1 00:00:00,000 --> 00:00:02,740 Evernorth brings the power of wonder and relentless 2 00:00:02,799 --> 00:00:05,599 innovation to create world class pharmacy, care, and 3 00:00:05,599 --> 00:00:06,580 benefit solutions. 4 00:00:07,200 --> 00:00:08,960 Barriers to care can lead to gaps in 5 00:00:08,960 --> 00:00:10,719 care, which can drive up the total cost 6 00:00:10,719 --> 00:00:13,839 of care. Our capabilities work seamlessly together to 7 00:00:13,839 --> 00:00:17,245 create innovative pharmacy care and benefit solutions for 8 00:00:17,245 --> 00:00:18,225 today and tomorrow. 9 00:00:18,765 --> 00:00:21,565 Our connected health services make the treatment, prediction, 10 00:00:21,565 --> 00:00:24,225 and prevention of health care's most complex conditions 11 00:00:24,685 --> 00:00:27,265 easier and more accessible as we drive organizations 12 00:00:27,484 --> 00:00:28,464 and people forward. 13 00:00:29,239 --> 00:00:31,480 This is Haley Recker with the Becker's Payer 14 00:00:31,480 --> 00:00:33,560 Podcast, and we are recording live at the 15 00:00:33,560 --> 00:00:36,219 Becker's third annual spring payer issues roundtable. 16 00:00:36,760 --> 00:00:38,600 I am thrilled today to be joined by 17 00:00:38,600 --> 00:00:41,399 Jared McNaughton, who is the CEO of Inland 18 00:00:41,399 --> 00:00:42,700 Empire Health Plan. 19 00:00:43,375 --> 00:00:45,134 Thank you so much for having this discussion 20 00:00:45,134 --> 00:00:46,494 with me today, Jared. Can you go ahead 21 00:00:46,494 --> 00:00:48,335 and introduce yourself and share a little bit 22 00:00:48,335 --> 00:00:50,655 about your background? Well, thanks, Hailey. It's great 23 00:00:50,655 --> 00:00:51,554 to be with you. 24 00:00:52,094 --> 00:00:54,094 I am with Inland Empire Health Plan. I've 25 00:00:54,094 --> 00:00:56,674 been with the organization for about seven years. 26 00:00:57,310 --> 00:00:57,810 And, 27 00:00:58,270 --> 00:00:59,329 prior to that, 28 00:00:59,789 --> 00:01:01,630 was on the provider side. So I was 29 00:01:01,630 --> 00:01:03,869 in hospitals and health systems my whole entire 30 00:01:03,869 --> 00:01:06,189 career. So it's been a lot of fun 31 00:01:06,189 --> 00:01:08,590 to see the difference between the provider and 32 00:01:08,590 --> 00:01:11,229 the payer side and how those two worlds 33 00:01:11,229 --> 00:01:12,530 can do more together. 34 00:01:13,224 --> 00:01:15,944 At our organization, we serve about 1,500,000 35 00:01:15,944 --> 00:01:17,564 members in Southern California 36 00:01:18,185 --> 00:01:21,224 and have about 9,000 contracted providers with about 37 00:01:21,224 --> 00:01:23,164 eight and a half billion dollars in revenue. 38 00:01:23,704 --> 00:01:25,625 Well, thank you so much for that brief 39 00:01:25,625 --> 00:01:26,125 introduction. 40 00:01:26,780 --> 00:01:28,859 Now to get started, there's been a lot 41 00:01:28,859 --> 00:01:31,439 of talk about the imperative to reduce costs, 42 00:01:31,500 --> 00:01:34,299 improve quality, and advance health equity, none of 43 00:01:34,299 --> 00:01:36,219 which are small tasks. So how do you 44 00:01:36,219 --> 00:01:39,340 approach aligning these priorities in your organization's strategic 45 00:01:39,340 --> 00:01:39,840 vision? 