Evernorth brings the power of wonder and relentless
innovation to create world class pharmacy care and
benefit solutions. Our connected health services make the
treatment, prediction, and prevention of health care's most
complex conditions
easier and more accessible as we drive organizations
and people forward. Ever North Home Based Care
provides value based care that helps patients with
multiple chronic conditions
and social determinant of health barriers get the
care they need and the personalized experience they
deserve. We serve patients who struggle to navigate
the health care system by bringing high quality
primary
and preventative care services to the home. By
providing clinical care and support services that provide
whole person care, we improve health equity, access,
and outcomes for the populations we serve.
This is Gracelyn Keller with the Buckers Healthcare
Podcast, and we are live with the 2024
payer issues roundtable.
I am joined right now by Scott Schweiger,
who is the vice president at the clinic
by Cleveland Clinic. Scott, thank you for being
here, and let's start off by having you
introduce yourself and telling us a little bit
more about your current role. Sure. Thank you
for the opportunity to, chat with Becker's.
Scott Schweiger vice president
at the Clinic by Cleveland Clinic. We provide
virtual second opinions
across accessing our 35 100 specialists and 550
subspecialists at the Cleveland Clinic.
Wonderful. Well, thank you for being here. And
let's talk about
member engagement to start our conversation here. So
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 your current strategy? Sure. Thank you. So
there's a couple of a couple of viewpoints
here. So in terms of barriers, if you
look at the payers,
there are thousands of digital health solutions to
navigate from, from
telehealth platforms
to advocacy and navigation solutions, which would include
everything from diabetes, cardiometabolic,
oncology,
neuro, GI, etcetera.
And payers face a patchwork of all these
disparate tools,
right? One report identified over 1400
digital health ventures worldwide.
Another reported more than
350,000
mobile health apps and there are 11,000
point solutions in the market which payers have
access to.
From a member perspective, they're equally frustrated, feeling
confused about their plans' offerings, and even facing
delays in care as a result.
So this, you know, we kind of call
that member abrasion. From a payer perspective, it
could be argued there's point solution fatigue in
the market and how do you bring all
these things together. The fatigue can leave patients
struggling to navigate the healthcare maze while leaving
payers with underutilized solutions
that failed to deliver the intended value.
On a personal
level, I often ask people, who are you
insured with? And they'll give me their insurer
and I'm like, are you aware of all
of your benefits available?
And I encourage them to go look in
the little magnifier
of their app and go plug in whatever
you want to do, diabetes control, weight loss,
whatever. And most of them have no idea
that even these payers offer premium discounts
to go after
the certain conditions that they want to get
in control.
So, opportunities for improvements, where do they lie?
You know, omnichannel strategy in the payer world
with the member is all about
being there for the member and their channel
of choice
at their time of need. So, how do
you do that? You know, for the payer,
as an example, this could mean enabling partners
and investments
together to collaborate on their solutions for integration
support
across the population,
across certain chronic conditions.
So, I would always encourage payers to say,
If you're being approached with
the broad areas of oncology, don't be afraid
to bring your partners together
because it could be single sign ons underneath
them.
For the members, they will see the result
of a platform integration,
more personalized support and allowing them to understand,
get the outreach they need. And oftentimes,
payers don't have the resources to outreach those
members.
So another piece that we look at is
you hear a lot about member engagement,
but it needs to go one step further.
I can reach out to you and tell
you there is a diabetes program for you.
I am engaging you, but how am I
enabling you to do that? How are you
going to reciprocate
by taking action? And so those are some
of the things that are ongoing
in the market. And as for the clinic,
when we talk chronic conditions,
high cost, complex, rare conditions that we can
help members
become aware of or control their journey, we
actually use nurse care navigators to reach out
to them
and help them in their journey.
Wonderful. And switching gears a little bit to
leadership growth, keeping pace in today's dynamic health
care landscape is challenging. So what is a
piece of advice you'd share with peer leaders
to grow their business while keeping members top
of mind? Yeah. Health care is a noble
business, but a business nonetheless. And to kind
of pivot off
of the recent world series in baseball, you
know, games are won on singles and doubles.
Rarely are you gonna win on a home
run. And similar in health care, if you
listen to what's going on at the Becker's
conference today, there's very few payers who are
getting up and saying, We solved this problem
and figured something out and it saved us
$81,000,000,000
right? It's, We found a solution aimed at
members and we're saving 1,000,000 here or millions
there or we're helping
thousands of patients and members here and there.
So, it's really breaking it down. So, the
theme there is
prioritize adaptability by investing in scalable,
member centered solutions, and look at your partner
base and bring them together.
And switching gears toward health equity, as this
becomes increasingly centered in payer strategies, how is
your organization addressing health disparities? And can you
share examples of measurable successes to date?
Sure. Two parts to that. The clinic by
Cleveland Clinic gives access to specialty care,
including
for people in rural or underserved areas.
Patients don't experience barriers like travel costs, limited
specialist availability,
or administrative red tape. The solution provides misdiagnosis
and unnecessary
treatments. The clinic offers member cost savings and
reduced out of pocket expenses.
So some of the statistics there are 60%
of Americans
have a chronic disease.
50% of that population has a subchronic
condition going on.
Misdiagnosises
lead to 750,000
deaths or disability each
year, and 51,000,000
inpatient surgeries
could have had an alternative
treatment plan. And that's really what we're doing.
And the last piece is everybody is aware
of the importance of care deserts in the
rural or underserved areas.
So virtual health in a number of areas,
reaching out to them can help that.
And as we think about quality,
in an ever changing
regulatory
environment,
what tools or key strategies have helped your
organization improve quality and clinical outcomes for members
while staying compliant?
Sure. The clinic's value is to unlock access
for the member and give them the ability
to have an informed
decision on their healthcare journey.
And as you look forward to
value based care and where that's going, you
know, it's the 3 legged stool. Can we
get the member? Can we get the provider?
And can we get the payer
all sitting on that same stool and being
aware of what's going on in their own
journeys? From secure telehealth platform members,
that powers the member experience,
to our approach ensuring physicians have a broad
licensing perspective and are able to meet that
need for the majority of people who come
through the program.
And we're fortunate enough to have
the 35100
plus physicians of the Cleveland Clinic to help
with that approach.
Wonderful. Well, Scott, thank you for joining me
today on the Becker's healthcare podcast. Again, we
are live at the 2024 payer issues roundtable.
Thank you.