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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 care issues roundtable.
Today, I am thrilled to be joined by
Brian Smolich,
VP of quality and managed care operations at
Health Alliance Medical Plans. Brian, thank you so
much for being with me today. Yeah. Thanks.
Good morning. Good morning to you too. So
before we begin, I'd like to have you
just introduce yourself and share a little bit
more about your background and your organization.
Sure.
So my name is Brian Smolich.
I serve as vice president of quality and
managed care operations for Healthline's medical plans
and First Carolina Care. We're part of the
Carle Health System, and we serve patients
that are primarily located in, Central And Southern
Illinois as well as North Carolina.
I have responsibilities
of,
pharmacy,
medical management,
quality,
and our member relations,
appeals team
at our health.
Well, thank you so much for sharing a
little bit about your background. Now to begin
our conversation today, I'd like to kick it
off by talking about balancing affordability and quality.
So how is your organization
innovating to manage the cost of care while
maintaining or improving member outcomes?
Yeah. So at Health Alliance Medical Plans and
First Carolina Care, quality is at the center
of everything that we do.
You know, you you really have to put
quality
in front of cost and affordability.
But, you know, we we do realize that
if if you're not financially sound and and
you're not able to balance
premiums and and revenue with rising cost, then
it's gonna be difficult to, you know, offer
the plans and and benefits that you want
to members.
But for us, I mean, our people are
exceptional. They
have
a wonderful,
engagement with our members, our customer solutions team,
our case management team, and our clinical platforms
really take the view of working collaboratively with
the provider to ensure patients have the best
care.
So far as innovation,
you know, we've put a lot of focus
in the biosimilar space at least on the
pharmacy benefit side. That has really helped us
reduce costs on medications
without compromising
patients'
access to care or helping us to afford
additional therapies that are newer or novel.
I'd like to explore that a little bit
further on the basis of member satisfaction as
a whole. So what experience or engagement strategies
have proven effective for your organization, and how
are you measuring that success?
Yeah. So our organization,
tracks not only, on our our vertically integrated
health system, the provider side MPS four, but
we're also tracking health plan MPS four.
And I think we do an exceptional job
of engaging members through our customer solutions team.
They also
have the resources to tap into our clinical
experts,
So there's a lot more
collaboration
on individual patient cases,
connecting the dots and getting patients access to
our medical management team, a pharmacist,
our population health or care coordination team. I
think really making it easier for patients to
navigate has been helpful.
We've also utilized digital solutions
and vendors,
some of which, you know,
have gamified,
health care and and
healthy behaviors like medication adherence,
and we're seeing a lot of positive outcomes
from member engagement through those digital platforms.
The other benefit they provide for us is
their high touch. You know, members will be
in apps daily
completing tech,
activities and and earning rewards. And we can
also then engage them with prompts and gaps
in care and things that they need to
do where that becomes much more difficult when
you're trying to engage a member just telephonically
and,
the hesitancy
to to pick up a phone. So I
think we've really seen how how the digital
solutions that we employ can supplement
all the great work that our people are
doing at the planet.
Absolutely. And I'd like to pivot our conversation
just a little bit to the imperative to
reduce costs, improve quality, and advance health equity.
So how do you approach aligning these priorities
in your organization's strategic vision?
I think it all goes back to quality,
and,
I I think our geography in in Central
Illinois as well as in North Carolina,
you know, our being a regional health plan,
we
directly interact on a daily basis with individuals
that have our health care coverage. So I
think that becomes the center of what you
do. You you know that, you're improving the
care within your communities, and that makes the
work that we do very rewarding.
I think,
overall,
we we look at approaches to reduce costs
within,
what we can control,
but I think the general philosophy
improving the care and access to health care
in our communities and bettering,
the population is kind of our North Star
in knowing that this
is health care that impacts those that we
work with, our family, our friends, and and
I think that really becomes impactful when you
think about
quality,
in the patients we serve.
And looking ahead, I wanna talk a little
bit more about the future of the payer
space. So what do you see are the
biggest opportunities
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,
a big area of opportunity is to continuing
to bridge the gap between providers and health
plans.
You know, for years
and
even today, there's oftentimes an adversarial
approach, and I think that puts the patient
in the middle of a lot of dynamics
that make,
navigating health care more difficult.
I know at our health care organization, we're
trying to work collaboratively with providers to pass
more information,
to make,
you know, access to information that the health
plan has easier and to reduce some of
the burden in prior authorization,
but really involving the provider and and finding
a solution where we can work collaboratively with
them to have a win win situation and
and make
all of the navigating of health care and
promoting,
you know, providers as as
key resources in in a patient's health care
journey as well as the provider recognizing that
the health plan is trying to do the
best interest in the patient and making sure
that health care remains affordable. I'd like to
see that dynamic happen, and I think it's,
just continuing to build bridges with providers, trying
to see how we can make their lives
easier on providing
access to care and reducing some of the
the challenges that they face on a daily
basis.
Well, Brian, thank you so much for taking
the time to have this conversation with me
today. Again, this is Haley Becker with the
Becker's Payer podcast recording live at the Becker's
third annual spring payer issues roundtable. Thank you
so much. Thank you.