46 00:01:40,305 --> 00:01:41,905 Yeah. You know, part of the work that 47 00:01:41,905 --> 00:01:44,325 we do, Haley, we always feel like 48 00:01:44,704 --> 00:01:46,865 the number one thing for us, because we're 49 00:01:46,865 --> 00:01:49,765 a public entity, we have no shareholder value, 50 00:01:50,385 --> 00:01:52,704 it's really all about the members and the 51 00:01:52,704 --> 00:01:53,204 providers, 52 00:01:53,650 --> 00:01:55,729 is to make sure that we're approaching every 53 00:01:55,729 --> 00:01:58,049 decision with our mission at heart. Our mission 54 00:01:58,049 --> 00:01:59,909 is to heal and inspire the human spirit, 55 00:02:00,049 --> 00:02:01,670 and we take that incredibly, 56 00:02:02,209 --> 00:02:02,709 incredibly 57 00:02:03,409 --> 00:02:03,909 impactful, 58 00:02:04,209 --> 00:02:06,369 and we really take it serious. And so 59 00:02:06,369 --> 00:02:07,269 for our organization, 60 00:02:07,994 --> 00:02:09,995 every single decision that we come up with 61 00:02:09,995 --> 00:02:11,935 is always guided by that principle. 62 00:02:12,314 --> 00:02:14,474 How can we bring optimal care at the 63 00:02:14,474 --> 00:02:16,094 same time as Vibrant Health, 64 00:02:16,474 --> 00:02:18,794 to our region? And it's not really even 65 00:02:18,794 --> 00:02:21,114 just about the Medi Cal lives that we 66 00:02:21,114 --> 00:02:22,420 serve. It's about 67 00:02:22,960 --> 00:02:24,980 raising, really, the tide for all boats. 68 00:02:25,439 --> 00:02:27,520 Thankfully, we have three different lines of business 69 00:02:27,520 --> 00:02:29,439 now, Medi Cal or Medicaid as it's known 70 00:02:29,439 --> 00:02:32,000 across the country. We have the dual eligible 71 00:02:32,000 --> 00:02:32,500 population 72 00:02:33,120 --> 00:02:35,439 as well as now Covered California. It's our 73 00:02:35,439 --> 00:02:37,665 first commercial product. And in all three of 74 00:02:37,665 --> 00:02:39,985 those lines of business, we're always looking and 75 00:02:39,985 --> 00:02:42,305 thinking about how can we make sure to 76 00:02:42,305 --> 00:02:43,905 do the right thing for the members that 77 00:02:43,905 --> 00:02:45,905 are in need. And the best way we 78 00:02:45,905 --> 00:02:48,064 found to do that is by really getting 79 00:02:48,064 --> 00:02:49,905 boots on the ground. Whether I'm out in 80 00:02:49,905 --> 00:02:50,405 neighborhoods, 81 00:02:50,840 --> 00:02:53,479 in the backyards of our members, learning directly 82 00:02:53,479 --> 00:02:54,219 from them, 83 00:02:54,599 --> 00:02:57,319 having monthly provider dinners where we're hearing directly 84 00:02:57,319 --> 00:02:59,560 from the provider community on what we could 85 00:02:59,560 --> 00:03:01,479 be doing better or different to serve them 86 00:03:01,479 --> 00:03:03,019 and their and their patients, 87 00:03:03,675 --> 00:03:05,534 whatever that is, the connection 88 00:03:05,835 --> 00:03:08,314 and the relationship to the membership and to 89 00:03:08,314 --> 00:03:08,895 the providers 90 00:03:09,515 --> 00:03:12,235 is absolutely key for us. And one of 91 00:03:12,235 --> 00:03:14,075 the best ways, Haley, that we found to 92 00:03:14,075 --> 00:03:16,314 do that is through something we call our 93 00:03:16,314 --> 00:03:18,254 global pay for performance program. 94 00:03:18,710 --> 00:03:21,509 We we provide almost $300,000,000 95 00:03:21,509 --> 00:03:22,650 a year to providers 96 00:03:23,110 --> 00:03:26,229 who help us meet quality outcomes that the 97 00:03:26,229 --> 00:03:28,090 states and the federal government, 98 00:03:28,789 --> 00:03:31,689 really are pushing through HEDIS and MCAS measures. 