bring all 68 00:02:41,215 --> 00:02:43,615 these things together. The fatigue can leave patients 69 00:02:43,615 --> 00:02:45,935 struggling to navigate the healthcare maze while leaving 70 00:02:45,935 --> 00:02:47,875 payers with underutilized solutions 71 00:02:48,419 --> 00:02:50,599 that failed to deliver the intended value. 72 00:02:51,379 --> 00:02:52,199 On a personal 73 00:02:52,739 --> 00:02:54,340 level, I often ask people, who are you 74 00:02:54,340 --> 00:02:56,340 insured with? And they'll give me their insurer 75 00:02:56,340 --> 00:02:57,780 and I'm like, are you aware of all 76 00:02:57,780 --> 00:02:59,239 of your benefits available? 77 00:03:00,020 --> 00:03:01,939 And I encourage them to go look in 78 00:03:01,939 --> 00:03:02,919 the little magnifier 79 00:03:03,379 --> 00:03:05,754 of their app and go plug in whatever 80 00:03:05,754 --> 00:03:08,235 you want to do, diabetes control, weight loss, 81 00:03:08,235 --> 00:03:10,415 whatever. And most of them have no idea 82 00:03:10,715 --> 00:03:13,455 that even these payers offer premium discounts 83 00:03:13,995 --> 00:03:14,895 to go after 84 00:03:15,514 --> 00:03:17,275 the certain conditions that they want to get 85 00:03:17,275 --> 00:03:18,014 in control. 86 00:03:18,629 --> 00:03:21,590 So, opportunities for improvements, where do they lie? 87 00:03:21,590 --> 00:03:24,870 You know, omnichannel strategy in the payer world 88 00:03:24,870 --> 00:03:26,729 with the member is all about 89 00:03:27,669 --> 00:03:29,669 being there for the member and their channel 90 00:03:29,669 --> 00:03:30,250 of choice 91 00:03:30,594 --> 00:03:32,914 at their time of need. So, how do 92 00:03:32,914 --> 00:03:34,594 you do that? You know, for the payer, 93 00:03:34,594 --> 00:03:37,474 as an example, this could mean enabling partners 94 00:03:37,474 --> 00:03:38,294 and investments 95 00:03:38,675 --> 00:03:41,334 together to collaborate on their solutions for integration 96 00:03:41,555 --> 00:03:42,055 support 97 00:03:42,594 --> 00:03:43,735 across the population, 98 00:03:44,034 --> 00:03:45,655 across certain chronic conditions. 99 00:03:46,040 --> 00:03:48,599 So, I would always encourage payers to say, 100 00:03:48,599 --> 00:03:50,300 If you're being approached with 101 00:03:50,599 --> 00:03:53,400 the broad areas of oncology, don't be afraid 102 00:03:53,400 --> 00:03:55,180 to bring your partners together 103 00:03:55,639 --> 00:03:58,200 because it could be single sign ons underneath 104 00:03:58,200 --> 00:03:58,700 them. 105 00:03:59,314 --> 00:04:01,555 For the members, they will see the result 106 00:04:01,555 --> 00:04:02,854 of a platform integration, 107 00:04:03,555 --> 00:04:06,775 more personalized support and allowing them to understand, 108 00:04:06,995 --> 00:04:09,254 get the outreach they need. And oftentimes, 109 00:04:09,955 --> 00:04:13,235 payers don't have the resources to outreach those 110 00:04:13,235 --> 00:04:13,735 members. 111 00:04:14,310 --> 00:04:16,389 So another piece that we look at is 112 00:04:16,389 --> 00:04:18,730 you hear a lot about member engagement, 113 00:04:19,669 --> 00:04:21,610 but it needs to go one step further. 