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This is Gracelyn Keller with the Becker's Health
Care podcast, and we are live at the
2024
payer issues roundtable.
I'm currently joined by Krisha Winwright, who is
the president of Medicare Advantage at Blue Cross
Blue Shield of Michigan. So, Krisha, thanks for
being here. We'd love to have you start
off by introducing yourself and explaining a little
bit more about your role. Thanks for having
me, Grace. It's so good to be here
and all the excitement. It's,
energetic just to walk through this this event.
Thanks for having me. As you mentioned, I'm
the president of Medicare Advantage for Blue Cross
Blue Shield of Michigan, and we are the
7th largest payer in the nation for Medicare
Advantage.
And we cover Michigan, several states that we
have partnerships with other Blues plans to really
drive performance in Medicare Advantage. So that's my
that's my role within the Blue System. I've
been in health care for
many, many years working in a variety of
roles across the health care continuum,
and this is a really great spot to
see the action in Medicare Advantage these days.
So glad to be here.
Wonderful. Well, thank you for taking the time.
And let's start our conversation today around growth
goals. So from improving member experience
and expanding value based care to controlling costs,
payer executives do have ambitious growth goals for
the rest of this year as well as
we're looking into 2025.
So in your role, what is your top
priority, and how are you planning to get
there? You know, it's interesting that you mentioned
the focus on growth. We know that the
Medicare Advantage market is growing, and it's growing
nationally.
Millions of Medicare Advantage members will come into
the pipeline in the coming decades, and
that is,
causing a a market reality right now in
Medicare Advantage and a market shift overall. And
so it's interesting when you mentioned that payers
have high growth goals. I would probably rephrase
that a little bit that we are facing
growth,
but it's also a moment when Medicare Advantage
is going through an inflection point. And so
what we're doing right now and what is
top of mind is how do we create
a sustainable
solution for Medicare Advantage and for seniors that
is really true to our mission, that doubles
down on that which we care a lot
about, which is access to excellent quality affordable
health care for seniors and do that in
a way that
is taking advantage of the market context, understand
the market context, but really being true to
who we are. I imagine that payers nationally
are doing that right now. It is, a
market shift that's happening.
Increased utilization
coming out post pandemic is causing pressure on
payers nationally
that is well above anything that we would
have imagined pre COVID nor seen.
And at the same time, the,
CMS program is contracting funding to cope with
the increased surge of Medicare Advantage lives, and
that's causing quite a moment for Medicare Advantage.
And so as we look ahead to positive
growth, we also wanna do that in a
way that's sustainable,
that we can be counted on by seniors
to continue to serve them in the manner
that we have for many, many years. And
so it's a very exciting time for sure.
Absolutely. Well, thank you for those insights. And
kind of going off of that in the
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 these being applied to your current strategies?
It's so interesting that you asked me that
question on today of all days, which is
election day nationally.
And I would,
hearken to that when I think about seniors
that are navigating the health care environment. It
is an incredibly noisy environment. Much like our
election day and leading up to it, just
even cutting through the noise has been very
difficult. And we know that that's happening nationally
just as a result of this event today
with voting day being so critically important to
our nation today. Well, very similarly,
it's tough to cut through the noise for
seniors. And,
seniors are telling us that they want more
alignment. They want easier selection.
They have a lot of choices to make
in the market, and sometimes they're not fun
to make. They're hard to navigate.
The
health care landscape
continues to be complex
due to lots of factors, but innovation is
happening in the market. And that causes even
more fantastic solutions for health care. It's also
more confusing at times for seniors. And so
one of the things that we're doing to
get through those barriers of noise and concern
and, confusion
is to really get aligned with providers. We
have fantastic
partnerships with providers in our market.
And, that's true of Blue Cross companies nationally.
Health care is very, very local, and the
partnerships that we build with providers tend to
be critically important. They're important more than ever
now.
The seniors that we talk to want us
to be on the same page with their
provider. They don't want confusion. They don't want
different answers. They want alignment, and that's what
we're working very, very hard to do. We
have enjoyed
success in partnering with providers. Our blueprint for
affordability program is among the leading in the
nation where we are coming alongside
providers in our market, partnering together to make
things better, more affordable, sustainable
for everyone in the market, including seniors. And
we're so proud of that work. Over 22
physician organizations
have joined us in that quest.