99 00:03:32,145 --> 00:03:34,224 And I am so thrilled that because of 100 00:03:34,224 --> 00:03:36,084 our providers work in that space, 101 00:03:36,625 --> 00:03:38,724 we've actually achieved our highest quality, 102 00:03:39,185 --> 00:03:41,025 in our history, in our almost thirty year 103 00:03:41,025 --> 00:03:42,564 history just this last year, 104 00:03:42,944 --> 00:03:44,865 thanks to to their work through our pay 105 00:03:44,865 --> 00:03:46,084 for performance program. 106 00:03:46,480 --> 00:03:48,640 And the key with that is to share 107 00:03:48,640 --> 00:03:50,659 the best practices that are happening, 108 00:03:51,280 --> 00:03:52,960 to make sure that it's not just happening 109 00:03:52,960 --> 00:03:55,760 in a silo but silo, but those those 110 00:03:55,760 --> 00:03:58,819 practices are being duplicated across the entire network. 111 00:03:58,925 --> 00:04:00,444 And that's what's so cool about that is 112 00:04:00,444 --> 00:04:01,965 to be able to share that with other 113 00:04:01,965 --> 00:04:04,444 providers so that you're helping them on their 114 00:04:04,444 --> 00:04:05,504 journey as well. 115 00:04:06,125 --> 00:04:08,044 Yeah. I'd like to keep that conversation on 116 00:04:08,044 --> 00:04:10,685 health equity going, as it's become a critical 117 00:04:10,685 --> 00:04:13,180 focus for many health plans. Can you share 118 00:04:13,180 --> 00:04:15,099 an overview of a key initiative here that 119 00:04:15,099 --> 00:04:17,819 you're involved in or particularly excited about, and 120 00:04:17,819 --> 00:04:19,199 what are you hoping to achieve? 121 00:04:19,579 --> 00:04:21,180 Yeah. You know, one of the things, Haley, 122 00:04:21,180 --> 00:04:23,039 that I'm super stoked about 123 00:04:23,339 --> 00:04:25,899 is that through our Pay for Performance program, 124 00:04:25,899 --> 00:04:28,604 we kinda thought, what can we do to 125 00:04:28,604 --> 00:04:29,104 leverage 126 00:04:29,564 --> 00:04:31,324 some of the things that are happening in 127 00:04:31,324 --> 00:04:32,625 the hospital space, 128 00:04:33,324 --> 00:04:35,964 especially with the joint commission? Folks know the 129 00:04:35,964 --> 00:04:38,544 joint commission is the a creditor for hospitals 130 00:04:38,604 --> 00:04:41,100 all across the country, and they have this 131 00:04:41,100 --> 00:04:42,060 really cool, 132 00:04:42,459 --> 00:04:42,959 program, 133 00:04:43,740 --> 00:04:45,040 this this certification 134 00:04:45,500 --> 00:04:49,039 program that they actually provide certification to hospitals 135 00:04:49,180 --> 00:04:51,279 that meet a certain threshold of performance. 136 00:04:51,819 --> 00:04:54,105 And it's tough. I mean, it's really tough 137 00:04:54,105 --> 00:04:55,245 to get this certification. 138 00:04:55,704 --> 00:04:57,704 And so we thought, what would it be 139 00:04:57,704 --> 00:04:59,084 like if a health plan 140 00:04:59,384 --> 00:05:02,044 actually put inside of our pay for performance 141 00:05:02,665 --> 00:05:03,485 a incentive 142 00:05:03,785 --> 00:05:04,524 to hospitals 143 00:05:05,189 --> 00:05:08,629 who are actually getting the accreditation through the 144 00:05:08,629 --> 00:05:09,449 joint commission. 