1 00:00:02,240 --> 00:00:02,899 At athenahealth, 2 00:00:03,279 --> 00:00:06,480 we know your ambulatory practice wants healthier, a 3 00:00:06,480 --> 00:00:09,779 healthier business, healthier care teams, and healthier patients. 4 00:00:10,160 --> 00:00:12,400 But the complexities of modern health care tech 5 00:00:12,400 --> 00:00:14,240 make it hard for you and your care 6 00:00:14,240 --> 00:00:15,855 teams to focus on what matters 7 00:00:16,414 --> 00:00:19,295 most? That's where athenahealth can help. Our AI 8 00:00:19,295 --> 00:00:22,594 native all in one solutions reduce administrative burdens, 9 00:00:22,894 --> 00:00:25,875 streamline billing and payments, and deliver critical insights 10 00:00:25,934 --> 00:00:28,734 when clinicians need it most. That means fewer 11 00:00:28,734 --> 00:00:31,614 clicks, more time for patients, and stronger bottom 12 00:00:31,614 --> 00:00:31,829 lines. 13 00:00:32,710 --> 00:00:35,989 Practicing medicine is complex, but running a practice 14 00:00:35,989 --> 00:00:37,850 can be that much simpler with athenahealth. 15 00:00:38,549 --> 00:00:42,250 See how simpler is healthier@athenahealth.com. 16 00:00:44,085 --> 00:00:46,325 Hello, everyone. This is Jacob Emerson with the 17 00:00:46,325 --> 00:00:48,185 Becker's Payer Issues podcast. 18 00:00:48,565 --> 00:00:50,984 Thrilled today to be joined by Michael Carson, 19 00:00:51,045 --> 00:00:53,765 who's the president and CEO of WellCare, which 20 00:00:53,765 --> 00:00:54,905 is part of Centene. 21 00:00:55,284 --> 00:00:56,965 Michael, thank you so much for taking the 22 00:00:56,965 --> 00:00:58,405 time to be with me on the podcast 23 00:00:58,405 --> 00:00:59,729 today. Thanks, Jacob. 24 00:01:00,350 --> 00:01:01,950 And, Michael, before we dive into everything we 25 00:01:01,950 --> 00:01:03,309 wanna talk with you about, can you tell 26 00:01:03,309 --> 00:01:05,390 us a little bit more about yourself, your 27 00:01:05,390 --> 00:01:07,310 background in health care, and what it is 28 00:01:07,310 --> 00:01:08,930 that you do today at WellCare? 29 00:01:09,549 --> 00:01:11,790 For sure. Pleasure to be here. Thanks for 30 00:01:11,790 --> 00:01:13,489 giving me the opportunity to connect. 31 00:01:14,165 --> 00:01:15,844 So time flies when you're having fun. I 32 00:01:15,844 --> 00:01:17,604 can't believe it's been thirty years in health 33 00:01:17,604 --> 00:01:20,244 care, but it's been a great ride and 34 00:01:20,244 --> 00:01:22,325 a great opportunity to work with some great 35 00:01:22,325 --> 00:01:22,825 organizations 36 00:01:23,125 --> 00:01:25,924 over those years. I've had privilege of working 37 00:01:25,924 --> 00:01:27,224 in in leading 38 00:01:27,629 --> 00:01:28,769 a few payer organizations, 39 00:01:29,069 --> 00:01:31,569 a few provider value based care type organizations, 40 00:01:32,430 --> 00:01:34,450 as well as some population health companies. 41 00:01:35,069 --> 00:01:38,049 So spectrum of administration and financing, 42 00:01:38,349 --> 00:01:39,170 care delivery 43 00:01:39,709 --> 00:01:41,629 mixed in with the care management aspect of 44 00:01:41,629 --> 00:01:44,734 things, which has been a great experience around 45 00:01:44,734 --> 00:01:45,634 those perspectives 46 00:01:46,254 --> 00:01:48,674 out. I've also had an opportunity to work 47 00:01:48,734 --> 00:01:51,055 across the types of benefits that we offer 48 00:01:51,055 --> 00:01:53,134 in our health care system, so fully in 49 00:01:53,134 --> 00:01:54,354 self insured commercial 50 00:01:54,974 --> 00:01:55,474 businesses, 51 00:01:56,334 --> 00:01:57,394 ACA business 52 00:01:57,700 --> 00:01:59,079 from a marketplace perspective, 53 00:01:59,700 --> 00:02:02,439 lots of Medicaid and lots of Medicare background. 54 00:02:03,060 --> 00:02:04,760 And then thinking across 55 00:02:05,299 --> 00:02:07,540 the types of companies that exist who've also 56 00:02:07,540 --> 00:02:09,319 had the opportunity to work in nonprofit, 57 00:02:09,780 --> 00:02:12,599 regional health plans, publicly traded companies, 58 00:02:13,115 --> 00:02:14,955 as well as some private equity start up 59 00:02:14,955 --> 00:02:16,014 organizations. So, 60 00:02:16,395 --> 00:02:18,635 again, I'd bring all that up just because 61 00:02:18,635 --> 00:02:20,955 of the breadth of experience and breadth of 62 00:02:20,955 --> 00:02:22,875 perspective that brings to what we're here to 63 00:02:22,875 --> 00:02:25,534 do for our members and constituents and communities. 