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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.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward. Hello, and welcome to the

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Becker's Payers Issues podcast recorded live at the

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third annual spring Payers Issues roundtable here in

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Chicago.

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I'm joined today by Karina Lupercio and Ann

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Marie Gomez.

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Karina, can you start by taking a moment

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to introduce yourself and your organization?

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Absolutely. Good morning, and thank you for having

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me. I'm excited to be here. My name

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is Karina Lupercio, and I serve as vice

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president of market integration and data quality management

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at Healthcare Highways.

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Our organization was founded in 02/2013,

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and we initially operated in Oklahoma before expanding

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into Texas

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and forming our first joint venture in Louisiana.

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We focus on building curated provider networks and

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delivering the technology and the operational infrastructure

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for clients who want to run their own

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health plan.

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In my role specifically, I lead joint venture

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implementations

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often between hospital systems and their provider sponsored

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health plans.

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My job is to ensure that the overall

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structure is in place and fully operational by

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the launch date.

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That includes everything from project management, facilitating steering

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committees, and work groups to coordinating across departments.

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There are a lot of moving parts, and

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every hospital system we partner with is different.

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Some have robust internal teams, while others need

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more hands on guidance.

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That also means I spend time listening, understanding

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the organization's

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culture,

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pain points, and where they need the most

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support.

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It's never a one size fits all. And

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what what makes the work so meaningful,

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is that we're building something truly custom for

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each community.

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But at the end of the day, my

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role is to ensure that all of those

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moving parts align so that the hospital system

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is fully equipped to operate as a payer

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on time and with confidence.

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That's just one of the many ways that

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I contribute.

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Now, Ann Marie, would you mind introducing yourself?

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Hi.

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I'm Ann Marie Gomez, senior director of marketing

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communications at Healthcare Highways.

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My journey into marketing started with a passion

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for advertising,

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but what really hooked me was a strategy

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behind it all. The idea that data could

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steer decisions

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and that delivering the right message at the

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right time could truly hit home with people.

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I quickly learned that data isn't just about

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looking at past behavior.

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It's an awesome way to predict what people

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might need next and create communications that resonate.

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I fell in love with using tech and

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data tools like CRM and marketing automation and

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predictive modeling to connect with the right audience.

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I gained my expertise

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working in fast paced agency settings where I

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handle loyalty programs and managed omnichannel campaigns for

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retail and tech brands.

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Then I made the leap into health care,

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and that's when it all clicked.

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I realized marketing could do so much more

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than just sell products or services.

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It could actually help people navigate

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tough choices

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and feel supported during some of life's

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key moments.

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Now I'm leading marketing and communications at my

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company, Health Care Highways,

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and we're shaking things up in the employer

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sponsored health plans.

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It's pretty exciting.

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We're challenging

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the norm by offering employers

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real alternatives

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to the big national carriers.

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We are doing this by proving that high

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performance provider networks lead to more effective health

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plans.

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With the right design,

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employers can offer access

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to high quality care and get more value

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out of every dollar spent.

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It's a win for them and for their

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employees.

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Thus, I focus on creating engaging content that

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sparks interest and drives growth.

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But the real win comes when employers can

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give their teams access to quality health care

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without breaking the bank.

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How is this done?

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It's through implementing effective provider network design,

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which can save cost and boost employee satisfaction

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by ensuring they can receive the proper care

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in the right place

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at the right time, but most importantly, for

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the right price.

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At the end of the day, I'm all

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about using marketing, not just to promote, but

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to educate,

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build trust,

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and enhance the health care experience for everyone

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involved.

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So balancing affordability and quality is a constant

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challenge for health plans. How is your organization

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innovating to manage the cost of care while

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maintaining or improving member outcomes?

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That's a great question,

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and it really gets to the heart of

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what we do at HealthCare Highways.

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We're focused on redefining how care is delivered

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and paid for.

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It starts with our curated high performance provider

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networks.

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What do we mean by curated?

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When we say curated, we mean we just

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don't include every hospital or doctor out there

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like the big national carriers.