145 00:05:10,069 --> 00:05:11,990 And so this is really cool. I just 146 00:05:11,990 --> 00:05:13,370 have to share this with you. 147 00:05:14,069 --> 00:05:17,129 Only there's there's only two advanced certifications 148 00:05:17,590 --> 00:05:19,770 in heart failure in the state of California, 149 00:05:20,555 --> 00:05:21,375 and and 150 00:05:21,754 --> 00:05:24,254 we actually have one of those two 151 00:05:24,555 --> 00:05:27,274 in our program. So out of the entire 152 00:05:27,274 --> 00:05:29,194 state of California, there's only two. One of 153 00:05:29,194 --> 00:05:31,274 them is in the Inland Empire, and the 154 00:05:31,274 --> 00:05:34,334 only hospital in California with pneumonia certification 155 00:05:34,769 --> 00:05:36,370 by the joint commission is actually in the 156 00:05:36,370 --> 00:05:37,110 Inland Empire. 157 00:05:37,410 --> 00:05:39,569 And so for us, when you look at 158 00:05:39,569 --> 00:05:41,970 that, it it really is making it one 159 00:05:41,970 --> 00:05:44,370 out of only seven in the entire United 160 00:05:44,370 --> 00:05:46,389 States is in the Inland Empire. 161 00:05:46,769 --> 00:05:48,944 So that, for me means that hospitals are 162 00:05:48,944 --> 00:05:51,185 paying attention because they're getting a little boost 163 00:05:51,185 --> 00:05:54,064 in their dollars. It's good for everybody who 164 00:05:54,064 --> 00:05:55,504 comes in through the front door of the 165 00:05:55,504 --> 00:05:57,665 emergency room of a hospital if they have 166 00:05:57,665 --> 00:05:58,485 that certification, 167 00:05:59,025 --> 00:06:01,205 and it's a great example of a partnership 168 00:06:01,264 --> 00:06:03,689 where it's really good for us. It's great 169 00:06:03,689 --> 00:06:06,410 for the hospital, great for the community. It's 170 00:06:06,410 --> 00:06:08,329 a win win for everybody when they have 171 00:06:08,329 --> 00:06:11,229 those certifications. And so those kinds of partnerships, 172 00:06:11,289 --> 00:06:13,389 I would just challenge my payer colleagues 173 00:06:13,849 --> 00:06:15,689 to get in the weeds and and get 174 00:06:15,689 --> 00:06:18,430 those kinds of partnerships happening in their communities 175 00:06:18,490 --> 00:06:21,105 as well. Yeah. That's absolutely so important. And 176 00:06:21,105 --> 00:06:22,884 thank you so much for painting a picture 177 00:06:22,944 --> 00:06:25,264 for us there. I'd like to pivot the 178 00:06:25,264 --> 00:06:27,605 conversation a little bit to member satisfaction. 179 00:06:28,544 --> 00:06:31,665 So what experience or engagement strategies have proven 180 00:06:31,665 --> 00:06:33,665 effective for your organization, and how are you 181 00:06:33,665 --> 00:06:35,879 measuring that success? Yeah. You know, this is 182 00:06:35,879 --> 00:06:38,600 a tough one because as folks know, different 183 00:06:38,600 --> 00:06:41,480 surveys that measure member satisfaction, whether it's caps 184 00:06:41,480 --> 00:06:43,800 on the consumer awareness side, all the way 185 00:06:43,800 --> 00:06:46,360 through to member satisfaction that happens within our 186 00:06:46,360 --> 00:06:48,680 providers or hospitals or even at the health 187 00:06:48,680 --> 00:06:51,004 plan, it can be tough because you get 188 00:06:51,165 --> 00:06:52,625 you have one interaction 189 00:06:53,245 --> 00:06:55,884 that a member has