64 00:02:25,729 --> 00:02:27,489 Before health care, I spent seven years in 65 00:02:27,489 --> 00:02:29,250 the air force. People ask me what kind 66 00:02:29,250 --> 00:02:30,769 of planes I flew. I say I flew 67 00:02:30,769 --> 00:02:33,430 a desk. So I did, like, quality assurance, 68 00:02:33,650 --> 00:02:34,150 standardization 69 00:02:34,530 --> 00:02:36,930 work for aircraft maintenance type work, and then 70 00:02:36,930 --> 00:02:38,689 I spent several years within as a bush 71 00:02:38,689 --> 00:02:39,669 after the military, 72 00:02:40,175 --> 00:02:42,495 something called total quality management. But it was 73 00:02:42,495 --> 00:02:43,955 really around performance improvement, 74 00:02:44,895 --> 00:02:47,474 helping businesses, helping companies do better. 75 00:02:48,014 --> 00:02:50,175 So that's sort of health care background and 76 00:02:50,175 --> 00:02:52,254 the things that led me into health care 77 00:02:52,254 --> 00:02:52,754 itself, 78 00:02:53,294 --> 00:02:53,794 which 79 00:02:54,510 --> 00:02:56,449 thinking about how to improve businesses 80 00:02:57,469 --> 00:02:59,550 and trying to be a change agent, those 81 00:02:59,550 --> 00:03:01,469 would are the kinds of things that have 82 00:03:01,469 --> 00:03:04,189 brought me throughout my career. And today at 83 00:03:04,189 --> 00:03:06,270 WellCare, where I serve, as you said, as 84 00:03:06,270 --> 00:03:08,830 the presidency of our of a WellCare Medicare 85 00:03:08,830 --> 00:03:09,330 business, 86 00:03:09,814 --> 00:03:10,215 It's, 87 00:03:10,775 --> 00:03:13,974 again, Centene's Medicare business. We're serving about 32 88 00:03:13,974 --> 00:03:15,194 states across the country 89 00:03:15,974 --> 00:03:18,375 with a very strong mission on on really 90 00:03:18,375 --> 00:03:20,854 serving our communities and improving the health of 91 00:03:20,854 --> 00:03:22,875 our communities one person at a time. 92 00:03:23,490 --> 00:03:25,330 Wow. I mean, so clearly, you've had a 93 00:03:25,330 --> 00:03:25,830 very 94 00:03:26,289 --> 00:03:29,490 diverse career background, Michael. And you mentioned you 95 00:03:29,490 --> 00:03:31,349 you served in the Air Force before 96 00:03:31,729 --> 00:03:34,550 really diving into the the health care industry. 97 00:03:35,569 --> 00:03:38,069 And for our audience who isn't aware, Michael 98 00:03:38,129 --> 00:03:38,985 served at organizations 99 00:03:39,384 --> 00:03:42,585 like Harvard Pilgrim Health Care, Bright Health Plan, 100 00:03:42,585 --> 00:03:43,884 and Care About. 101 00:03:44,344 --> 00:03:46,585 So, Michael, talk to us about how all 102 00:03:46,585 --> 00:03:47,805 these past experiences 103 00:03:48,745 --> 00:03:50,444 brought you brought you to Wealthcare 104 00:03:50,985 --> 00:03:52,985 and how that's really shaped your approach of 105 00:03:52,985 --> 00:03:55,330 leading what what you just said, Centene's 106 00:03:55,710 --> 00:03:57,409 Medicare division, such a massive, 107 00:03:58,270 --> 00:03:58,770 organization. 108 00:04:00,030 --> 00:04:01,870 Yeah. And not to my colleagues at this 109 00:04:01,870 --> 00:04:03,629 stage of our careers, the the list of 110 00:04:03,629 --> 00:04:06,590 companies becomes embarrassingly long to have to run 111 00:04:06,590 --> 00:04:08,834 through, But I actually started my health care 112 00:04:08,834 --> 00:04:10,775 career with a regional blues plan, 113 00:04:11,155 --> 00:04:13,155 Colorado, Nevada, New Mexico at the time. It 114 00:04:13,155 --> 00:04:14,694 was a non for profit plan 115 00:04:15,074 --> 00:04:15,814 just before, 116 00:04:16,514 --> 00:04:19,095 Anthem acquired it in the late nineties 117 00:04:19,634 --> 00:04:21,814 or so. So I've spent my time, 118 00:04:22,500 --> 00:04:24,419 as you said, with Harvard Pilgrim and Bright 119 00:04:24,419 --> 00:04:26,740 and care about sort of from a provider 120 00:04:26,740 --> 00:04:27,240 perspective, 121 00:04:27,779 --> 00:04:31,959 but also with, Amerigroup serving national Medicaid businesses, 122 00:04:33,060 --> 00:04:35,300 with Anthem quite a bit helping to build 123 00:04:35,300 --> 00:04:36,839 Medicare businesses as well, 124 00:04:37,384 --> 00:04:39,785 which again has been a great challenge and 125 00:04:39,785 --> 00:04:40,524 and opportunity. 