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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy care and

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benefit solutions. Our connected health services make the

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treatment, prediction, and prevention of health care's most

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complex conditions

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easier and more accessible as we drive organizations

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and people forward. Ever North home based care

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provides value based care that helps patients with

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multiple chronic conditions

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and social determinant of health barriers get the

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care they need and the personalized experience they

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deserve. We serve patients who struggle to navigate

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the health care system by bringing high quality

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primary

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and preventative care services to the home. By

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providing clinical care and support services that provide

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whole person care, we improve health equity, access,

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and outcomes for the populations we serve.

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This is Gracelyn Keller with the Becker's Health

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Care podcast, and we are live at the

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2024

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payer issues roundtable.

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I'm currently joined by Krisha Winwright, who is

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the president of Medicare Advantage at Blue Cross

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Blue Shield of Michigan. So, Krisha, thanks for

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being here. We'd love to have you start

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off by introducing yourself and explaining a little

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bit more about your role. Thanks for having

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me, Grace. It's so good to be here

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and all the excitement. It's,

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energetic just to walk through this this event.

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Thanks for having me. As you mentioned, I'm

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the president of Medicare Advantage for Blue Cross

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Blue Shield of Michigan, and we are the

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7th largest payer in the nation for Medicare

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Advantage.

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And we cover Michigan, several states that we

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have partnerships with other Blues plans to really

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drive performance in Medicare Advantage. So that's my

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that's my role within the Blue System. I've

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been in health care for

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many, many years working in a variety of

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roles across the health care continuum,

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and this is a really great spot to

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see the action in Medicare Advantage these days.

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So glad to be here.

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Wonderful. Well, thank you for taking the time.

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And let's start our conversation today around growth

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goals. So from improving member experience

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and expanding value based care to controlling costs,

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payer executives do have ambitious growth goals for

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the rest of this year as well as

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we're looking into 2025.

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So in your role, what is your top

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priority, and how are you planning to get

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there? You know, it's interesting that you mentioned

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the focus on growth. We know that the

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Medicare Advantage market is growing, and it's growing

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nationally.

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Millions of Medicare Advantage members will come into

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the pipeline in the coming decades, and

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that is,

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causing a a market reality right now in

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Medicare Advantage and a market shift overall. And

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so it's interesting when you mentioned that payers

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have high growth goals. I would probably rephrase

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that a little bit that we are facing

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growth,

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but it's also a moment when Medicare Advantage

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is going through an inflection point. And so

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what we're doing right now and what is

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top of mind is how do we create

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a sustainable

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solution for Medicare Advantage and for seniors that

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is really true to our mission, that doubles

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down on that which we care a lot

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about, which is access to excellent quality affordable

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health care for seniors and do that in

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a way that

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is taking advantage of the market context, understand

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the market context, but really being true to

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who we are. I imagine that payers nationally

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are doing that right now. It is, a

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market shift that's happening.

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Increased utilization

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coming out post pandemic is causing pressure on

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payers nationally

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that is well above anything that we would

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have imagined pre COVID nor seen.

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And at the same time, the,

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CMS program is contracting funding to cope with

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the increased surge of Medicare Advantage lives, and

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that's causing quite a moment for Medicare Advantage.

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And so as we look ahead to positive

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growth, we also wanna do that in a

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way that's sustainable,

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that we can be counted on by seniors

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to continue to serve them in the manner

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that we have for many, many years. And

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so it's a very exciting time for sure.

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Absolutely. Well, thank you for those insights. And

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kind of going off of that in the

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industry level, how would you describe the biggest

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barriers to effectively

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serving and engaging members? And what opportunities do

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you see for large scale improvements, and how

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are these being applied to your current strategies?

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It's so interesting that you asked me that

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question on today of all days, which is

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election day nationally.

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And I would,

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hearken to that when I think about seniors

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that are navigating the health care environment. It

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is an incredibly noisy environment. Much like our

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election day and leading up to it, just

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even cutting through the noise has been very

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difficult. And we know that that's happening nationally

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just as a result of this event today

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with voting day being so critically important to

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our nation today. Well, very similarly,

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it's tough to cut through the noise for

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seniors. And,

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seniors are telling us that they want more

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alignment. They want easier selection.

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They have a lot of choices to make

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in the market, and sometimes they're not fun

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to make. They're hard to navigate.

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The

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health care landscape

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continues to be complex

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due to lots of factors, but innovation is

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happening in the market. And that causes even

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more fantastic solutions for health care. It's also

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more confusing at times for seniors. And so

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one of the things that we're doing to

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get through those barriers of noise and concern

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and, confusion

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is to really get aligned with providers. We

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have fantastic

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partnerships with providers in our market.

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And, that's true of Blue Cross companies nationally.

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Health care is very, very local, and the

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partnerships that we build with providers tend to

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be critically important. They're important more than ever

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now.

