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Our connected health services make the treatment, prediction,
and prevention of health care's most complex conditions
easier and more accessible as we drive organizations
and people forward. Hello, and welcome to the
Becker's Payers Issues podcast recorded live at the
third annual spring Payers Issues roundtable here in
Chicago.
I'm joined today by Karina Lupercio and Ann
Marie Gomez.
Karina, can you start by taking a moment
to introduce yourself and your organization?
Absolutely. Good morning, and thank you for having
me. I'm excited to be here. My name
is Karina Lupercio, and I serve as vice
president of market integration and data quality management
at Healthcare Highways.
Our organization was founded in 02/2013,
and we initially operated in Oklahoma before expanding
into Texas
and forming our first joint venture in Louisiana.
We focus on building curated provider networks and
delivering the technology and the operational infrastructure
for clients who want to run their own
health plan.
In my role specifically, I lead joint venture
implementations
often between hospital systems and their provider sponsored
health plans.
My job is to ensure that the overall
structure is in place and fully operational by
the launch date.
That includes everything from project management, facilitating steering
committees, and work groups to coordinating across departments.
There are a lot of moving parts, and
every hospital system we partner with is different.
Some have robust internal teams, while others need
more hands on guidance.
That also means I spend time listening, understanding
the organization's
culture,
pain points, and where they need the most
support.
It's never a one size fits all. And
what what makes the work so meaningful,
is that we're building something truly custom for
each community.
But at the end of the day, my
role is to ensure that all of those
moving parts align so that the hospital system
is fully equipped to operate as a payer
on time and with confidence.
That's just one of the many ways that
I contribute.
Now, Ann Marie, would you mind introducing yourself?
Hi.
I'm Ann Marie Gomez, senior director of marketing
communications at Healthcare Highways.
My journey into marketing started with a passion
for advertising,
but what really hooked me was a strategy
behind it all. The idea that data could
steer decisions
and that delivering the right message at the
right time could truly hit home with people.
I quickly learned that data isn't just about
looking at past behavior.
It's an awesome way to predict what people
might need next and create communications that resonate.
I fell in love with using tech and
data tools like CRM and marketing automation and
predictive modeling to connect with the right audience.
I gained my expertise
working in fast paced agency settings where I
handle loyalty programs and managed omnichannel campaigns for
retail and tech brands.
Then I made the leap into health care,
and that's when it all clicked.
I realized marketing could do so much more
than just sell products or services.
It could actually help people navigate
tough choices
and feel supported during some of life's
key moments.
Now I'm leading marketing and communications at my
company, Health Care Highways,
and we're shaking things up in the employer
sponsored health plans.
It's pretty exciting.
We're challenging
the norm by offering employers
real alternatives
to the big national carriers.
We are doing this by proving that high
performance provider networks lead to more effective health
plans.
With the right design,
employers can offer access
to high quality care and get more value
out of every dollar spent.
It's a win for them and for their
employees.
Thus, I focus on creating engaging content that
sparks interest and drives growth.
But the real win comes when employers can
give their teams access to quality health care
without breaking the bank.
How is this done?
It's through implementing effective provider network design,
which can save cost and boost employee satisfaction
by ensuring they can receive the proper care
in the right place
at the right time, but most importantly, for
the right price.
At the end of the day, I'm all
about using marketing, not just to promote, but
to educate,
build trust,
and enhance the health care experience for everyone
involved.
So balancing affordability and quality is a constant
challenge for health plans. How is your organization
innovating to manage the cost of care while
maintaining or improving member outcomes?
That's a great question,
and it really gets to the heart of
what we do at HealthCare Highways.
We're focused on redefining how care is delivered
and paid for.
It starts with our curated high performance provider
networks.
What do we mean by curated?
When we say curated, we mean we just
don't include every hospital or doctor out there
like the big national carriers.
We carefully select providers who deliver great care,
have strong outcomes,
and are committed to keeping costs reasonable.
It's quality over quantity approach.
We don't believe in massive one size fits
all networks.
Instead, we partner with health care systems and
providers that meet rigorous quality standards
and are aligned around value based care.
These partnerships
help us ensure members are getting the right
care from the right providers at the right
time,
but that's just the beginning.
We're also committed to price transparency.
When employers and members know what costs upfront,
they're empowered
to make smarter, more informed decisions.
It's about removing the mystery from medical billing
and replacing it with clarity and confidence.
And beyond that, our model is built to
support advanced care management.
We leverage data and predictive analytics to coordinate
care more effectively,
especially for members with chronic or complex conditions.
This includes proactive wellness initiatives,
helping members navigate their benefits in a way
that feels human and is not transactional.
So all of this, curated networks,
transparent pricing,
proactive care coordination,
adds up to better outcomes and real cost
savings.
We're making health care work better for employers,
for members, and for the providers delivering the
care.
Now, Karina, I'm gonna turn this next one
over to you. Addressing health equity has become
a critical focus for many health plans. Can
you share a brief overview of a key
initiative here that you that you're involved in
or particularly excited about? And, what are you
hoping to achieve?
I'm excited about the panel on health literacy
happening tomorrow because to me, that's where the
work of health equity truly begins.
The idea of simplifying
complex health care information,
integrating mobile tools, and tailoring outreach to meet
people where they are, that's where the real
impact lies. It's also a topic that's deeply
personal to me because I come from an
immigrant family. And growing up, navigating The US
health care system was hard. We didn't always
know what was covered, how to access care,
or even who to turn to. Even today,
as I help my own parents transition into
Medicare, I realize it's still hard.
There are so many different types of plans
and coverage levels. It's overwhelming
even for those of of of us who
work in the industry.