And, so I would say that that's probably
the number one thing that we're doing right
now to overcome those barriers with consumers is
doubling down on our partnership with providers.
Absolutely.
And shifting our conversation
toward digital innovation,
what role is technology currently playing in your
organization's growth strategies?
And can you share any specific examples with
us? Sure can. The Medicare Advantage market
ends up serving members with a lot of
complex chronic disease, and that's the cause of,
as we mentioned, not only,
a lot of care being delivered in that
market, confusion, but also,
is fraught with
opportunities and challenges. Technology
helps us get precise in how we work
with seniors.
It also helps us get more precise in
how we work with providers so that we're
working in the context of someone's illness burden
and their unique situation.
It's not just about the the clinical challenges
that you have. It's about your social
environment, your context in which you journey through
that. And health care is so much more
than what we've given it, credit for in
the past, and we wanna do a really
good job and get more precise as we're
journeying with seniors in context.
Technology,
especially
artificial intelligence, generative AI, new solutions that are
hitting the market are table stakes to be
able to provide that type of care precision
and, be able to be there for members
in new ways and in new more meaningful
ways that are tailored specifically to where they're
at, meeting them where they're at. As it
turns out, the CMS program for Medicare Advantage
also rewards our doing that on a member
by member basis. It's very unique
in that way. And so it's a really
good fit. Technology innovation and contemporary technology that's
in market right now allows you to do
exactly what we need to do right now,
which is get more precise for members, align
better with the CMS Medicare Advantage Program, and
that's what we're doing.
And how is technology supporting value based care
or member focused initiatives at your organization, and
what is most exciting to you here?
I think the most exciting thing is the
conversations that we're able to have with providers
to
understand that we're really after many of the
same things, but we have different sources of
information.
Providers are working at the point of care,
and the insurer and the payer is seeing
the longitudinal care across every
provider and facility that that member might be
seeing. They they see all of the,
pharmaceuticals, the drugs that they might they might
be on and take. And we also see
the benefits
in the environment that the senior is working
in with their products. And so those perspectives
are very helpful when they're working together. And
so the most exciting work that we're doing
right now is in partnership again with providers
to see the whole person
and to be able to participate in that
positive conversation
with providers to make sure that we're moving
the ball down the field and that we're
getting where the senior wants to go and
helping them live their very best life.
And shifting toward quality, in an ever
evolving regulatory environment, what tools or key strategies
have helped your organization improve quality and clinical
outcomes for members while staying compliant?
Embrace the reality
of the program
and
look at the intent
of the regulatory
guidance
and still stay true to the mission that
your organization
is,
attempting to implement.
For us,
we want to be senior centric, and we
will always be senior centric. We're gonna be
local. We're gonna be, pro provider. Those things
are unchanged. They work very well in their
changing regulatory environment. But there are challenges.
Changing regulatory makes you more, need to be
more nimble. It makes you need to,
operate in a way that's very responsive. That's
been hard for health care organizations to do,
and we're continuing to chase that as well.
How do you get to be a more
responsive, nimble organization? We're working really hard at
that, making some fantastic strides in doing that.
And so I would say it's those few
handful of things. It's making sure that you're
embracing the intent, you are committed to be
compliant, but you're also on mission. And that
drives you to do incredibly inspiring things on
behalf of the members that you serve.
Absolutely. Well, Krisha, before we wrap up here,
are there any parting words you'd like to
share on the podcast today?
I'm just, inspired to be a part of
the conversation right now. The market in health
care is very, very,
challenging. But with that challenge also comes opportunity.
And, Blue Cross Blue Shield of Michigan is
a part of that right now, and we
couldn't be more thrilled
to be, creating solutions for members that we
believe are gonna last for a very, very
long time. And so I would just leave
the the,
the listeners with that. Be true to your
mission, double down on it, and be excited
about the impact that we can have in
this moment.
Wonderful. Well, thank you so much for taking
the time to be here today and join
me on the Becker's Healthcare podcast. Again, we
are live at the 2024 payer issues roundtable.