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Hi, everyone. This is Laura Dierda with Becker's

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Healthcare. Thank you so much for tuning in

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to the Becker's Healthcare podcast series. Today, we're

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going to talk about network performance.

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Joining me for today's discussion are Bob Tavernier,

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who is a solution executive for Quest Analytics,

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and Karen Tashian, who is senior director of

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network regulatory operations at Health Care Service Corporation.

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Bob, Karen, thank you so much for being

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here today.

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Thank you, Lauren. Thank you very much, Lauren.

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To get us started, can you please introduce

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yourselves and tell us a little bit about

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your work in health care? And, Karen, we'll

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start with you. Thanks for having us, Laura.

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As you stated, I'm Karen Tashian. I work

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for health care service corporation, which is a

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Blue Cross Blue Shield franchisee.

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My job is to make sure that we

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stay compliant, and so most of my teams

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work on making sure our networks are adequate

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and that we're providing enough member access to

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care. So we manage all of the regulatory

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filings that are attributed to that. Bob, do

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you wanna go next?

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Thank you, Karen.

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Hi. My name is Bob Tavernier.

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I am a solutions executive here at Quest

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Analytics.

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My role is primarily focused on client engagement,

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focusing on on all solution verticals as it

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relates to network data management,

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network management,

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and network monitoring.

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Super happy to be here today. Thank you.

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Well, Bob, Quest Analytics recently partnered with Becker's

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to survey health plan leaders on network performance

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and related challenges.

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What were the most striking or validating findings

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from your perspective, and why are these insights

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timely and important for payer executives today?

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That's a great question, Lauren.

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Some of the primary

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focus areas when organizations think about what's most

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important to them,

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network performance is hot. It really is.

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When they think about the top three priorities,

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lowering administrative costs,

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improving clinical quality, focusing in on truly member

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satisfaction,

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we're those top three.

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They know that network performance is truly foundational

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when it comes to ultimately measuring

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performance of the network and ultimately helping them

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with their organizational

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priorities.

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What's interesting is

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they really focused on

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taking a look at deeper dive at competitive

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intelligence,

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focusing in on wanting to know more from

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the data around

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not only access to care, but understanding more

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provider costs and quality. Yet the data that

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they have access to isn't good. From a

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competitive landscape, they

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actually stated that they do not have any

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high quality data. When it came to access

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to care, they actually had moderate level of

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quality data. So really understanding how do we

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collectively help improve overall data to get them

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to the position of where they want to

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ultimately go

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with aligning network data

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with network design, which ultimately helps with organizational

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priorities.

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It's very interesting space. It's super hot space

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to go in. But, ultimately, when we're focusing

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in on network,

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it's not only about where the organizations are

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at today. It's how do we help them

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to get to the next level. They not

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only need to be network adequate,

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but they want to be able to use

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the network data to ultimately be competitive in

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the marketplace,

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have truly marketplace differentiators,

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and ultimately help to improve the member's experience.

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Well, that's fascinating to hear. And certainly, whatever

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you can do to get that competitive advantage,

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in today's health care space makes a big

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difference. So I appreciate your thoughts there and

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and is currently what Quastya Analytics is doing,

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to make a big difference.

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Karen, in hearing about reviewing

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the survey findings, which two or three themes

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resonated most strongly with your experience at HCSC,

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how is your organization approaching these challenges or

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opportunities? And can you share any examples of

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strategies or initiatives that are gaining traction?

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Yep. So that is a really, really good

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set of questions.

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We have a saying in the payer industry

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that I'm sure probably will resonate to some

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of the listeners where we are, data rich

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but information poor. And so, especially at HCSC,

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we have access to all kinds of different

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types of data, but I think making sure

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that you are

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leveraging the right insights in a cohesive manner

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so that you can have actionable results and

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strategies,

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that's really key. You have to know your

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members, you have to know your provider population,

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and you have to know what your organization's

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priorities are. So certainly for us,

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we are very much prioritizing,

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making sure that we are lowering medical cost

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as much as humanly possible,

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making sure our members are getting the right

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type of care they need when they need

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it,

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and then also making sure that while doing

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all of this, we're able to grow in

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a compliant manner,

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as we're trying to keep up with different

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regulatory

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expectations that continue to grow. And managing all

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of that with, you know, different levels of

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clinical needs is sometimes a challenge for us.