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The seniors that we talk to want us

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to be on the same page with their

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provider. They don't want confusion. They don't want

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different answers. They want alignment, and that's what

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we're working very, very hard to do. We

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have enjoyed

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success in partnering with providers. Our blueprint for

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affordability program is among the leading in the

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nation where we are coming alongside

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providers in our market, partnering together to make

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things better, more affordable, sustainable

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for everyone in the market, including seniors. And

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we're so proud of that work. Over 22

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physician organizations

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have joined us in that quest.

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And, so I would say that that's probably

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the number one thing that we're doing right

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now to overcome those barriers with consumers is

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doubling down on our partnership with providers.

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Absolutely.

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And shifting our conversation

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toward digital innovation,

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what role is technology currently playing in your

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organization's growth strategies?

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And can you share any specific examples with

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us? Sure can. The Medicare Advantage market

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ends up serving members with a lot of

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complex chronic disease, and that's the cause of,

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as we mentioned, not only,

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a lot of care being delivered in that

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market, confusion, but also,

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is fraught with

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opportunities and challenges. Technology

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helps us get precise in how we work

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with seniors.

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It also helps us get more precise in

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how we work with providers so that we're

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working in the context of someone's illness burden

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and their unique situation.

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It's not just about the the clinical challenges

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that you have. It's about your social

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environment, your context in which you journey through

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that. And health care is so much more

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than what we've given it, credit for in

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the past, and we wanna do a really

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good job and get more precise as we're

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journeying with seniors in context.

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Technology,

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especially

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artificial intelligence, generative AI, new solutions that are

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hitting the market are table stakes to be

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able to provide that type of care precision

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and, be able to be there for members

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in new ways and in new more meaningful

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ways that are tailored specifically to where they're

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at, meeting them where they're at. As it

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turns out, the CMS program for Medicare Advantage

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also rewards our doing that on a member

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by member basis. It's very unique

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in that way. And so it's a really

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good fit. Technology innovation and contemporary technology that's

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in market right now allows you to do

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exactly what we need to do right now,

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which is get more precise for members, align

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better with the CMS Medicare Advantage Program, and

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that's what we're doing.

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And how is technology supporting value based care

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or member focused initiatives at your organization, and

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what is most exciting to you here?

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I think the most exciting thing is the

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conversations that we're able to have with providers

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to

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understand that we're really after many of the

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same things, but we have different sources of

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information.

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Providers are working at the point of care,

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and the insurer and the payer is seeing

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the longitudinal care across every

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provider and facility that that member might be

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seeing. They they see all of the,

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pharmaceuticals, the drugs that they might they might

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be on and take. And we also see

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the benefits

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in the environment that the senior is working

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in with their products. And so those perspectives

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are very helpful when they're working together. And

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so the most exciting work that we're doing

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right now is in partnership again with providers

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to see the whole person

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and to be able to participate in that

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positive conversation

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with providers to make sure that we're moving

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the ball down the field and that we're

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getting where the senior wants to go and

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helping them live their very best life.

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And shifting toward quality, in an ever

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evolving regulatory environment, what tools or key strategies

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have helped your organization improve quality and clinical

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outcomes for members while staying compliant?

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Embrace the reality

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of the program

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and

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look at the intent

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of the regulatory

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guidance

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and still stay true to the mission that

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your organization

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is,

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attempting to implement.

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For us,

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we want to be senior centric, and we

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will always be senior centric. We're gonna be

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local. We're gonna be, pro provider. Those things

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are unchanged. They work very well in their

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changing regulatory environment. But there are challenges.

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Changing regulatory makes you more, need to be

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more nimble. It makes you need to,

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operate in a way that's very responsive. That's

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been hard for health care organizations to do,

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and we're continuing to chase that as well.

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How do you get to be a more

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responsive, nimble organization? We're working really hard at

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that, making some fantastic strides in doing that.

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And so I would say it's those few

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handful of things. It's making sure that you're

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embracing the intent, you are committed to be

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compliant, but you're also on mission. And that

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drives you to do incredibly inspiring things on

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behalf of the members that you serve.

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Absolutely. Well, Krisha, before we wrap up here,

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are there any parting words you'd like to

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share on the podcast today?

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I'm just, inspired to be a part of

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the conversation right now. The market in health

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care is very, very,

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challenging. But with that challenge also comes opportunity.

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And, Blue Cross Blue Shield of Michigan is

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a part of that right now, and we

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couldn't be more thrilled

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to be, creating solutions for members that we

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believe are gonna last for a very, very

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long time. And so I would just leave

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the the,

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the listeners with that. Be true to your

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mission, double down on it, and be excited

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about the impact that we can have in

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this moment.

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Wonderful. Well, thank you so much for taking

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the time to be here today and join

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me on the Becker's Healthcare podcast. Again, we

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are live at the 2024 payer issues roundtable.