114 00:04:21,910 --> 00:04:23,669 I can reach out to you and tell 115 00:04:23,669 --> 00:04:26,629 you there is a diabetes program for you. 116 00:04:26,629 --> 00:04:28,550 I am engaging you, but how am I 117 00:04:28,550 --> 00:04:30,524 enabling you to do that? How are you 118 00:04:30,524 --> 00:04:31,264 going to reciprocate 119 00:04:31,964 --> 00:04:34,285 by taking action? And so those are some 120 00:04:34,285 --> 00:04:35,584 of the things that are ongoing 121 00:04:36,125 --> 00:04:38,464 in the market. And as for the clinic, 122 00:04:38,764 --> 00:04:40,305 when we talk chronic conditions, 123 00:04:41,404 --> 00:04:44,389 high cost, complex, rare conditions that we can 124 00:04:44,389 --> 00:04:45,209 help members 125 00:04:45,750 --> 00:04:48,870 become aware of or control their journey, we 126 00:04:48,870 --> 00:04:51,829 actually use nurse care navigators to reach out 127 00:04:51,829 --> 00:04:52,490 to them 128 00:04:53,029 --> 00:04:54,410 and help them in their journey. 129 00:04:55,605 --> 00:04:58,004 Wonderful. And switching gears a little bit to 130 00:04:58,004 --> 00:05:01,285 leadership growth, keeping pace in today's dynamic health 131 00:05:01,285 --> 00:05:03,524 care landscape is challenging. So what is a 132 00:05:03,524 --> 00:05:05,204 piece of advice you'd share with peer leaders 133 00:05:05,204 --> 00:05:07,125 to grow their business while keeping members top 134 00:05:07,125 --> 00:05:09,810 of mind? Yeah. Health care is a noble 135 00:05:09,810 --> 00:05:12,370 business, but a business nonetheless. And to kind 136 00:05:12,370 --> 00:05:13,350 of pivot off 137 00:05:13,970 --> 00:05:16,370 of the recent world series in baseball, you 138 00:05:16,370 --> 00:05:18,550 know, games are won on singles and doubles. 139 00:05:18,769 --> 00:05:20,370 Rarely are you gonna win on a home 140 00:05:20,370 --> 00:05:22,524 run. And similar in health care, if you 141 00:05:22,524 --> 00:05:24,285 listen to what's going on at the Becker's 142 00:05:24,285 --> 00:05:26,605 conference today, there's very few payers who are 143 00:05:26,605 --> 00:05:29,165 getting up and saying, We solved this problem 144 00:05:29,165 --> 00:05:31,165 and figured something out and it saved us 145 00:05:31,165 --> 00:05:31,665 $81,000,000,000 146 00:05:32,764 --> 00:05:35,964 right? It's, We found a solution aimed at 147 00:05:35,964 --> 00:05:38,740 members and we're saving 1,000,000 here or millions 148 00:05:38,740 --> 00:05:40,040 there or we're helping 149 00:05:40,500 --> 00:05:42,740 thousands of patients and members here and there. 150 00:05:42,740 --> 00:05:45,779 So, it's really breaking it down. So, the 151 00:05:45,779 --> 00:05:47,000 theme there is 152 00:05:47,379 --> 00:05:50,279 prioritize adaptability by investing in scalable, 153 00:05:50,855 --> 00:05:53,654 member centered solutions, and look at your partner 154 00:05:53,654 --> 00:05:55,115 base and bring them together. 155 00:05:57,095 --> 00:06:00,694 And switching gears toward health equity, as this 156 00:06:00,694 --> 00:06:03,810 becomes increasingly centered in payer strategies, how is 157 00:06:03,889 --> 00:06:06,769 your organization addressing health disparities? And can you 158 00:06:06,769 --> 00:06:09,350 share examples of measurable successes to date? 159 00:06:09,810 --> 00:06:11,810 Sure. Two parts to that. The clinic by 160 00:06:11,810 --> 00:06:14,550 Cleveland Clinic gives access to specialty care, 161 00:06:14,930 --> 00:06:15,430 including 162 00:06:15,730 --> 00:06:18,389 for people in rural or underserved areas. 163 00:06:18,914 --> 00:06:22,354 Patients don't experience barriers like travel costs, limited 164 00:06:22,354 --> 00:06:23,414 specialist availability, 165 00:06:24,034 --> 00:06:27,495 or administrative red tape. The solution provides misdiagnosis 166 00:06:27,954 --> 00:06:28,774 and unnecessary 167 00:06:29,555 --> 00:06:32,435 treatments. The clinic offers member cost savings and 168 00:06:32,435 --> 00:06:34,214 reduced out of pocket expenses. 