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So, certainly, I definitely agree with a lot

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of the survey results. There's a lot more

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too that we'll be discussing later today, but

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I know that HCSC is not necessarily a

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standout differentiator.

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We share a lot of the same pain

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points that Bob just spoke to.

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That's great to hear and really helpful to

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have that context

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in how, you know, you're navigating through today

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is really a lot of challenges within the

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health care space and but building and designing

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the future of health care, what an exciting

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opportunity that, you know, leaders within the space

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have today. So as we look toward that

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future of network strategy,

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what approaches

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will best position

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payers to deliver value and differentiation?

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How do you both see data and technology

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evolving to support this? What innovations are you

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most excited about?

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So,

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one of the wonderful things about being in

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this juncture is technology is on our side.

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And so with so many advancements in recent

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technology, just even in the last ten to

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fifteen years, data is not only more accessible,

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but there are more solutions and opportunities to

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do more with them.

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And so I think there is a world

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of options and different solutions for payers to

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take on depending on what their low hanging

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fruit, solutions are or approaches or opportunities they

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wanna go after as well as some of

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those, opportunities that take a longer pathway.

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Excellent points, Karen. I'd love to add that

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really when you're thinking about network strategy, it's

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understanding where you're at in the market and

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where do you wanna be when you grow

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up. Do you really wanna focus in on

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your broadest networks? Do you want to have

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a high performance network? Are you focused in

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on tiering? How do you ultimately help to

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set up the the appropriate networks and product

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benefit designs

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that are ultimately helping the member to get

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to the level of care that they need.

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It's absolutely critical when you're thinking about data

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and technology.

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It's important that you're considering all avenues, not

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only the network teams, but clinical quality, customer

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service product, and that you're able

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to utilize the dataset that can help a

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variety of those health care verticals to ultimately

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work together to utilize the data to make

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informed decisions

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to ultimately create the best experience for members.

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Fascinating to hear, and great to have those

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types of capabilities.

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I I know everything you mentioned,

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really is, you know, truly top of mind

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for so many health plan leaders and executives

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today.

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Before we wrap up here, I'm curious. Is

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there anything we didn't cover or final thoughts

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you'd like to share? And, Bob, we'll start

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with you. Great question, Lauren. One of the

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things that's really critical when you're thinking about

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innovation and really taking a step forward is

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understanding

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where you are and ultimately where you want

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to go. When you think about competitive intelligence,

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understanding what the competitors have,

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being able to break down down that level

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of information in terms of things about what

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clinical outcomes, thinking about quality, thinking about costs,

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thinking about

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are the providers ultimately following things like clinical

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practice guidelines?

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Are they billing for additional services that those

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members don't need?

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The payers are very familiar with this space

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knowing, working very closely with HEDIS performance measures,

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star ratings, cap surveys. If you look at

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those surveys and performance measures,

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a lot of those are really driven by

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ultimately the member experience. So it's not only

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building that that appropriate member experience.

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It's also being able to understand what are

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the key differences

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in your space and how do you ultimately

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differentiate yourselves

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from your competitors with the utilization of network

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data.

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That's fascinating. Thank you so much, Bob. And,

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Karen, what are your final thoughts?

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I think Bob hit on some really great

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points.

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In general, I think it's a really exciting

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time for payers. Our industry is evolving and

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growing, and there's more asked of us to

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serve our members.

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And so in general, I'm excited to see

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how we can leverage any level of data

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enhancement, if you will, or data filtering

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in order for us to keep up because,

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again, that's just what our members require.

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Well, thank you, Bob and Karen, for your

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time and insights today. We also want to

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thank our podcast sponsor, Quest Analytics.

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You can tune into more podcasts from Becker's

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Healthcare by visiting our podcast page at beckershospitalreview.com.