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We carefully select providers who deliver great care,

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have strong outcomes,

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and are committed to keeping costs reasonable.

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It's quality over quantity approach.

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We don't believe in massive one size fits

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all networks.

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Instead, we partner with health care systems and

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providers that meet rigorous quality standards

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and are aligned around value based care.

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These partnerships

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help us ensure members are getting the right

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care from the right providers at the right

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time,

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but that's just the beginning.

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We're also committed to price transparency.

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When employers and members know what costs upfront,

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they're empowered

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to make smarter, more informed decisions.

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It's about removing the mystery from medical billing

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and replacing it with clarity and confidence.

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And beyond that, our model is built to

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support advanced care management.

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We leverage data and predictive analytics to coordinate

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care more effectively,

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especially for members with chronic or complex conditions.

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This includes proactive wellness initiatives,

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helping members navigate their benefits in a way

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that feels human and is not transactional.

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So all of this, curated networks,

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transparent pricing,

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proactive care coordination,

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adds up to better outcomes and real cost

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savings.

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We're making health care work better for employers,

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for members, and for the providers delivering the

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care.

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Now, Karina, I'm gonna turn this next one

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over to you. Addressing health equity has become

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a critical focus for many health plans. Can

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you share a brief overview of a key

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initiative here that you that you're involved in

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or particularly excited about? And, what are you

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hoping to achieve?

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I'm excited about the panel on health literacy

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happening tomorrow because to me, that's where the

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work of health equity truly begins.

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The idea of simplifying

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complex health care information,

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integrating mobile tools, and tailoring outreach to meet

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people where they are, that's where the real

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impact lies. It's also a topic that's deeply

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personal to me because I come from an

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immigrant family. And growing up, navigating The US

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health care system was hard. We didn't always

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know what was covered, how to access care,

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or even who to turn to. Even today,

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as I help my own parents transition into

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Medicare, I realize it's still hard.

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There are so many different types of plans

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and coverage levels. It's overwhelming

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even for those of of of us who

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work in the industry.

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And hidden in all of that complexity are

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important details, like the fact that some plans

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offer incentives

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for completing

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preventative screenings.

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But that information is hard to find and

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easy to miss. And that matters because these

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missed opportunities

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could impact patient outcomes.

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So how do we communicate that better?

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It's something I've had to explain to my

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own parents, and every time I'm reminded how

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confusing the system can be. That lived experience

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has shaped how I see health equity, not

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as an abstract com concept, but as something

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deeply human.

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For me, health literacy is the entry point

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to equity.

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You can have the best doctors, the best

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hospitals, and the best benefits,

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but if people don't understand them, they won't

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use them. And I've seen how marginalized

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communities, especially those where English isn't the first

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language, face yet another layer of complexity

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when trying to access care.

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It's not just a language barrier, it's a

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fluency barrier with the entire system.

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That's why I'm so passionate about initiatives that

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help people not just learn about their health,

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but also how to navigate the system around

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it. And this goes beyond brochures and websites.

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It's about consistent,

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culturally competent communication,

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whether that's through a bilingual care navigator,

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community health events, or partnerships with trusted organizations.

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True health literacy isn't just about information.

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It's about access, trust, and understanding.

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And so I'm hopeful that health plans will

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start seeing education as a core part of

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member care, not just as an add on,

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but as an essential service.

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Because if we want better outcomes,

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we have to build a better understanding first.

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And I want families like mine to feel

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empowered, not confused when it comes to managing

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their health. Because when people understand their care,

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they're more likely to trust it. And that's

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how we start to close the gaps. That's

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what I wish my family had, and it's

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what drives me every day to help make

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the system better.

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Karina, I can really see why you're so

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passionate about that. I really appreciate you sharing

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that personal story.

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Now, Anne Marie,

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I wanna ask you. So member satisfaction is

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essential to thrive in today's competitive market.

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What experience or engagement strategies have proven effective

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for your organization,

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and, you know, what are your KPIs? How

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are you managing success?

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Absolutely. And it's a good segue off of

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what Karina had mentioned about health equity and

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education for the members.

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Member satisfaction is everything

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in today's health care environment.