169 00:06:34,740 --> 00:06:37,000 So some of the statistics there are 60% 170 00:06:37,139 --> 00:06:37,879 of Americans 171 00:06:38,420 --> 00:06:39,720 have a chronic disease. 172 00:06:40,339 --> 00:06:42,839 50% of that population has a subchronic 173 00:06:43,220 --> 00:06:44,600 condition going on. 174 00:06:44,900 --> 00:06:45,400 Misdiagnosises 175 00:06:46,180 --> 00:06:47,480 lead to 750,000 176 00:06:48,420 --> 00:06:50,404 deaths or disability each 177 00:06:50,705 --> 00:06:51,605 year, and 51,000,000 178 00:06:52,064 --> 00:06:53,125 inpatient surgeries 179 00:06:53,504 --> 00:06:54,964 could have had an alternative 180 00:06:55,585 --> 00:06:58,225 treatment plan. And that's really what we're doing. 181 00:06:58,225 --> 00:07:00,545 And the last piece is everybody is aware 182 00:07:00,545 --> 00:07:02,705 of the importance of care deserts in the 183 00:07:02,705 --> 00:07:04,404 rural or underserved areas. 184 00:07:04,829 --> 00:07:07,649 So virtual health in a number of areas, 185 00:07:07,709 --> 00:07:10,129 reaching out to them can help that. 186 00:07:10,589 --> 00:07:12,290 And as we think about quality, 187 00:07:12,669 --> 00:07:14,290 in an ever changing 188 00:07:14,750 --> 00:07:15,250 regulatory 189 00:07:15,629 --> 00:07:16,129 environment, 190 00:07:17,004 --> 00:07:19,245 what tools or key strategies have helped your 191 00:07:19,245 --> 00:07:22,205 organization improve quality and clinical outcomes for members 192 00:07:22,205 --> 00:07:23,264 while staying compliant? 193 00:07:23,964 --> 00:07:27,185 Sure. The clinic's value is to unlock access 194 00:07:27,404 --> 00:07:29,964 for the member and give them the ability 195 00:07:29,964 --> 00:07:31,025 to have an informed 196 00:07:31,750 --> 00:07:34,250 decision on their healthcare journey. 197 00:07:34,790 --> 00:07:36,889 And as you look forward to 198 00:07:37,350 --> 00:07:39,270 value based care and where that's going, you 199 00:07:39,270 --> 00:07:41,350 know, it's the 3 legged stool. Can we 200 00:07:41,350 --> 00:07:43,270 get the member? Can we get the provider? 201 00:07:43,270 --> 00:07:44,730 And can we get the payer 202 00:07:45,034 --> 00:07:47,514 all sitting on that same stool and being 203 00:07:47,514 --> 00:07:49,435 aware of what's going on in their own 204 00:07:49,435 --> 00:07:52,334 journeys? From secure telehealth platform members, 205 00:07:52,794 --> 00:07:54,414 that powers the member experience, 206 00:07:55,274 --> 00:07:57,514 to our approach ensuring physicians have a broad 207 00:07:57,514 --> 00:07:59,730 licensing perspective and are able to meet that 208 00:07:59,730 --> 00:08:01,410 need for the majority of people who come 209 00:08:01,410 --> 00:08:02,310 through the program. 210 00:08:02,689 --> 00:08:04,550 And we're fortunate enough to have 211 00:08:04,850 --> 00:08:05,589 the 35100 212 00:08:05,970 --> 00:08:08,610 plus physicians of the Cleveland Clinic to help 213 00:08:08,610 --> 00:08:09,509 with that approach. 214 00:08:10,258 --> 00:08:12,338 Wonderful. Well, Scott, thank you for joining me 215 00:08:12,338 --> 00:08:14,418 today on the Becker's healthcare podcast. Again, we 216 00:08:14,418 --> 00:08:16,918 are live at the 2024 payer issues roundtable. 217 00:08:17,458 --> 00:08:18,198 Thank you.