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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,

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access, 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're recording live at the 2024

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fall payer issues roundtable.

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I'm joined right now by Paige Brogan,

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who is the principal CalAIM at Blue Shield

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of California.

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Paige, thanks for being here. We'd love to

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have you briefly introduce yourself as we get

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started.

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Thank you, Grace.

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Again, my name is Paige Brogan, and I

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am from the Blue Shield California Promise Health

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Plan, where I am responsible for implementing

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our medical transformation work, which is really what

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CalAIM, California Innovating and Advancing Medical is really

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all about. It's a program designed to fundamentally

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address the whole person needs of our medical

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population,

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as well as to streamline

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the

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bureaucratic process for payers, for providers, for community

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based organizations,

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and, ultimately the community.

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Wonderful. Well, thanks for being here and let's

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start our conversation with growth goals. So from

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improving member experience and expanding value based care

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to controlling costs, payer executives have ambitious growth

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goals for the rest of this year and

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looking ahead into 2025.

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So in your role, what is your top

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priority right now and how are you planning

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to get there?

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So it's interesting because when we think about

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value based models from a Medi Cal perspective,

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we really for us, this is something that's

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so critical because we really wanna make sure

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that our most vulnerable members are really getting

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care that is based on value.

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And I think for us, it's really

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better engagement with our providers,

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ensuring that they really understand what value based

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models of payment look like, and really making

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sure that we are aligned both from a

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provider perspective

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and a payer perspective,

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what that means for both of us and

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what it ultimately means for our members.

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I think we will continue to

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grow, and I think our contracting teams will

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continue to evolve

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as they work with our providers

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to

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really encompass a true value based model. But

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we're not there yet. I think we're getting

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there. And I'm excited to see kinda where

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that takes us into 2025 and beyond.

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Wonderful. And going off of that at an

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industry level, how would you describe the biggest

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barriers to effectively serving and engaging members? And

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what opportunities do you see for larger scale

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improvements? And then how are you applying all

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of that to your strategy?

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Well, Medi Cal traditionally has been a very

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difficult population to engage. Part of it is

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knowledge, just understanding that these benefits exist for

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this vulnerable population.

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And then another piece piece of it is

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once they are enrolled in the program, making

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sure that they're aware of the wide array

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of benefits that are available to them. Medi

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Cal is not just strictly clinical services. It

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encompasses things like medically tailed meals,

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housing

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supports,

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community supports, such as substance use

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disorder support, behavioral health.

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And I think that

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at Blue Shield Promise,

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we really are a leader and an innovator

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in connecting with our communities.

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And I think that's our strength in member

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engagement, member retention,

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and also member utilization because we are there

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in the communities.

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We are engaged with our members, and we're

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helping them to understand

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the wide array of opportunities that they have

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to improve the health of them, their families.

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And then beyond that, acting as peer advocates

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for other Medi Cal members. You know, I

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think about one of the sessions that I

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heard at this year's conference

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around substance use disorder. And one of the

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things that the moderator brought up was how

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powerful it is to have a peer who's

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been through and has lived experience.

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And that person can then act as a

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conduit

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to assist other members within the community that

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are part of the Medi Cal population

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to really inform

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and create a successful recovery

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outcome.

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And shifting gears just slightly toward leadership,

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keeping pace in today's health care

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landscape is challenging. So what is a piece

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of advice you'd share with peer leaders to

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grow their businesses while keeping members top of

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mind?

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Well,

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I don't like to think of Medi Cal

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as a business. I like to think about

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it as a program that's really designed to

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capture the needs

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and provide support and services for

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our most vulnerable members.

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I think from a provider perspective,

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if you're thinking about growing your business, you

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really need to think about how you're collaborating

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with plans

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to really prove and show that what you're

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offering is both congruent with the needs of

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the population,

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but also

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very respectful

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of health equity outcomes, very respectful of consideration

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of how they're thinking about health equity in

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their delivery of their practice.

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I think that is so important. I health

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equity is not a buzzword that's gonna go

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away. It is critical to how we think

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about it and how we serve our members,

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thinking about social determinants of health, and really

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thinking about how are they utilizing

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data,

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both the ingestion of data and then the

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sharing of data. I think that for any

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provider, that is really key to success in

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the health care landscape.

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And as we round our conversation out here

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today, are there any parting words you'd like

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to share on the podcast?

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I would like to say thank you for

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this opportunity, not just to talk to you

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for a bit, Grace, but also for the

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opportunity

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to speak to some incredibly

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intelligent, well informed, and passionate leaders in health

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care. I think Becker's is just a wonderful

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forum for innovation, for conversation,

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and to build ideas that we can use

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moving going forward.

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Wonderful. Well, Paige, thanks for joining me today

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on the Becker's health Care Podcast. Again, we're

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live at the fall 2024

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payer issues round table.