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This is Haley Recker with the Becker's Payer
Podcast, and we are recording live at the
Becker's third annual spring payer issues roundtable.
I am thrilled today to be joined by
Jared McNaughton, who is the CEO of Inland
Empire Health Plan.
Thank you so much for having this discussion
with me today, Jared. Can you go ahead
and introduce yourself and share a little bit
about your background? Well, thanks, Hailey. It's great
to be with you.
I am with Inland Empire Health Plan. I've
been with the organization for about seven years.
And,
prior to that,
was on the provider side. So I was
in hospitals and health systems my whole entire
career. So it's been a lot of fun
to see the difference between the provider and
the payer side and how those two worlds
can do more together.
At our organization, we serve about 1,500,000
members in Southern California
and have about 9,000 contracted providers with about
eight and a half billion dollars in revenue.
Well, thank you so much for that brief
introduction.
Now to get started, there's been a lot
of talk about the 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. You know, part of the work that
we do, Haley, we always feel like
the number one thing for us, because we're
a public entity, we have no shareholder value,
it's really all about the members and the
providers,
is to make sure that we're approaching every
decision with our mission at heart. Our mission
is to heal and inspire the human spirit,
and we take that incredibly,
incredibly
impactful,
and we really take it serious. And so
for our organization,
every single decision that we come up with
is always guided by that principle.
How can we bring optimal care at the
same time as Vibrant Health,
to our region? And it's not really even
just about the Medi Cal lives that we
serve. It's about
raising, really, the tide for all boats.
Thankfully, we have three different lines of business
now, Medi Cal or Medicaid as it's known
across the country. We have the dual eligible
population
as well as now Covered California. It's our
first commercial product. And in all three of
those lines of business, we're always looking and
thinking about how can we make sure to
do the right thing for the members that
are in need. And the best way we
found to do that is by really getting
boots on the ground. Whether I'm out in
neighborhoods,
in the backyards of our members, learning directly
from them,
having monthly provider dinners where we're hearing directly
from the provider community on what we could
be doing better or different to serve them
and their and their patients,
whatever that is, the connection
and the relationship to the membership and to
the providers
is absolutely key for us. And one of
the best ways, Haley, that we found to
do that is through something we call our
global pay for performance program.
We we provide almost $300,000,000
a year to providers
who help us meet quality outcomes that the
states and the federal government,
really are pushing through HEDIS and MCAS measures.
And I am so thrilled that because of
our providers work in that space,
we've actually achieved our highest quality,
in our history, in our almost thirty year
history just this last year,
thanks to to their work through our pay
for performance program.
And the key with that is to share
the best practices that are happening,
to make sure that it's not just happening
in a silo but silo, but those those
practices are being duplicated across the entire network.
And that's what's so cool about that is
to be able to share that with other
providers so that you're helping them on their
journey as well.
Yeah. I'd like to keep that conversation on
health equity going, as it's 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. You know, one of the things, Haley,
that I'm super stoked about
is that through our Pay for Performance program,
we kinda thought, what can we do to
leverage
some of the things that are happening in
the hospital space,
especially with the joint commission? Folks know the
joint commission is the a creditor for hospitals
all across the country, and they have this
really cool,
program,
this this certification
program that they actually provide certification to hospitals
that meet a certain threshold of performance.
And it's tough. I mean, it's really tough
to get this certification.
And so we thought, what would it be
like if a health plan
actually put inside of our pay for performance
a incentive
to hospitals
who are actually getting the accreditation through the
joint commission.
And so this is really cool. I just
have to share this with you.
Only there's there's only two advanced certifications
in heart failure in the state of California,
and and
we actually have one of those two
in our program. So out of the entire
state of California, there's only two. One of
them is in the Inland Empire, and the
only hospital in California with pneumonia certification
by the joint commission is actually in the
Inland Empire.
And so for us, when you look at
that, it it really is making it one
out of only seven in the entire United
States is in the Inland Empire.
So that, for me means that hospitals are
paying attention because they're getting a little boost
in their dollars. It's good for everybody who
comes in through the front door of the
emergency room of a hospital if they have
that certification,
and it's a great example of a partnership
where it's really good for us. It's great
for the hospital, great for the community. It's
a win win for everybody when they have
those certifications. And so those kinds of partnerships,
I would just challenge my payer colleagues
to get in the weeds and and get
those kinds of partnerships happening in their communities
as well. Yeah. That's absolutely so important. And
thank you so much for painting a picture
for us there. I'd like to pivot the
conversation a little bit to member satisfaction.
So what experience or engagement strategies have proven
effective for your organization, and how are you
measuring that success? Yeah. You know, this is
a tough one because as folks know, different
surveys that measure member satisfaction, whether it's caps
on the consumer awareness side, all the way
through to member satisfaction that happens within our
providers or hospitals or even at the health
plan, it can be tough because you get
you have one interaction
that a member has with maybe a a
physician or a hospital or even a team
member of ours that doesn't go great, and
that's what they think about. So they could
have nine great interactions,
but they have one bad one, and that's
all you think about. And so when they
take the survey, that's what they're thinking about.
So it's really imperative for us to make
sure that everybody is on their game when
they're connected in with the members or and
or the providers.
So one thing that we've done is to
really leverage something called the community health worker
program,
also known as CHW.
In California, our state has really been on
the forefront of being able to make these
community health workers available to the community. And
the part that I love about this program
is it's not somebody that's necessarily just on
the phone, which is important at times to
to have that interaction, but they're also on
the ground. They're boots on the ground actually
connected directly with
the member
and their whole family to say, hey. How
can I help navigate you through this very
complex health system? And the cool part about
that is the lasting impression that takes place
with the member and the family is now
with that community health worker because they're the
real face of the health plan. And so
I love that program, Haley, because I think
not only is it going to improve our
overall
satisfaction that our members experience, but more importantly,
they're actually helping navigate
in a system that is arguably one of
the most complex and unwieldy systems
ever created in our country, health care. And
so that's really a cool thing, really a
value add for the membership.
Well, before we wrap up here, I'd like
to talk about the future of the payer
space.
So 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 could leaders
take a step in this direction now?
Yeah. Well, I'm a big advocate,
for culture. I think the culture of the
organization
is absolutely paramount.
Stay true to your mission. Make sure that
it's on the forefront of every decision that's
being made.
I really, really can't stress enough that that
whole adage of of culture eats strategy for
lunch is so true. If you've got a
wacky culture or a culture that's just not
in line with your mission, it's very difficult
to move your strategic objectives forward while keeping
your team members at the forefront of the
of the decisions that they're trying to make.
So for me, culture is a huge one.
Of course, staying true to your mission is
huge. And then I I would really challenge
folks to just think bold and audacious during
this time. There's so much change
happening in the federal landscape with health care
and the state, and I actually think it's
a a great time,
to be innovative,
to think differently than the way we've thought
before,
to launch those new lines of business that
maybe you've been thinking about because there will
be space open for people that are thinking
boldly and innovatively
as other people are starting to constrain back.
And I would encourage my colleagues to just
make sure you're staying in the game, staying
relevant, and always, always keeping your mission at
the forefront of every decision.
Well, absolutely. That's so important.
Thank you so much for joining me today
on the podcast. Again, this is Haley Recker
with the Becker's Payer Podcast
recorded live at the Becker's third annual spring
payer issues roundtable.
Jared, thank you so much. Thanks so much,
Haley. Have a great day.