126 00:04:41,305 --> 00:04:43,305 As I think about, you know, how those 127 00:04:43,305 --> 00:04:45,305 things have led me here and how they 128 00:04:45,305 --> 00:04:46,685 helped shape my approach 129 00:04:47,144 --> 00:04:48,685 to leading well care today, 130 00:04:49,225 --> 00:04:50,365 but really overall, 131 00:04:50,959 --> 00:04:54,080 I kinda reflect on the combination of my 132 00:04:54,080 --> 00:04:56,339 work and health care experience with my uplink. 133 00:04:57,040 --> 00:04:58,899 And at the risk of sort 134 00:04:59,279 --> 00:05:01,520 of getting boring here, I think we all 135 00:05:01,520 --> 00:05:03,779 have a background and certain pillars 136 00:05:04,240 --> 00:05:06,339 to our foundation. And to me, 137 00:05:06,694 --> 00:05:09,014 I was born and raised in Germany, grew 138 00:05:09,014 --> 00:05:09,834 up in Europe. 139 00:05:10,375 --> 00:05:11,834 Mom was a factory worker. 140 00:05:12,855 --> 00:05:14,454 My dinner was the stuff that was left 141 00:05:14,454 --> 00:05:15,595 over from the cafeteria. 142 00:05:16,055 --> 00:05:18,375 Dad wasn't in the picture, so no silver 143 00:05:18,375 --> 00:05:20,535 spoon, a healthy dose of reality of what 144 00:05:20,535 --> 00:05:22,154 we have to work very hard for. 145 00:05:22,830 --> 00:05:24,930 That coupled with that early military 146 00:05:25,550 --> 00:05:27,089 and business improvement experience 147 00:05:27,389 --> 00:05:30,110 being, you know, on the ready at any 148 00:05:30,110 --> 00:05:31,790 given time to go do what we have 149 00:05:31,790 --> 00:05:33,170 to do to fulfill a mission. 150 00:05:33,709 --> 00:05:36,270 So those pieces as a foundation combined with 151 00:05:36,270 --> 00:05:37,410 my health care experience 152 00:05:37,985 --> 00:05:40,805 have me focused on WellCare today in terms 153 00:05:41,264 --> 00:05:43,185 of what's our vision. Where do we need 154 00:05:43,185 --> 00:05:44,404 to go? What are opportunities? 155 00:05:45,185 --> 00:05:46,544 What plan do we need to put in 156 00:05:46,544 --> 00:05:48,404 place? How do we execute on that plan 157 00:05:48,625 --> 00:05:50,785 in a diligent rigorous way? I love the 158 00:05:50,785 --> 00:05:53,210 eighty twenty rule. To what extent can we 159 00:05:53,210 --> 00:05:55,790 build an infrastructure that allows us to 160 00:05:56,090 --> 00:05:57,629 manage what we have to manage 161 00:05:57,930 --> 00:06:00,250 at the 80% levels that we can be 162 00:06:00,250 --> 00:06:01,310 ready to react 163 00:06:01,610 --> 00:06:03,689 to the 20% of things that sort of 164 00:06:03,689 --> 00:06:05,529 punches in the mouth, and then we have 165 00:06:05,529 --> 00:06:08,165 to react to with the healthy dose of 166 00:06:08,165 --> 00:06:09,625 courage to make a difference. 167 00:06:10,004 --> 00:06:12,504 Many of us pride ourselves on being disruptors 168 00:06:12,725 --> 00:06:13,225 or 169 00:06:13,605 --> 00:06:16,084 challenging the status quo, but I think all 170 00:06:16,084 --> 00:06:17,605 of us that are trying to make a 171 00:06:17,605 --> 00:06:19,625 difference and that are led by a mission 172 00:06:20,080 --> 00:06:22,639 lean into that and try to find our 173 00:06:22,639 --> 00:06:23,540 own space 174 00:06:24,000 --> 00:06:26,180 in creating improvement, creating difference. 175 00:06:27,199 --> 00:06:28,340 Very few of us, 176 00:06:29,040 --> 00:06:30,639 sort of just view this as a job. 177 00:06:30,639 --> 00:06:32,100 We view this as an opportunity 178 00:06:32,400 --> 00:06:33,300 to make a difference. 179 00:06:34,395 --> 00:06:35,754 Sure. That makes a lot of sense, and 180 00:06:35,754 --> 00:06:37,915 I appreciate you weaving in for us how 181 00:06:37,915 --> 00:06:38,895 your your upbringing, 182 00:06:39,435 --> 00:06:41,115 has really influenced how you, 183 00:06:41,675 --> 00:06:42,175 oversee, 184 00:06:42,714 --> 00:06:44,975 the current population that you serve as well. 185 00:06:45,115 --> 00:06:46,795 And in that vein, Michael, I wonder if 186 00:06:46,795 --> 00:06:48,895 you could talk with us about one segment 187 00:06:49,259 --> 00:06:52,139 of the Medicare population that that you serve 188 00:06:52,139 --> 00:06:53,759 and and, of course, that we've seen, 189 00:06:54,300 --> 00:06:57,180 major growth in terms of enrollment in over 190 00:06:57,180 --> 