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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.

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This is Haley Recker with the Becker's Payer

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podcast. And today, we are recording live at

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the Becker's third annual spring payer issues roundtable.

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I am thrilled today to be joined by

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Angie Kalousek,

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senior director of clinical strategy and programs at

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Blue Shield of California.

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Angie, thank you so much for being with

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me today. Can you go ahead and introduce

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yourself and share a little bit about your

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background?

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Absolutely.

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So,

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like you said, Angie Kalousek. I'm with Blue

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Shield of California. I've actually been with Blue

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Shield for about fifteen years.

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So I had a really

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great long tenured career there and have done

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a lot of different things.

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Right now, I'm working on our clinical strategy

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and programs, which is really an effort

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to prioritize

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clinical priorities,

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based on,

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need. So what is the prevalence? What is

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the cost drivers?

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And it's been really interesting

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work to dive into that.

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Previously,

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I was the wellness,

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program director at Visa, and I also have,

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a fitness background. I was a personal trainer

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and,

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helped others,

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get to their best health as well.

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Well, thank you so much for that introduction.

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Now I'd like to get things started by

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asking you about balancing affordability and quality.

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So this is a constant challenge for health

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plans. So how is your organization

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innovating to manage the cost of care

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while maintaining or improving member outcomes? Yeah. It's

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a absolutely great question, and it really is

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a double edged sword between affordability

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and quality. But I really do think you

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can have both.

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One of the ways that we are tackling

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this conundrum

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is by really doubling down on

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value based care. So we are working with

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a lot of our providers across our network

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as well as vendor contracts,

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and sort of the,

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clinical

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program contracts as well

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to always

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create

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a payment structure that incentivizes

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the provider

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to deliver outcomes. And then when you're aligning

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the cost with the outcomes,

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you are then getting to a place where

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your care is more affordable

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and also higher quality.

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I think the other thing that we can

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really take a look at and focus on

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is, does our medical policy

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align

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with reducing

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unnecessary

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procedures, reducing waste?

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You know, you think about,

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people who are

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going getting an injury and going straight to

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surgery instead of doing the physical therapy first.

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You know, we see up to, like, fifty

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percent reduction

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in surgery if people are doing physical therapy

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first. So, again, just aligning that medical policy

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so that,

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the best clinical care

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is

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utilized.

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I think the final thing, and I think

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this one's really important, is really focusing on

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prevention,

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prevention,

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early screenings,

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and lifestyle based programs. So if all health

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plans were working to

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optimize the health of their members,

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then all members, no matter which health plan

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they went to, would show up at at

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the lowest possible risk.

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Getting ahead of chronic conditions like

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obesity, type two diabetes, hypertension,

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these are things that downstream

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can

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drive a lot of the cost in the

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system.

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And if we can get ahead of it,

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that's certainly the best approach.

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Well, that was just fascinating. Thank you so

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much for going into detail there.

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I'd like to pivot the conversation a little

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bit since there's a lot of talk about

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imperative to reduce costs, improve quality, and advance

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health equity,

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none of which are small tasks. So how

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do you approach aligning these priorities in your

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organization's

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strategic vision?

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Yeah. Well, our our mission is to deliver

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affordable health care to our, members

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in a way that is worthy of our

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family and friends. And so,

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I always kind of keep that at heart.

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One of the things that we are doing

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right now is we are shifting our approach

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to a very specific line of business approach.

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And I was talking about how I'm beginning

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to work on some of the clinical priorities

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and, strategizing on how we do that.

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The truth is depending on the line of

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business,

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the priorities might be a little different. So

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when we look at prevalence and we look

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at high cost drivers,

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there are some of the usual suspects that

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show up kind of across all the lines

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of business, like cancer, often MSK,

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and, of course, cardiovascular.

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But beyond that,

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priorities change. For example, Medi Cal may have

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a higher maternity need.

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There might be more in the digestive health

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space

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with,

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our our commercial membership.

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Medicare may have its own considerations because we're

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dealing with the senior population.

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So I think it's it's crucial to

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align the the action that you're taking and

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the focus that you're you're driving towards with

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the actual

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line of business. And I think by doing

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this and being more targeted and more precise

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in how we're approaching these lines of business,

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we are also able to address health equity.

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As I mentioned, you know,

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the Medi Cal line of business has its

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own unique

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needs,

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based on some of the underserved populations. And

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so we're able to address health equity by

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being precise in how we deliver clinical care.

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Looking ahead, what do you see as the

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biggest opportunity for payers to lead the charge

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in transforming care delivery and driving better outcomes

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for all stakeholders?

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And how can leaders take a step in

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this direction now?

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Yeah. I think,

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digital care and virtual care are here to

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stay. And when we when we talk about

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the care delivery

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kind of vehicle or how we're delivering care,

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if we can inject virtual care and digital

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care,

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more upstream

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and early on in the intervention,

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we can save costs by reducing the point

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of service,

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expense. Right? And and so I I think

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delivering

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on virtual care and digital care in the

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right way,

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is gonna be critical to transforming

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care delivery.

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I also believe that health plans are notorious

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for

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not being super transparent

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and,

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treating health care like it's this very confusing

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topic, and

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most consumers are very confused by health care.

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So I think we could all do a

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much better job of treating

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the member or the patient

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like a consumer. You know? What would a

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a normal consumer

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retail site do to engage the customer,

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drive them in, help them understand how to

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use the site? And if we could sort

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of mimic that in the health care space,

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we'd go a long way to improving the

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way that we deliver care.

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Alright. And just to wrap up here, I'd

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like to address health equity, which has become

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a critical focus for many health plans.

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Can you share an overview of a key

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initiative here that you're involved in or particularly

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excited about, and what are you hoping to

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achieve?

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Yeah. I mean, we have a lot of

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health equity initiatives, and so I'll just maybe

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pull out two or three that we're working

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on. One that we have sort of ongoing

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all the time is for our Medi Cal

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line of business.

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We are

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focused in the San Diego and Los Angeles

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County area,

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and so we have,

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a number of community resource centers

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that are available to not only our members,

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not only our Medi Cal members, but all

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members of that community. And at those community

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resource centers,

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you can get help with advocacy for your

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health plan. Again, we're talking about how confusing

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health care is. So you can go there

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and get help on

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how do you utilize your plan. But there's

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also health educators there that are doing coaching

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and classes. There's fitness classes,

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cooking classes,

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child activities. So a lot of different things

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for the community that we have across

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San Diego and,

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Los Angeles County.

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We're also,

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implementing

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doulas for the medical population. That has become

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a benefit that has really helped improve,

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maternal health.

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And,

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finally, we are doing a pilot also in

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the counties surrounding our Medi Cal line of

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business area, San Diego and Los Angeles,

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where we're partnering with the local Walmarts. And

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so,

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the members can go to the Walmart. They

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can get their blood pressure checked. They can

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get nutrition counseling,

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and they can get

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rewards

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to shop for healthy foods at Walmart. So

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kind of tackling it from all different angles.

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There are many more, but it those are

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just a few that I'd like to highlight.

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Well, Angie, thank you so much for having

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this conversation with me today. Again, this is

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Haley Recker with the Becker's Payer Podcast recorded

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live at the Becker's third annual spring payer

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issues roundtable.

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Thank you so much. Thank you.