And hidden in all of that complexity are
important details, like the fact that some plans
offer incentives
for completing
preventative screenings.
But that information is hard to find and
easy to miss. And that matters because these
missed opportunities
could impact patient outcomes.
So how do we communicate that better?
It's something I've had to explain to my
own parents, and every time I'm reminded how
confusing the system can be. That lived experience
has shaped how I see health equity, not
as an abstract com concept, but as something
deeply human.
For me, health literacy is the entry point
to equity.
You can have the best doctors, the best
hospitals, and the best benefits,
but if people don't understand them, they won't
use them. And I've seen how marginalized
communities, especially those where English isn't the first
language, face yet another layer of complexity
when trying to access care.
It's not just a language barrier, it's a
fluency barrier with the entire system.
That's why I'm so passionate about initiatives that
help people not just learn about their health,
but also how to navigate the system around
it. And this goes beyond brochures and websites.
It's about consistent,
culturally competent communication,
whether that's through a bilingual care navigator,
community health events, or partnerships with trusted organizations.
True health literacy isn't just about information.
It's about access, trust, and understanding.
And so I'm hopeful that health plans will
start seeing education as a core part of
member care, not just as an add on,
but as an essential service.
Because if we want better outcomes,
we have to build a better understanding first.
And I want families like mine to feel
empowered, not confused when it comes to managing
their health. Because when people understand their care,
they're more likely to trust it. And that's
how we start to close the gaps. That's
what I wish my family had, and it's
what drives me every day to help make
the system better.
Karina, I can really see why you're so
passionate about that. I really appreciate you sharing
that personal story.
Now, Anne Marie,
I wanna ask you. So member satisfaction is
essential to thrive in today's competitive market.
What experience or engagement strategies have proven effective
for your organization,
and, you know, what are your KPIs? How
are you managing success?
Absolutely. And it's a good segue off of
what Karina had mentioned about health equity and
education for the members.
Member satisfaction is everything
in today's health care environment.
People are no longer just patients.
They're consumers, and they expect healthcare to feel
more personal,
more transparent, and easier to navigate.
One of the most effective strategies I have
found is showing up for members in real
tangible ways.
And this is through personalized outreach,
providing bilingual resources,
and easy to understand materials that help take
the guesswork out of their benefits.
We also work closely with our partners and
our internal team to provide on-site support.
This is through
real people who are available to answer questions,
help with benefit navigation, and be a friendly
face when members need it most.
Whether it's
during open enrollment,
onboarding, or just day to day life.
That kind of presence makes a huge impact.
It turns the health care experience from confusing
and frustrating into one that's approachable and human.
And it's not just about being went there
when something goes wrong.
We partner with care coordination services,
chronic condition support programs,
and primary care providers
to proactively help members stay healthier.
The more engaged people are with their care
early on, the better the outcomes and the
more trust we build.
We measure success through a mix of data,
engagement metrics, satisfaction surveys,
net promoter scores, and the stories we hear.
Because when members tell us that her person
helped me when I didn't know where to
turn,
that's when we know we're doing something right.
Because at the end of the day, satisfaction
isn't just a number. It's how someone feels
when they know they're not alone,
especially when they need medical help.
And, Maria, I really love that answer, especially
when, you know, you're saying it lets people
know they're not alone. Karina,
final question. Looking ahead, what do you see
as the biggest opportunity for payers to lead
the charge in transforming health care delivery and
driving better outcomes for all stakeholders?
How can leaders take a step in this
direction right now?
Everything that Anne Marie said reinforces the point
that today's members expect more, and they should.
And as we look ahead, this is one
of the most exciting moments I've seen in
health care. The opportunity for payers isn't just
to optimize what we already do. It's to
reimagine how we show up for members, providers,
and our communities.
Artificial intelligence or AI gives us the tools
to rethink, not just automate how we work.
It helps streamline operations, speed up decision making,
and proactively
identify care needs, often before a member even
knows to ask for help.
But I think the biggest shift is this.
AI allows us to be proactive
and not reactive.
We can use data not just to analyze
what went wrong, but to anticipate what could
go right. For the first time, we have
the tools to act on that insight at
scale.
It's an opportunity
we haven't had before, and now is the
time to take full advantage of it. It
unlocks earlier outreach, smarter navigation, and more personalized
care journeys.
And it's not about replacing people. It's about
empowering people, especially those on the front line
to do more of what matters.
Imagine
freeing up time for a care manager to
focus on a high risk member because AI
is handling the repeatable admin task in the
background.
One of the biggest opportunities
I see
transforming the front door of health care is
making the member experience intuitive,
digital first, and built around trust.
But all of that depends on one thing,
readiness.
Readiness in your data,
readiness in your people, readiness in your mindset.
So how can leaders take that step now?
For leaders,
I believe it means committing to continuous learning.
The leaders who stay curious, who evolve
alongside the technology
are the ones who will create lasting change.
The pace of change is, like, unlike anything
we've seen, and AI has only accelerated that
curve. To lead in this moment, we don't
have to know everything,
but we do have to be willing to
keep learning because staying open and adaptable
alongside the technology
is what will allow us to lead through
the change, not just react to it. And
that's what excites me. We're not just building
tools. We're building entirely new ways to think
about care delivery.
The organizations
that embrace this mindset are going to reshape
what it means to be a payer, a
partner, and a leader in this industry.
These are exciting times. And the real question
now isn't whether we can transform care. It's
whether we're bold enough to lead it.
Well, Karina and Marie, I really appreciate you
both joining us today on the Becker's Healthcare
podcast. It's been an absolute pleasure. Thank you
so much.
Thank you. It was a pleasure. You both
have a lovely rest of your day.