00:06:59,180 these last few years. And I'm I'm referring 191 00:06:59,180 --> 00:07:00,240 to the dual eligible 192 00:07:00,699 --> 00:07:01,199 population, 193 00:07:02,254 --> 00:07:04,735 that, of course, Centene has, so many, 194 00:07:05,134 --> 00:07:07,154 enrollees in this segment as well. 195 00:07:07,774 --> 00:07:09,455 Talk to us a little bit about this 196 00:07:09,455 --> 00:07:11,535 this specific segment. What are some of the 197 00:07:11,535 --> 00:07:12,355 unique challenges, 198 00:07:12,975 --> 00:07:15,314 that you are seeing dual eligible beneficiaries 199 00:07:15,694 --> 00:07:18,430 face right now? And how does WellCare specifically 200 00:07:18,650 --> 00:07:21,470 approach support for this vulnerable population? 201 00:07:22,490 --> 00:07:24,990 As I think about mission, I I oftentimes 202 00:07:25,529 --> 00:07:26,350 speak to 203 00:07:26,889 --> 00:07:27,389 how 204 00:07:27,770 --> 00:07:30,645 there are very few other populations for which 205 00:07:30,645 --> 00:07:32,324 our mission comes to life the way it 206 00:07:32,324 --> 00:07:33,464 does for dual eligibles. 207 00:07:34,004 --> 00:07:36,504 Across the country, there are roughly 13,000,000, 208 00:07:37,045 --> 00:07:39,865 dual eligibles, so people that qualify for Medicaid 209 00:07:40,245 --> 00:07:41,944 and Medicare benefits and services. 210 00:07:42,485 --> 00:07:44,264 Many of us know the demographics 211 00:07:44,699 --> 00:07:45,680 of this population, 212 00:07:46,220 --> 00:07:49,259 but seventy percent have at least three, if 213 00:07:49,259 --> 00:07:50,080 not four, 214 00:07:50,460 --> 00:07:52,620 chronic conditions that they work that they're dealing 215 00:07:52,620 --> 00:07:53,120 with. 216 00:07:53,660 --> 00:07:56,240 Almost half are have at least one, 217 00:07:56,860 --> 00:07:58,720 a mental health condition that exasperates 218 00:07:59,224 --> 00:08:00,125 the chronic conditions 219 00:08:00,664 --> 00:08:01,564 that they're experiencing. 220 00:08:02,745 --> 00:08:06,345 The food insecurity rate is roughly four times 221 00:08:06,345 --> 00:08:06,845 higher 222 00:08:07,305 --> 00:08:07,805 than, 223 00:08:08,264 --> 00:08:09,404 for other populations. 224 00:08:10,264 --> 00:08:10,925 And then, 225 00:08:11,305 --> 00:08:13,004 there's so many sort of dynamics, 226 00:08:13,669 --> 00:08:16,469 to this population, but another one that's of 227 00:08:16,469 --> 00:08:19,589 interest and importance is that over 50% are 228 00:08:19,589 --> 00:08:21,129 people of color and cultural 229 00:08:21,669 --> 00:08:24,969 diversity. So so adding to all of those 230 00:08:25,964 --> 00:08:27,665 components, there are other barriers, 231 00:08:28,285 --> 00:08:30,464 to care. So oftentimes, it's 232 00:08:30,845 --> 00:08:31,985 urban communities 233 00:08:32,285 --> 00:08:34,625 that may be underserved from a clinical 234 00:08:35,004 --> 00:08:36,705 care access or rural 235 00:08:37,164 --> 00:08:39,579 areas that are that aren't served well and 236 00:08:39,579 --> 00:08:41,579 where we need to do better in finding 237 00:08:41,579 --> 00:08:42,079 penetrating 238 00:08:42,779 --> 00:08:45,659 opportunities to provide care. There are, as I 239 00:08:45,659 --> 00:08:47,919 said, cultural and generational diversity 240 00:08:48,459 --> 00:08:50,299 components that come into play in terms of 241 00:08:50,299 --> 00:08:52,620 how people have engaged with the health care 242 00:08:52,620 --> 00:08:53,120 system, 243 00:08:53,914 --> 00:08:56,394 over their lives. So all these things make 244 00:08:56,394 --> 00:08:59,995 it extremely challenging for members to navigate what's 245 00:08:59,995 --> 00:09:00,495 already 246 00:09:00,875 --> 00:09:03,274 a very complex fragmented health care system. I 247 00:09:03,274 --> 00:09:03,774 often 248 00:09:04,315 --> 00:09:06,315 sort of joke that even as a health 249 00:09:06,315 --> 00:09:08,815 care CEO, it's hard for me to navigate 250 00:09:08,850 --> 00:09:10,309 the system at times. 