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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.
Today, I am thrilled to be joined by
Sean Schumann, director of medical management at PEAK
Health. Thank you so much for joining me
today. Can you go ahead and get us
started by telling us a little bit about
yourself, your background, and your organization?
Absolutely. Good afternoon, and thank you for having
me on today's podcast.
I appreciate being here. I am from PEAK
Health. PEAK Health is a provider payer. We
started in operations three years ago,
and we service the market of West Virginia,
and surrounding communities.
Well, thank you so much for that introduction,
and I'd like to get our conversation started
by talking about the ever evolving regulatory landscape.
So what best practices or tools does your
organization rely on to keep quality of care
at the forefront?
At Peak Health,
our whole goal is to improve the health
outcomes and the health trajectory of the residents
that live within the state of West Virginia,
and our whole goal is really to work
towards
improving the lives of the people that we
serve. We do that through a variety of
ways. Internally, we look at what utilization looks
like. Is it standard? Is there anything that's
outliers?
We also look at quality of care. We
do chart audits on our team to make
sure that we're providing the best service possible.
And then also, we are working with our
providers, making sure that our members have access
to the highest quality of care possible. And
then also, we look with our fraud, waste,
and abuse team, working with compliance,
etcetera, making sure that we are providing the
highest level of service and quality to the
members that we serve.
So going off of that a little bit,
I wanna talk more about member satisfaction,
which would probably most likely have to do
with the quality of care at the forefront.
So what experience or engagement strategies have proven
effective for your organization, and how are you
measuring that success?
Sure.
At Peak Health, member satisfaction is the highest
priority.
We see that as our differentiator.
We know that health care is hard, and
we know that there's a lot of barriers
to accessing health care. Our goal at peak
health is how do we remove those barriers?
So we work with our members,
around care management,
and we access we help them access care,
and we help them get in a more
streamlined fashion. So making sure that we connect
them with the community resources that are available
and then how we can make sure that
they get the appointments and the services they
need in order to live their best life.
And we have a great team of folks
that have assembled around care management, utilization management,
and quality that really wrap around a member
to provide the highest level of services.
Well, that's amazing to hear. And I can
imagine that reducing costs and improving quality
and advancing health equity have a lot to
do with that member satisfaction.
So how do you approach aligning these priorities
in your organization's strategic vision?
Thank you for that. We do,
look at ways to
increase quality, decrease cost overall. And as an
organization, we do that
by a variety of ways.
One of those ways is upon enrollment before
people enroll in our plan. Have they had
any interaction with our health system partners?
And how do we work to get them
enrolled into care management programs? Those folks that
are unwilling to go into care management programs
that are high utilizers,
we put them in a program we call
PEAK CARES.
And PEAK CARES is sort of a comprehensive
care management program that wraps around a member.
They have one care manager, one number to
call, and then that care manager navigates
for the member on the member's behalf
to the health care ecosystem.
And we work with that member, and we've
been having positive results around that. But it
allows us the ability to not only
address the,
health,
inequity,
of individuals that live in the Appalachia region,
as well as in West Virginia,
and it allows us to make sure they're
connected to the care and services that they
need. Absolutely.
Now for my final question today, 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?
Sure. Absolutely. I think the biggest opportunity for
payers is to have line of sight into
the member experience, member satisfaction. I think if
you get that right, everything else will fall
on the line.
And I think, from a health plan care
perspective and a vision perspective, I think leaders
need to take bold steps in addressing
how and what their members are experiencing from
health plan operations to
provider
that are available in the network, how members
navigate the system. And if the health plan
plays a central role, which we are trying
to do at Peak Health,
that's what would be a winning strategy in
order to approve the health trajectory of the
members that we serve.
Well, I've really enjoyed our conversation 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, Sean,
for joining me today. Thank you for having
me. Of course.