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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy, care, and

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benefit solutions.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward.

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This is Haley Recker with the Becker's Payer

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Podcast, and we are recording live at the

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Becker's third annual spring payer issues roundtable.

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Today, I am thrilled to be joined by

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Sean Schumann, director of medical management at PEAK

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Health. Thank you so much for joining me

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today. Can you go ahead and get us

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started by telling us a little bit about

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yourself, your background, and your organization?

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Absolutely. Good afternoon, and thank you for having

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me on today's podcast.

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I appreciate being here. I am from PEAK

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Health. PEAK Health is a provider payer. We

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started in operations three years ago,

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and we service the market of West Virginia,

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and surrounding communities.

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Well, thank you so much for that introduction,

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and I'd like to get our conversation started

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by talking about the ever evolving regulatory landscape.

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So what best practices or tools does your

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organization rely on to keep quality of care

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at the forefront?

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At Peak Health,

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our whole goal is to improve the health

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outcomes and the health trajectory of the residents

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that live within the state of West Virginia,

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and our whole goal is really to work

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towards

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improving the lives of the people that we

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serve. We do that through a variety of

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ways. Internally, we look at what utilization looks

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like. Is it standard? Is there anything that's

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outliers?

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We also look at quality of care. We

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do chart audits on our team to make

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sure that we're providing the best service possible.

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And then also, we are working with our

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providers, making sure that our members have access

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to the highest quality of care possible. And

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then also, we look with our fraud, waste,

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and abuse team, working with compliance,

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etcetera, making sure that we are providing the

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highest level of service and quality to the

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members that we serve.

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So going off of that a little bit,

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I wanna talk more about member satisfaction,

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which would probably most likely have to do

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with the quality of care at the forefront.

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So what experience or engagement strategies have proven

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effective for your organization, and how are you

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measuring that success?

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Sure.

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At Peak Health, member satisfaction is the highest

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priority.

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We see that as our differentiator.

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We know that health care is hard, and

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we know that there's a lot of barriers

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to accessing health care. Our goal at peak

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health is how do we remove those barriers?

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So we work with our members,

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around care management,

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and we access we help them access care,

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and we help them get in a more

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streamlined fashion. So making sure that we connect

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them with the community resources that are available

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and then how we can make sure that

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they get the appointments and the services they

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need in order to live their best life.

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And we have a great team of folks

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that have assembled around care management, utilization management,

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and quality that really wrap around a member

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to provide the highest level of services.

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Well, that's amazing to hear. And I can

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imagine that reducing costs and improving quality

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and advancing health equity have a lot to

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do with that member satisfaction.

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So how do you approach aligning these priorities

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in your organization's strategic vision?

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Thank you for that. We do,

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look at ways to

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increase quality, decrease cost overall. And as an

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organization, we do that

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by a variety of ways.

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One of those ways is upon enrollment before

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people enroll in our plan. Have they had

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any interaction with our health system partners?

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And how do we work to get them

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enrolled into care management programs? Those folks that

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are unwilling to go into care management programs

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that are high utilizers,

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we put them in a program we call

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PEAK CARES.

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And PEAK CARES is sort of a comprehensive

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care management program that wraps around a member.

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They have one care manager, one number to

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call, and then that care manager navigates

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for the member on the member's behalf

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to the health care ecosystem.

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And we work with that member, and we've

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been having positive results around that. But it

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allows us the ability to not only

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address the,

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health,

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inequity,

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of individuals that live in the Appalachia region,

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as well as in West Virginia,

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and it allows us to make sure they're

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connected to the care and services that they

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need. Absolutely.

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Now for my final question today, looking ahead,

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what do you see as the biggest opportunity

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for payers to lead the charge in transforming

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care delivery and driving better outcomes for all

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stakeholders? And how can leaders take a step

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in this direction now?

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Sure. Absolutely. I think the biggest opportunity for

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payers is to have line of sight into

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the member experience, member satisfaction. I think if

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you get that right, everything else will fall

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on the line.

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And I think, from a health plan care

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perspective and a vision perspective, I think leaders

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need to take bold steps in addressing

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how and what their members are experiencing from

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health plan operations to

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provider

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that are available in the network, how members

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navigate the system. And if the health plan

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plays a central role, which we are trying

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to do at Peak Health,

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that's what would be a winning strategy in

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order to approve the health trajectory of the

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members that we serve.

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Well, I've really enjoyed our conversation today. Again,

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this is Haley Recker with the Becker's Payer

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Podcast,

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recorded live at the Becker's third annual spring

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payer issues roundtable. Thank you so much, Sean,

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for joining me today. Thank you for having

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me. Of course.