251 00:09:10,690 --> 00:09:11,509 So, unfortunately, 252 00:09:12,289 --> 00:09:14,230 in a complex fragmented system 253 00:09:14,769 --> 00:09:15,829 with all of those 254 00:09:16,529 --> 00:09:19,750 complexities and dynamics that pertain to a dual, 255 00:09:19,970 --> 00:09:21,649 it it means that it makes it extra 256 00:09:21,649 --> 00:09:24,855 challenging for them. So we have complex enrollment 257 00:09:24,855 --> 00:09:26,315 and eligibility processes, 258 00:09:27,735 --> 00:09:29,355 that combined with 259 00:09:29,735 --> 00:09:30,475 high medical 260 00:09:30,934 --> 00:09:32,154 and social needs 261 00:09:32,855 --> 00:09:35,174 really create one of the most challenging environments 262 00:09:35,174 --> 00:09:37,735 in health care for doulas. But, frankly, it's 263 00:09:37,735 --> 00:09:38,235 also 264 00:09:38,620 --> 00:09:40,220 where I think we can make the biggest 265 00:09:40,220 --> 00:09:40,720 difference. 266 00:09:41,179 --> 00:09:43,360 I'm always encouraged and, 267 00:09:44,220 --> 00:09:45,120 sort of motivated 268 00:09:45,420 --> 00:09:46,480 to lean into 269 00:09:47,100 --> 00:09:47,600 where 270 00:09:47,980 --> 00:09:49,759 we have populations or communities 271 00:09:50,300 --> 00:09:52,139 that have particular opportunity in this, and I 272 00:09:52,139 --> 00:09:53,237 think the duals, certainly represent that. So, financially, 273 00:09:53,237 --> 00:09:53,840 just another sort 274 00:09:55,625 --> 00:09:56,125 financially, 275 00:09:56,904 --> 00:09:59,565 just another sort of foundational component. 276 00:10:00,345 --> 00:10:02,125 Duals is a growing population, 277 00:10:02,664 --> 00:10:03,804 but they also 278 00:10:04,264 --> 00:10:06,345 make up a significant portion of the overall 279 00:10:06,345 --> 00:10:08,365 spend in Medicare and Medicaid. 280 00:10:08,985 --> 00:10:09,485 Roughly, 281 00:10:10,080 --> 00:10:12,100 less than 20% of the Medicare population 282 00:10:12,559 --> 00:10:15,440 are dual eligible, but they drive over 35% 283 00:10:15,440 --> 00:10:18,500 of the cost. That's about $500,000,000,000 284 00:10:18,720 --> 00:10:20,420 in state and federal spending. 285 00:10:20,879 --> 00:10:22,879 So not only are we an opportunity to 286 00:10:22,879 --> 00:10:24,019 do good by helping 287 00:10:24,584 --> 00:10:27,625 members, communities navigate this health care system for 288 00:10:27,625 --> 00:10:30,105 better health care outcomes, it also addresses a 289 00:10:30,105 --> 00:10:33,225 significant driver of health care costs. So what's 290 00:10:33,225 --> 00:10:37,064 WellCare focused on specifically around this? Obviously, all 291 00:10:37,064 --> 00:10:39,084 the talk is integration and alignment. 292 00:10:40,000 --> 00:10:42,080 So we're very much focused on how do 293 00:10:42,080 --> 00:10:43,840 we connect the dots for our members in 294 00:10:43,840 --> 00:10:45,540 our communities to make it easier 295 00:10:46,000 --> 00:10:47,779 to navigate and optimize 296 00:10:48,480 --> 00:10:51,139 their access to benefits and to services. 297 00:10:52,014 --> 00:10:54,654 Simple things like one ID card so that 298 00:10:54,654 --> 00:10:56,014 we don't have to show up with two, 299 00:10:56,014 --> 00:10:57,074 three, four different 300 00:10:57,454 --> 00:11:01,074 cards for things. It's one customer service representative 301 00:11:01,615 --> 00:11:03,294 to be able to speak to. Take that 302 00:11:03,294 --> 00:11:05,730 to the provider side, a single point of 303 00:11:05,730 --> 00:11:07,110 contact for our providers 304 00:11:07,570 --> 00:11:10,310 to ensure that their Medicaid and Medicare benefits, 305 00:11:11,410 --> 00:11:13,970 and services are appropriately communicated so that the 306 00:11:13,970 --> 00:11:15,670 provider can be a best asset, 307 00:11:16,210 --> 00:11:17,414 to the member as well. 308 00:11:18,134 --> 00:11:20,534 But it also comes down to one of 309 00:11:20,534 --> 00:11:21,834 Centene's major strengths. 310 00:11:22,294 --> 00:11:22,794 Centene, 311 00:11:23,254 --> 00:11:26,054 for the record here, is the number one 312 00:11:26,054 --> 00:11:27,195 provider of Medicaid, 313 00:11:28,054 --> 00:11:29,274 coverage in the country. 314 00:11:29,820 --> 00:11:32,139 That includes being the number one provider of 315 00:11:32,139 --> 00:11:33,679 long term supports and services 316 00:11:34,139 --> 00:11:36,960 as well as age blind and disabled coverage, 317 00:11:37,500 --> 00:11:39,360 in the country. We collectively 318 00:11:39,740 --> 00:11:42,480 within Centene serve over a million duals today. 