with maybe a a 190 00:06:55,884 --> 00:06:57,644 physician or a hospital or even a team 191 00:06:57,644 --> 00:07:00,044 member of ours that doesn't go great, and 192 00:07:00,044 --> 00:07:01,725 that's what they think about. So they could 193 00:07:01,725 --> 00:07:03,345 have nine great interactions, 194 00:07:03,720 --> 00:07:05,480 but they have one bad one, and that's 195 00:07:05,480 --> 00:07:07,160 all you think about. And so when they 196 00:07:07,160 --> 00:07:09,500 take the survey, that's what they're thinking about. 197 00:07:09,639 --> 00:07:12,360 So it's really imperative for us to make 198 00:07:12,360 --> 00:07:14,839 sure that everybody is on their game when 199 00:07:14,839 --> 00:07:17,000 they're connected in with the members or and 200 00:07:17,000 --> 00:07:17,819 or the providers. 201 00:07:18,264 --> 00:07:20,504 So one thing that we've done is to 202 00:07:20,504 --> 00:07:23,064 really leverage something called the community health worker 203 00:07:23,064 --> 00:07:23,564 program, 204 00:07:23,865 --> 00:07:25,085 also known as CHW. 205 00:07:25,625 --> 00:07:28,185 In California, our state has really been on 206 00:07:28,185 --> 00:07:29,944 the forefront of being able to make these 207 00:07:29,944 --> 00:07:33,050 community health workers available to the community. And 208 00:07:33,050 --> 00:07:35,149 the part that I love about this program 209 00:07:35,769 --> 00:07:37,930 is it's not somebody that's necessarily just on 210 00:07:37,930 --> 00:07:40,409 the phone, which is important at times to 211 00:07:40,409 --> 00:07:43,050 to have that interaction, but they're also on 212 00:07:43,050 --> 00:07:45,129 the ground. They're boots on the ground actually 213 00:07:45,129 --> 00:07:46,990 connected directly with 214 00:07:47,305 --> 00:07:48,125 the member 215 00:07:48,584 --> 00:07:50,504 and their whole family to say, hey. How 216 00:07:50,504 --> 00:07:53,064 can I help navigate you through this very 217 00:07:53,064 --> 00:07:55,784 complex health system? And the cool part about 218 00:07:55,784 --> 00:07:58,685 that is the lasting impression that takes place 219 00:07:58,985 --> 00:08:01,305 with the member and the family is now 220 00:08:01,305 --> 00:08:03,480 with that community health worker because they're the 221 00:08:03,480 --> 00:08:06,120 real face of the health plan. And so 222 00:08:06,120 --> 00:08:08,519 I love that program, Haley, because I think 223 00:08:08,519 --> 00:08:10,860 not only is it going to improve our 224 00:08:10,919 --> 00:08:11,419 overall 225 00:08:12,040 --> 00:08:14,620 satisfaction that our members experience, but more importantly, 226 00:08:14,839 --> 00:08:16,379 they're actually helping navigate 227 00:08:16,824 --> 00:08:18,904 in a system that is arguably one of 228 00:08:18,904 --> 00:08:21,245 the most complex and unwieldy systems 229 00:08:21,545 --> 00:08:23,944 ever created in our country, health care. And 230 00:08:23,944 --> 00:08:26,024 so that's really a cool thing, really a 231 00:08:26,024 --> 00:08:27,404 value add for the membership. 232 00:08:28,185 --> 00:08:30,120 Well, before we wrap up here, I'd like 233 00:08:30,120 --> 00:08:32,200 to talk about the future of the payer 234 00:08:32,200 --> 00:08:32,700 space. 