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This is Haley Recker with the Becker's Payer
podcast. And today, we are recording live at
the Becker's third annual spring payer issues roundtable.
I am thrilled today to be joined by
Angie Kalousek,
senior director of clinical strategy and programs at
Blue Shield of California.
Angie, thank you so much for being with
me today. Can you go ahead and introduce
yourself and share a little bit about your
background?
Absolutely.
So,
like you said, Angie Kalousek. I'm with Blue
Shield of California. I've actually been with Blue
Shield for about fifteen years.
So I had a really
great long tenured career there and have done
a lot of different things.
Right now, I'm working on our clinical strategy
and programs, which is really an effort
to prioritize
clinical priorities,
based on,
need. So what is the prevalence? What is
the cost drivers?
And it's been really interesting
work to dive into that.
Previously,
I was the wellness,
program director at Visa, and I also have,
a fitness background. I was a personal trainer
and,
helped others,
get to their best health as well.
Well, thank you so much for that introduction.
Now I'd like to get things started by
asking you about balancing affordability and quality.
So this is a constant challenge for health
plans. So how is your organization
innovating to manage the cost of care
while maintaining or improving member outcomes? Yeah. It's
a absolutely great question, and it really is
a double edged sword between affordability
and quality. But I really do think you
can have both.
One of the ways that we are tackling
this conundrum
is by really doubling down on
value based care. So we are working with
a lot of our providers across our network
as well as vendor contracts,
and sort of the,
clinical
program contracts as well
to always
create
a payment structure that incentivizes
the provider
to deliver outcomes. And then when you're aligning
the cost with the outcomes,
you are then getting to a place where
your care is more affordable
and also higher quality.
I think the other thing that we can
really take a look at and focus on
is, does our medical policy
align
with reducing
unnecessary
procedures, reducing waste?
You know, you think about,
people who are
going getting an injury and going straight to
surgery instead of doing the physical therapy first.
You know, we see up to, like, fifty
percent reduction
in surgery if people are doing physical therapy
first. So, again, just aligning that medical policy
so that,
the best clinical care
is
utilized.
I think the final thing, and I think
this one's really important, is really focusing on
prevention,
early screenings,
and lifestyle based programs. So if all health
plans were working to
optimize the health of their members,
then all members, no matter which health plan
they went to, would show up at at
the lowest possible risk.
Getting ahead of chronic conditions like
obesity, type two diabetes, hypertension,
these are things that downstream
can
drive a lot of the cost in the
system.
And if we can get ahead of it,
that's certainly the best approach.
Well, that was just fascinating. Thank you so
much for going into detail there.
I'd like to pivot the conversation a little
bit since there's a lot of talk about
imperative to reduce costs, improve quality, and advance
health equity,
none of which are small tasks. So how
do you approach aligning these priorities in your
organization's
strategic vision?
Yeah. Well, our our mission is to deliver
affordable health care to our, members
in a way that is worthy of our
family and friends. And so,
I always kind of keep that at heart.
One of the things that we are doing
right now is we are shifting our approach
to a very specific line of business approach.
And I was talking about how I'm beginning
to work on some of the clinical priorities
and, strategizing on how we do that.
The truth is depending on the line of
business,
the priorities might be a little different. So
when we look at prevalence and we look
at high cost drivers,
there are some of the usual suspects that
show up kind of across all the lines
of business, like cancer, often MSK,
and, of course, cardiovascular.
But beyond that,
priorities change. For example, Medi Cal may have
a higher maternity need.
There might be more in the digestive health
space
with,
our our commercial membership.
Medicare may have its own considerations because we're
dealing with the senior population.
So I think it's it's crucial to
align the the action that you're taking and
the focus that you're you're driving towards with
the actual
line of business. And I think by doing
this and being more targeted and more precise
in how we're approaching these lines of business,
we are also able to address health equity.
As I mentioned, you know,
the Medi Cal line of business has its
own unique
needs,
based on some of the underserved populations. And
so we're able to address health equity by
being precise in how we deliver clinical care.
Looking ahead, what do you see as the
biggest opportunity for payers to lead the charge
in transforming care delivery and driving better outcomes
for all stakeholders?
And how can leaders take a step in
this direction now?
Yeah. I think,
digital care and virtual care are here to
stay. And when we when we talk about
the care delivery
kind of vehicle or how we're delivering care,
if we can inject virtual care and digital
care,
more upstream
and early on in the intervention,
we can save costs by reducing the point
of service,
expense. Right? And and so I I think
delivering
on virtual care and digital care in the
right way,
is gonna be critical to transforming
care delivery.
I also believe that health plans are notorious
for
not being super transparent
and,
treating health care like it's this very confusing
topic, and
most consumers are very confused by health care.
So I think we could all do a
much better job of treating
the member or the patient
like a consumer. You know? What would a
a normal consumer
retail site do to engage the customer,
drive them in, help them understand how to
use the site? And if we could sort
of mimic that in the health care space,
we'd go a long way to improving the
way that we deliver care.
Alright. And just to wrap up here, I'd
like to address health equity, which has become
a critical focus for many health plans.
Can you share an overview of a key
initiative here that you're involved in or particularly
excited about, and what are you hoping to
achieve?
Yeah. I mean, we have a lot of
health equity initiatives, and so I'll just maybe
pull out two or three that we're working
on. One that we have sort of ongoing
all the time is for our Medi Cal
line of business.
We are
focused in the San Diego and Los Angeles
County area,
and so we have,
a number of community resource centers
that are available to not only our members,
not only our Medi Cal members, but all
members of that community. And at those community
resource centers,
you can get help with advocacy for your
health plan. Again, we're talking about how confusing
health care is. So you can go there
and get help on
how do you utilize your plan. But there's
also health educators there that are doing coaching
and classes. There's fitness classes,
cooking classes,
child activities. So a lot of different things
for the community that we have across
San Diego and,
Los Angeles County.
We're also,
implementing
doulas for the medical population. That has become
a benefit that has really helped improve,
maternal health.
And,
finally, we are doing a pilot also in
the counties surrounding our Medi Cal line of
business area, San Diego and Los Angeles,
where we're partnering with the local Walmarts. And
so,
the members can go to the Walmart. They
can get their blood pressure checked. They can
get nutrition counseling,
and they can get
rewards
to shop for healthy foods at Walmart. So
kind of tackling it from all different angles.
There are many more, but it those are
just a few that I'd like to highlight.
Well, Angie, thank you so much for having
this conversation with me today. Again, this is
Haley Recker with the Becker's Payer Podcast recorded
live at the Becker's third annual spring payer
issues roundtable.
Thank you so much. Thank you.