319 00:11:42,860 --> 00:11:44,080 What that means is 320 00:11:44,634 --> 00:11:47,434 Centene and WellCare are deeply embedded in the 321 00:11:47,434 --> 00:11:50,394 communities that we serve. We're deeply embedded in 322 00:11:50,394 --> 00:11:52,414 state as well as federal relationships 323 00:11:53,274 --> 00:11:55,754 that pertain to how programs and policies are 324 00:11:55,754 --> 00:11:56,254 designed 325 00:11:56,570 --> 00:11:57,470 to best serve, 326 00:11:57,769 --> 00:11:58,990 dual eligible members. 327 00:11:59,370 --> 00:12:01,470 We're embedded in provider relationships, 328 00:12:02,409 --> 00:12:03,149 I e, 329 00:12:03,769 --> 00:12:04,269 FQHCs 330 00:12:04,730 --> 00:12:07,309 and other sort of community health organizations 331 00:12:07,929 --> 00:12:10,169 as well as other community organizations that are 332 00:12:10,169 --> 00:12:11,149 there to serve 333 00:12:11,634 --> 00:12:12,375 and engage, 334 00:12:12,834 --> 00:12:15,554 dual members in our community. So we really 335 00:12:15,554 --> 00:12:17,954 try to lean in on the breadth and 336 00:12:17,954 --> 00:12:20,294 depth of our relationships at the community, 337 00:12:20,674 --> 00:12:22,774 at the state, and at the federal level, 338 00:12:23,315 --> 00:12:26,549 combined with that integrated approach from a member 339 00:12:26,549 --> 00:12:27,049 experience, 340 00:12:27,350 --> 00:12:28,490 consumerism perspective 341 00:12:29,110 --> 00:12:31,690 that needs to happen. Because of the complexities 342 00:12:31,830 --> 00:12:32,649 of the population 343 00:12:33,110 --> 00:12:35,450 and the complexities of the health care system, 344 00:12:35,590 --> 00:12:37,590 we feel like it's our responsibility to lean 345 00:12:37,590 --> 00:12:39,269 in and figure out ways to make it 346 00:12:39,269 --> 00:12:40,730 easier to do business work. 347 00:12:41,355 --> 00:12:45,595 Absolutely. And navigating these system complexities across so 348 00:12:45,595 --> 00:12:48,154 many different geographies and and systems. Like you 349 00:12:48,154 --> 00:12:50,735 mentioned, Centene operates in so many different states. 350 00:12:50,875 --> 00:12:53,355 What you're really touching on, Michael, is drilling 351 00:12:53,355 --> 00:12:55,855 down into it is is improving that member 352 00:12:56,110 --> 00:12:57,009 experience across 353 00:12:57,389 --> 00:12:59,389 the spectrum. And, you know, that's something that 354 00:12:59,389 --> 00:13:00,610 we hear about consistently 355 00:13:00,910 --> 00:13:03,149 right now from leaders like yourself here on 356 00:13:03,149 --> 00:13:05,230 the podcast, and and certainly what we've heard 357 00:13:05,230 --> 00:13:07,870 from the Centene leaders we've spoken to over 358 00:13:07,870 --> 00:13:10,064 these last few years is that the major 359 00:13:10,064 --> 00:13:13,605 focus is is improving that member experience. So 360 00:13:14,304 --> 00:13:16,384 how do you ensure that these investments you're 361 00:13:16,384 --> 00:13:19,345 making, this focus you are having on this 362 00:13:19,345 --> 00:13:21,044 experience for those that you serve, 363 00:13:21,360 --> 00:13:24,079 how does that also translate into better health 364 00:13:24,079 --> 00:13:25,779 outcomes at the end of the day? 365 00:13:26,559 --> 00:13:27,059 Yep. 366 00:13:27,679 --> 00:13:29,459 We have our metrics that we, 367 00:13:29,759 --> 00:13:32,480 hold ourselves accountable to and that certainly states 368 00:13:32,480 --> 00:13:35,440 and CMS and federal government holds accountable to. 369 00:13:35,440 --> 00:13:36,899 So things like 370 00:13:37,245 --> 00:13:41,024 voluntary disenrollment rates, member satisfaction scores, provider 371 00:13:41,565 --> 00:13:44,365 satisfaction scores. So there's a litany of sort 372 00:13:44,365 --> 00:13:46,764 of metrics that we evaluate there and work 373 00:13:46,764 --> 00:13:48,544 toward constant improvement. 