235 00:08:33,240 --> 00:08:35,240 So looking ahead, what do you see as 236 00:08:35,240 --> 00:08:37,639 the biggest opportunity for payers to lead the 237 00:08:37,639 --> 00:08:40,600 charge in transforming care delivery and driving better 238 00:08:40,600 --> 00:08:42,919 outcomes for all stakeholders, and how could leaders 239 00:08:42,919 --> 00:08:44,620 take a step in this direction now? 240 00:08:45,055 --> 00:08:46,754 Yeah. Well, I'm a big advocate, 241 00:08:47,295 --> 00:08:49,455 for culture. I think the culture of the 242 00:08:49,455 --> 00:08:49,955 organization 243 00:08:50,815 --> 00:08:52,355 is absolutely paramount. 244 00:08:52,975 --> 00:08:55,295 Stay true to your mission. Make sure that 245 00:08:55,295 --> 00:08:57,375 it's on the forefront of every decision that's 246 00:08:57,375 --> 00:08:58,115 being made. 247 00:08:59,129 --> 00:09:01,850 I really, really can't stress enough that that 248 00:09:01,850 --> 00:09:04,649 whole adage of of culture eats strategy for 249 00:09:04,649 --> 00:09:06,649 lunch is so true. If you've got a 250 00:09:06,649 --> 00:09:09,610 wacky culture or a culture that's just not 251 00:09:09,610 --> 00:09:12,575 in line with your mission, it's very difficult 252 00:09:12,714 --> 00:09:15,595 to move your strategic objectives forward while keeping 253 00:09:15,595 --> 00:09:17,995 your team members at the forefront of the 254 00:09:17,995 --> 00:09:20,154 of the decisions that they're trying to make. 255 00:09:20,154 --> 00:09:22,154 So for me, culture is a huge one. 256 00:09:22,154 --> 00:09:23,834 Of course, staying true to your mission is 257 00:09:23,834 --> 00:09:26,019 huge. And then I I would really challenge 258 00:09:26,080 --> 00:09:28,720 folks to just think bold and audacious during 259 00:09:28,720 --> 00:09:30,339 this time. There's so much change 260 00:09:30,639 --> 00:09:32,879 happening in the federal landscape with health care 261 00:09:32,879 --> 00:09:35,360 and the state, and I actually think it's 262 00:09:35,360 --> 00:09:36,980 a a great time, 263 00:09:37,360 --> 00:09:38,179 to be innovative, 264 00:09:38,875 --> 00:09:40,875 to think differently than the way we've thought 265 00:09:40,875 --> 00:09:41,375 before, 266 00:09:41,914 --> 00:09:44,074 to launch those new lines of business that 267 00:09:44,074 --> 00:09:46,394 maybe you've been thinking about because there will 268 00:09:46,394 --> 00:09:48,875 be space open for people that are thinking 269 00:09:48,875 --> 00:09:50,014 boldly and innovatively 270 00:09:50,634 --> 00:09:53,190 as other people are starting to constrain back. 271 00:09:53,269 --> 00:09:55,509 And I would encourage my colleagues to just 272 00:09:55,509 --> 00:09:57,350 make sure you're staying in the game, staying 273 00:09:57,350 --> 00:10:00,950 relevant, and always, always keeping your mission at 274 00:10:00,950 --> 00:10:02,409 the forefront of every decision. 275 00:10:02,950 --> 00:10:05,049 Well, absolutely. That's so important. 276 00:10:05,524 --> 00:10:07,524 Thank you so much for joining me today 277 00:10:07,524 --> 00:10:09,764 on the podcast. Again, this is Haley Recker 278 00:10:09,764 --> 00:10:11,225 with the Becker's Payer Podcast 279 00:10:11,684 --> 00:10:14,404 recorded live at the Becker's third annual spring 280 00:10:14,404 --> 00:10:15,544 payer issues roundtable. 281 00:10:15,845 --> 00:10:17,924 Jared, thank you so much. Thanks so much, 282 00:10:17,924 --> 00:10:19,183 Haley. Have a great day.