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This is Gracelyn Keller with the Becker's Healthcare
podcast, and we're recording live at the 2024
fall payer issues roundtable.
I'm joined right now by Paige Brogan,
who is the principal CalAIM at Blue Shield
of California.
Paige, thanks for being here. We'd love to
have you briefly introduce yourself as we get
started.
Thank you, Grace.
Again, my name is Paige Brogan, and I
am from the Blue Shield California Promise Health
Plan, where I am responsible for implementing
our medical transformation work, which is really what
CalAIM, California Innovating and Advancing Medical is really
all about. It's a program designed to fundamentally
address the whole person needs of our medical
population,
as well as to streamline
the
bureaucratic process for payers, for providers, for community
based organizations,
and, ultimately the community.
Wonderful. Well, thanks for being here and let's
start our conversation with growth goals. So from
improving member experience and expanding value based care
to controlling costs, payer executives have ambitious growth
goals for the rest of this year and
looking ahead into 2025.
So in your role, what is your top
priority right now and how are you planning
to get there?
So it's interesting because when we think about
value based models from a Medi Cal perspective,
we really for us, this is something that's
so critical because we really wanna make sure
that our most vulnerable members are really getting
care that is based on value.
And I think for us, it's really
better engagement with our providers,
ensuring that they really understand what value based
models of payment look like, and really making
sure that we are aligned both from a
provider perspective
and a payer perspective,
what that means for both of us and
what it ultimately means for our members.
I think we will continue to
grow, and I think our contracting teams will
continue to evolve
as they work with our providers
to
really encompass a true value based model. But
we're not there yet. I think we're getting
there. And I'm excited to see kinda where
that takes us into 2025 and beyond.
Wonderful. And going off of that at an
industry level, how would you describe the biggest
barriers to effectively serving and engaging members? And
what opportunities do you see for larger scale
improvements? And then how are you applying all
of that to your strategy?
Well, Medi Cal traditionally has been a very
difficult population to engage. Part of it is
knowledge, just understanding that these benefits exist for
this vulnerable population.
And then another piece piece of it is
once they are enrolled in the program, making
sure that they're aware of the wide array
of benefits that are available to them. Medi
Cal is not just strictly clinical services. It
encompasses things like medically tailed meals,
housing
supports,
community supports, such as substance use
disorder support, behavioral health.
And I think that
at Blue Shield Promise,
we really are a leader and an innovator
in connecting with our communities.
And I think that's our strength in member
engagement, member retention,
and also member utilization because we are there
in the communities.
We are engaged with our members, and we're
helping them to understand
the wide array of opportunities that they have
to improve the health of them, their families.
And then beyond that, acting as peer advocates
for other Medi Cal members. You know, I
think about one of the sessions that I
heard at this year's conference
around substance use disorder. And one of the
things that the moderator brought up was how
powerful it is to have a peer who's
been through and has lived experience.
And that person can then act as a
conduit
to assist other members within the community that
are part of the Medi Cal population
to really inform
and create a successful recovery
outcome.
And shifting gears just slightly toward leadership,
keeping pace in today's health care
landscape is challenging. So what is a piece
of advice you'd share with peer leaders to
grow their businesses while keeping members top of
mind?
Well,
I don't like to think of Medi Cal
as a business. I like to think about
it as a program that's really designed to
capture the needs
and provide support and services for
our most vulnerable members.
I think from a provider perspective,
if you're thinking about growing your business, you
really need to think about how you're collaborating
with plans
to really prove and show that what you're
offering is both congruent with the needs of
the population,
but also
very respectful
of health equity outcomes, very respectful of consideration
of how they're thinking about health equity in
their delivery of their practice.
I think that is so important. I health
equity is not a buzzword that's gonna go
away. It is critical to how we think
about it and how we serve our members,
thinking about social determinants of health, and really
thinking about how are they utilizing
data,
both the ingestion of data and then the
sharing of data. I think that for any
provider, that is really key to success in
the health care landscape.
And as we round our conversation out here
today, are there any parting words you'd like
to share on the podcast?
I would like to say thank you for
this opportunity, not just to talk to you
for a bit, Grace, but also for the
opportunity
to speak to some incredibly
intelligent, well informed, and passionate leaders in health
care. I think Becker's is just a wonderful
forum for innovation, for conversation,
and to build ideas that we can use
moving going forward.
Wonderful. Well, Paige, thanks for joining me today
on the Becker's health Care Podcast. Again, we're
live at the fall 2024
payer issues round table.