374 00:13:49,085 --> 00:13:51,910 But as I think about this question about 375 00:13:51,910 --> 00:13:54,090 member experience and how to make it better, 376 00:13:54,550 --> 00:13:56,710 I think of some real hardcore blocking and 377 00:13:56,710 --> 00:13:59,990 tackling. Think of a member selecting a health 378 00:13:59,990 --> 00:14:00,490 plan. 379 00:14:01,029 --> 00:14:03,430 Maybe they're with a company from Medicaid, and 380 00:14:03,430 --> 00:14:05,894 now they're joining a dual eligible SNP plan 381 00:14:05,894 --> 00:14:08,615 for their Medicare benefits, or they're just new 382 00:14:08,615 --> 00:14:11,095 to managed care to begin with. What is 383 00:14:11,095 --> 00:14:13,575 that onboarding experience? So to me, I'm looking 384 00:14:13,575 --> 00:14:14,475 for our teams 385 00:14:14,855 --> 00:14:15,835 and our capabilities 386 00:14:16,215 --> 00:14:18,054 to get ahead of that. How do we 387 00:14:18,054 --> 00:14:19,274 engage with the member 388 00:14:19,709 --> 00:14:22,990 where appropriate and where permitted even pre effective 389 00:14:22,990 --> 00:14:24,829 dates so that we can hit the ground 390 00:14:24,829 --> 00:14:27,230 running? We can know each other. We can 391 00:14:27,230 --> 00:14:29,709 develop an understanding of who our members are, 392 00:14:29,709 --> 00:14:32,029 what their most critical needs are right from 393 00:14:32,029 --> 00:14:32,769 day one, 394 00:14:33,149 --> 00:14:34,929 and begin to build that trusting, 395 00:14:35,684 --> 00:14:36,904 reliable relationship 396 00:14:37,445 --> 00:14:40,664 right up front. So we're looking for solutions 397 00:14:40,965 --> 00:14:41,625 to be 398 00:14:42,004 --> 00:14:42,985 early starters, 399 00:14:43,605 --> 00:14:44,745 proactive engagement, 400 00:14:45,524 --> 00:14:48,644 trusting relationship up front. Obviously, that requires us 401 00:14:48,644 --> 00:14:50,929 to be there for our folks to be 402 00:14:50,929 --> 00:14:51,829 trained, for 403 00:14:52,289 --> 00:14:54,629 our systems to work, for our, 404 00:14:55,889 --> 00:14:58,209 provider directors to be correct. So it's all 405 00:14:58,289 --> 00:15:00,209 it we need to be able to be 406 00:15:00,209 --> 00:15:01,669 a reliable source 407 00:15:02,049 --> 00:15:04,985 of appropriate access. And then couple that with 408 00:15:05,445 --> 00:15:08,424 making sure that our provider partnerships are strong 409 00:15:08,725 --> 00:15:11,044 so that our providers can be our eyes 410 00:15:11,044 --> 00:15:13,764 and ears on the ground, especially as members 411 00:15:13,764 --> 00:15:16,325 come to receive care so that we create 412 00:15:16,325 --> 00:15:17,304 a bit of a triangle, 413 00:15:18,519 --> 00:15:21,100 effect between us as a payer, our providers, 414 00:15:21,399 --> 00:15:24,039 and our members and really create an optimal 415 00:15:24,039 --> 00:15:26,299 solution there. But it really starts with us 416 00:15:26,600 --> 00:15:29,100 leaning in and saying, we have a responsibility 417 00:15:29,639 --> 00:15:31,740 from the get go to know, 418 00:15:32,475 --> 00:15:33,695 to connect with, 419 00:15:34,154 --> 00:15:35,375 and to help 420 00:15:35,834 --> 00:15:37,534 the member navigate into, 421 00:15:38,235 --> 00:15:40,075 managed care as well as through then the 422 00:15:40,075 --> 00:15:43,434 initial process so that there's familiarity and trust 423 00:15:43,434 --> 00:15:44,174 that's built. 424 00:15:44,950 --> 00:15:47,830 Understood. Your your passion for serving these members 425 00:15:47,830 --> 00:15:49,690 really comes through the the conversation, 426 00:15:50,230 --> 00:15:52,389 Michael. One thing I wanted to also ask 427 00:15:52,389 --> 00:15:54,950 you about is, again, when we've spoken to 428 00:15:54,950 --> 00:15:56,409 other leaders at Centene, 429 00:15:56,735 --> 00:15:59,375 we've heard so many about so many new 430 00:15:59,375 --> 00:15:59,875 innovations 431 00:16:00,335 --> 00:16:02,575 in terms of the clinical model across the 432 00:16:02,575 --> 00:16:05,295 different populations that the company serves. And I 433 00:16:05,295 --> 00:16:06,735 wonder if you could delve into that for 434 00:16:06,735 --> 00:16:08,514 us a bit in terms of your perspective 435 00:16:08,654 --> 00:16:10,980 at WellCare and and how you see the 436 00:16:10,980 --> 00:16:14,740 integration of behavioral, physical, and and social health 437 00:16:14,740 --> 00:16:15,240 evolving, 438 00:16:16,179 --> 00:16:18,120 within your part of the company? 439 00:16:18,820 --> 00:16:19,959 The beauty of 440 00:16:20,259 --> 00:16:21,159 dual eligibles, 441 00:16:22,100 --> 00:16:24,100 I find, you know, we can we have 442 00:16:24,100 --> 00:16:26,274 a whole list of things that can become 443 00:16:26,274 --> 00:16:27,735 challenging from a, 444 00:16:28,754 --> 00:16:31,875 regulatory requirement perspective at times. But the beauty 445 00:16:31,875 --> 00:16:33,335 of the dual eligible program, 446 00:16:33,715 --> 00:16:36,835 it introduces requirements such as an ICT, an 447 00:16:36,835 --> 00:16:38,009 integrated care team. 448 00:16:38,570 --> 00:16:42,649 And the intent and and objective here is 449 00:16:42,649 --> 00:16:43,710 to have multidisciplinary 450 00:16:44,730 --> 00:16:46,029 team working together 451 00:16:46,410 --> 00:16:48,169 with a single point of contact for that 452 00:16:48,169 --> 00:16:48,669 member. 