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Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: Thanks so much, Haley. Have a great day.