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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 Healthcare

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podcast, and we are live at the 2024

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payer issues roundtable.

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I'm currently joined by Anne Groves who serves

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as market president, Arcos

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Health. Anne, thank you for being here. Would

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love to have you start off by introducing

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yourself and telling us about your current role

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and organization.

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Hi. My name's Anne Groves. I am the

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market president for Illinois for Arcos Health. I'm

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also the chief medical officer in the market.

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We are a value based startup company.

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We take full risk on

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populations

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contracting with insurance companies

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to provide

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wraparound services outside of the hospital

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in order to drive down utilization

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costs.

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Our model is built on the idea that

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most health care

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is actually delivered at home

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and not in the hospital or clinic.

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And too many patients leave the doctor's office

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and then don't follow-up on care plans for

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whatever reason.

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Wonderful. Well, thank you for being here. And

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let's start our conversation

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with growth goals. So from improving member experience

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and expanding value based care to controlling costs,

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payer executives have ambitious growth goals for the

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rest of this year and looking ahead into

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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?

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So our top priority

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is member engagement.

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All of the challenges that you just described

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have this similar route.

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Patients don't understand

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why it's important for them to

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do all of the health care measures that

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we're asking of them. They don't understand why

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their annual exam matters.

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We have a Medicare Advantage population.

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Our members don't understand why they need to

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do their blood pressure screening, get their hemoglobin

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a one c checked, or any of the

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other HEDIS measures that play into

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the payers star ratings.

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So we need to get out and talk

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to our members 1 on 1

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in order to

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educate them and in order to get their

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cooperation.

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Absolutely.

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And going off of that at an industry

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level, how would you describe the biggest barriers

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to effectively serving and engaging members? And what

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opportunities do you see for large scale improvements

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and how you're applying these to your current

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strategies?

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So by far, the biggest barrier is data.

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This is a theme that I'm seeing over

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and over again here at Becker's.

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Data management is so very difficult.

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It's

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the root cause is the fact that data

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is coming from multiple different sources.

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These sources are not integrated.

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It is difficult to

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tell what is accurate

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in the data. And so

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the old maxim of garbage in garbage out

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applies. We've got to make sure that our

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data is

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trustworthy

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before we act on it.

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So

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we are

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concentrating

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on building out a platform where we can

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compile data from multiple different payers and then

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draw our own conclusions as to where we

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need to focus our attention.

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When we're looking at large scale improvements,

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we have to remember that health care is

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personal. So large scale improvements

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only come from engaging individual members.

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We are working on forms of outreach that

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actually get patients

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to communicate with us and where we can

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educate

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as to

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our case management services.

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And shifting gears slightly toward leadership growth. Keeping

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pace in today's dynamic health care landscape

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mission, and you have to remember your mission.

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You've got to keep also a mission. And

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you have to remember your mission. You've got

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to keep it front and center with everything

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you do. It is absolutely possible to make

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money in health care, but you can't forget

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why you're doing what you're doing.

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Absolutely.

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And is there anything else you'd like to

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share as a closing remark while we finish

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up the podcast here?

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So I am a physician by training. I'm

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a neonatologist.

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And

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one theme that I've seen over and over

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again is how very siloed

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health care is.

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We have 3 primary groups

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that needs to all interact with each other.

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We have our patient,

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our providers, and our payers.

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And what I'm seeing at the moment is

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that the silos don't interconnect

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at all.

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Even here at a big payer conference, the

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number of physicians I've seen

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who are

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practicing

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is so few. It's a little scary. We've

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got to have all the voices sitting at

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the same table.

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Otherwise,

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we're never gonna make the changes that we

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need to.

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Absolutely. Well, Anne, thank you for being here

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today and sharing your insights on the Becker's

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healthcare podcast. Again, we are recording live at

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the 2024 payer issues roundtable. It was my

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pleasure. Thank you.