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People are no longer just patients.

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They're consumers, and they expect healthcare to feel

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more personal,

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more transparent, and easier to navigate.

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One of the most effective strategies I have

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found is showing up for members in real

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tangible ways.

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And this is through personalized outreach,

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providing bilingual resources,

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and easy to understand materials that help take

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the guesswork out of their benefits.

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We also work closely with our partners and

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our internal team to provide on-site support.

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This is through

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real people who are available to answer questions,

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help with benefit navigation, and be a friendly

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face when members need it most.

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Whether it's

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during open enrollment,

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onboarding, or just day to day life.

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That kind of presence makes a huge impact.

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It turns the health care experience from confusing

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and frustrating into one that's approachable and human.

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And it's not just about being went there

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when something goes wrong.

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We partner with care coordination services,

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chronic condition support programs,

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and primary care providers

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to proactively help members stay healthier.

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The more engaged people are with their care

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early on, the better the outcomes and the

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more trust we build.

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We measure success through a mix of data,

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engagement metrics, satisfaction surveys,

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net promoter scores, and the stories we hear.

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Because when members tell us that her person

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helped me when I didn't know where to

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turn,

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that's when we know we're doing something right.

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Because at the end of the day, satisfaction

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isn't just a number. It's how someone feels

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when they know they're not alone,

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especially when they need medical help.

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And, Maria, I really love that answer, especially

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when, you know, you're saying it lets people

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know they're not alone. Karina,

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final question. Looking ahead, what do you see

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as the biggest opportunity for payers to lead

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the charge in transforming health care delivery and

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driving better outcomes for all stakeholders?

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How can leaders take a step in this

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direction right now?

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Everything that Anne Marie said reinforces the point

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that today's members expect more, and they should.

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And as we look ahead, this is one

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of the most exciting moments I've seen in

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health care. The opportunity for payers isn't just

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to optimize what we already do. It's to

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reimagine how we show up for members, providers,

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and our communities.

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Artificial intelligence or AI gives us the tools

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to rethink, not just automate how we work.

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It helps streamline operations, speed up decision making,

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and proactively

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identify care needs, often before a member even

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knows to ask for help.

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But I think the biggest shift is this.

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AI allows us to be proactive

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and not reactive.

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We can use data not just to analyze

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what went wrong, but to anticipate what could

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go right. For the first time, we have

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the tools to act on that insight at

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scale.

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It's an opportunity

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we haven't had before, and now is the

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time to take full advantage of it. It

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unlocks earlier outreach, smarter navigation, and more personalized

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care journeys.

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And it's not about replacing people. It's about

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empowering people, especially those on the front line

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to do more of what matters.

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Imagine

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freeing up time for a care manager to

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focus on a high risk member because AI

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is handling the repeatable admin task in the

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background.

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One of the biggest opportunities

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I see

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transforming the front door of health care is

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making the member experience intuitive,

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digital first, and built around trust.

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But all of that depends on one thing,

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readiness.

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Readiness in your data,

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readiness in your people, readiness in your mindset.

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So how can leaders take that step now?

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For leaders,

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I believe it means committing to continuous learning.

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The leaders who stay curious, who evolve

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alongside the technology

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are the ones who will create lasting change.

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The pace of change is, like, unlike anything

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we've seen, and AI has only accelerated that

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curve. To lead in this moment, we don't

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have to know everything,

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but we do have to be willing to

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keep learning because staying open and adaptable

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alongside the technology

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is what will allow us to lead through

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the change, not just react to it. And

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that's what excites me. We're not just building

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tools. We're building entirely new ways to think

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about care delivery.

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The organizations

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that embrace this mindset are going to reshape

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what it means to be a payer, a

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partner, and a leader in this industry.

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These are exciting times. And the real question

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now isn't whether we can transform care. It's

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whether we're bold enough to lead it.

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Well, Karina and Marie, I really appreciate you

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both joining us today on the Becker's Healthcare

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podcast. It's been an absolute pleasure. Thank you

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so much.

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Thank you. It was a pleasure. You both

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have a lovely rest of your day.