Hi, everyone. This is Laura Dierda with Becker's
Healthcare. Thank you so much for tuning in
to the Becker's Healthcare podcast series. Today, we're
going to talk about network performance.
Joining me for today's discussion are Bob Tavernier,
who is a solution executive for Quest Analytics,
and Karen Tashian, who is senior director of
network regulatory operations at Health Care Service Corporation.
Bob, Karen, thank you so much for being
here today.
Thank you, Lauren. Thank you very much, Lauren.
To get us started, can you please introduce
yourselves and tell us a little bit about
your work in health care? And, Karen, we'll
start with you. Thanks for having us, Laura.
As you stated, I'm Karen Tashian. I work
for health care service corporation, which is a
Blue Cross Blue Shield franchisee.
My job is to make sure that we
stay compliant, and so most of my teams
work on making sure our networks are adequate
and that we're providing enough member access to
care. So we manage all of the regulatory
filings that are attributed to that. Bob, do
you wanna go next?
Thank you, Karen.
Hi. My name is Bob Tavernier.
I am a solutions executive here at Quest
Analytics.
My role is primarily focused on client engagement,
focusing on on all solution verticals as it
relates to network data management,
network management,
and network monitoring.
Super happy to be here today. Thank you.
Well, Bob, Quest Analytics recently partnered with Becker's
to survey health plan leaders on network performance
and related challenges.
What were the most striking or validating findings
from your perspective, and why are these insights
timely and important for payer executives today?
That's a great question, Lauren.
Some of the primary
focus areas when organizations think about what's most
important to them,
network performance is hot. It really is.
When they think about the top three priorities,
lowering administrative costs,
improving clinical quality, focusing in on truly member
satisfaction,
we're those top three.
They know that network performance is truly foundational
when it comes to ultimately measuring
performance of the network and ultimately helping them
with their organizational
priorities.
What's interesting is
they really focused on
taking a look at deeper dive at competitive
intelligence,
focusing in on wanting to know more from
the data around
not only access to care, but understanding more
provider costs and quality. Yet the data that
they have access to isn't good. From a
competitive landscape, they
actually stated that they do not have any
high quality data. When it came to access
to care, they actually had moderate level of
quality data. So really understanding how do we
collectively help improve overall data to get them
to the position of where they want to
ultimately go
with aligning network data
with network design, which ultimately helps with organizational
priorities.
It's very interesting space. It's super hot space
to go in. But, ultimately, when we're focusing
in on network,
it's not only about where the organizations are
at today. It's how do we help them
to get to the next level. They not
only need to be network adequate,
but they want to be able to use
the network data to ultimately be competitive in
the marketplace,
have truly marketplace differentiators,
and ultimately help to improve the member's experience.
Well, that's fascinating to hear. And certainly, whatever
you can do to get that competitive advantage,
in today's health care space makes a big
difference. So I appreciate your thoughts there and
and is currently what Quastya Analytics is doing,
to make a big difference.
Karen, in hearing about reviewing
the survey findings, which two or three themes
resonated most strongly with your experience at HCSC,
how is your organization approaching these challenges or
opportunities? And can you share any examples of
strategies or initiatives that are gaining traction?
Yep. So that is a really, really good
set of questions.
We have a saying in the payer industry
that I'm sure probably will resonate to some
of the listeners where we are, data rich
but information poor. And so, especially at HCSC,
we have access to all kinds of different
types of data, but I think making sure
that you are
leveraging the right insights in a cohesive manner
so that you can have actionable results and
strategies,
that's really key. You have to know your
members, you have to know your provider population,
and you have to know what your organization's
priorities are. So certainly for us,
we are very much prioritizing,
making sure that we are lowering medical cost
as much as humanly possible,
making sure our members are getting the right
type of care they need when they need
it,
and then also making sure that while doing
all of this, we're able to grow in
a compliant manner,
as we're trying to keep up with different
regulatory
expectations that continue to grow. And managing all
of that with, you know, different levels of
clinical needs is sometimes a challenge for us.
So, certainly, I definitely agree with a lot
of the survey results. There's a lot more
too that we'll be discussing later today, but
I know that HCSC is not necessarily a
standout differentiator.
We share a lot of the same pain
points that Bob just spoke to.
That's great to hear and really helpful to
have that context
in how, you know, you're navigating through today
is really a lot of challenges within the
health care space and but building and designing
the future of health care, what an exciting
opportunity that, you know, leaders within the space
have today. So as we look toward that
future of network strategy,
what approaches
will best position
payers to deliver value and differentiation?
How do you both see data and technology
evolving to support this? What innovations are you
most excited about?
So,
one of the wonderful things about being in
this juncture is technology is on our side.
And so with so many advancements in recent
technology, just even in the last ten to
fifteen years, data is not only more accessible,
but there are more solutions and opportunities to
do more with them.
And so I think there is a world
of options and different solutions for payers to
take on depending on what their low hanging
fruit, solutions are or approaches or opportunities they
wanna go after as well as some of
those, opportunities that take a longer pathway.
Excellent points, Karen. I'd love to add that
really when you're thinking about network strategy, it's
understanding where you're at in the market and
where do you wanna be when you grow
up. Do you really wanna focus in on
your broadest networks? Do you want to have
a high performance network? Are you focused in
on tiering? How do you ultimately help to
set up the the appropriate networks and product
benefit designs
that are ultimately helping the member to get
to the level of care that they need.
It's absolutely critical when you're thinking about data
and technology.
It's important that you're considering all avenues, not
only the network teams, but clinical quality, customer
service product, and that you're able
to utilize the dataset that can help a
variety of those health care verticals to ultimately
work together to utilize the data to make
informed decisions
to ultimately create the best experience for members.
Fascinating to hear, and great to have those
types of capabilities.
I I know everything you mentioned,
really is, you know, truly top of mind
for so many health plan leaders and executives
today.
Before we wrap up here, I'm curious. Is
there anything we didn't cover or final thoughts
you'd like to share? And, Bob, we'll start
with you. Great question, Lauren. One of the
things that's really critical when you're thinking about
innovation and really taking a step forward is
understanding
where you are and ultimately where you want
to go. When you think about competitive intelligence,
understanding what the competitors have,
being able to break down down that level
of information in terms of things about what
clinical outcomes, thinking about quality, thinking about costs,
thinking about
are the providers ultimately following things like clinical
practice guidelines?
Are they billing for additional services that those
members don't need?
The payers are very familiar with this space
knowing, working very closely with HEDIS performance measures,
star ratings, cap surveys. If you look at
those surveys and performance measures,
a lot of those are really driven by
ultimately the member experience. So it's not only
building that that appropriate member experience.
It's also being able to understand what are
the key differences
in your space and how do you ultimately
differentiate yourselves
from your competitors with the utilization of network
data.
That's fascinating. Thank you so much, Bob. And,
Karen, what are your final thoughts?
I think Bob hit on some really great
points.
In general, I think it's a really exciting
time for payers. Our industry is evolving and
growing, and there's more asked of us to
serve our members.
And so in general, I'm excited to see
how we can leverage any level of data
enhancement, if you will, or data filtering
in order for us to keep up because,
again, that's just what our members require.
Well, thank you, Bob and Karen, for your
time and insights today. We also want to
thank our podcast sponsor, Quest Analytics.
You can tune into more podcasts from Becker's
Healthcare by visiting our podcast page at beckershospitalreview.com.