453 00:16:49,850 --> 00:16:51,450 So this is where I love and I 454 00:16:51,450 --> 00:16:51,950 welcome 455 00:16:52,475 --> 00:16:55,835 the public private partnership coming together because that's 456 00:16:55,835 --> 00:16:57,615 really what we should be doing. So for 457 00:16:57,754 --> 00:16:59,215 WellCareforce and team, 458 00:16:59,915 --> 00:17:02,735 as our colleagues do across the industry, 459 00:17:03,195 --> 00:17:06,335 we lean in on building the most effective 460 00:17:07,150 --> 00:17:07,650 interdisciplinary 461 00:17:08,109 --> 00:17:09,250 care teams possible 462 00:17:09,630 --> 00:17:11,569 that bring together the medical 463 00:17:12,109 --> 00:17:12,930 or the physical, 464 00:17:13,630 --> 00:17:14,130 behavioral, 465 00:17:14,750 --> 00:17:17,630 and social components of things and try to 466 00:17:17,630 --> 00:17:20,269 bring solutions to them that are hands on. 467 00:17:20,269 --> 00:17:21,490 So just, you know, 468 00:17:21,894 --> 00:17:24,634 use your single point of contact care manager 469 00:17:25,255 --> 00:17:25,755 or, 470 00:17:26,934 --> 00:17:27,434 LTSS 471 00:17:27,815 --> 00:17:28,714 service coordinator 472 00:17:29,335 --> 00:17:31,974 that helps you navigate the system. But it's 473 00:17:31,974 --> 00:17:35,230 then also complementing that with the right data 474 00:17:35,230 --> 00:17:36,849 at the right time, perhaps 475 00:17:37,230 --> 00:17:37,970 an app 476 00:17:38,349 --> 00:17:40,669 to those that wanna use it. Access to 477 00:17:40,669 --> 00:17:41,169 data 478 00:17:41,470 --> 00:17:43,169 and access to digital strategies 479 00:17:43,470 --> 00:17:43,970 appropriately 480 00:17:44,509 --> 00:17:46,669 to complement sort of the blocking and tackling, 481 00:17:46,669 --> 00:17:47,970 just rolling up our sleeves 482 00:17:48,349 --> 00:17:51,144 and being there in person or being there 483 00:17:51,144 --> 00:17:53,144 live for a member as well. So the 484 00:17:53,144 --> 00:17:53,644 innovation 485 00:17:54,265 --> 00:17:55,244 here really is 486 00:17:56,345 --> 00:17:57,244 the the right 487 00:17:57,625 --> 00:17:58,125 interdisciplinary 488 00:17:58,664 --> 00:17:59,164 focus, 489 00:17:59,785 --> 00:18:01,945 where the member is. We can't wait for 490 00:18:01,945 --> 00:18:02,605 the member 491 00:18:02,904 --> 00:18:03,404 to 492 00:18:03,809 --> 00:18:05,670 come meet us at the doctor's office 493 00:18:06,370 --> 00:18:07,970 or wait for them to call us. We 494 00:18:07,970 --> 00:18:10,070 have to go to where the members are, 495 00:18:10,130 --> 00:18:12,049 and that's in the community. It's important for 496 00:18:12,049 --> 00:18:13,190 us to be in the community. 497 00:18:13,570 --> 00:18:15,809 And then to the extent that people want 498 00:18:15,809 --> 00:18:17,494 to use it, bring 499 00:18:17,795 --> 00:18:18,295 digital 500 00:18:18,994 --> 00:18:19,815 data solutions, 501 00:18:20,994 --> 00:18:23,634 that help them navigate the system in a 502 00:18:23,634 --> 00:18:25,335 more efficient and effective manner. 503 00:18:25,875 --> 00:18:28,994 Wonderful. Well, Michael, before we go today, what 504 00:18:28,994 --> 00:18:31,740 else are we missing? What other final thoughts 505 00:18:31,740 --> 00:18:33,660 or final bits of advice do you wanna 506 00:18:33,660 --> 00:18:35,900 share with our listeners? We've got so many 507 00:18:35,900 --> 00:18:38,620 others from across the industry listening in, within 508 00:18:38,620 --> 00:18:41,100 the dual eligible, the Medicare, and the Medicaid 509 00:18:41,100 --> 00:18:41,600 spaces. 510 00:18:41,980 --> 00:18:43,259 What else do you wanna share with them 511 00:18:43,259 --> 00:18:45,884 today? Listen. I appreciate you, Jacob. I appreciate 512 00:18:45,884 --> 00:18:48,125 you calling out that the passion is coming 513 00:18:48,125 --> 00:18:50,204 through. It's one of these things where we're 514 00:18:50,204 --> 00:18:50,704 dealing 515 00:18:51,404 --> 00:18:51,904 with 516 00:18:52,204 --> 00:18:52,704 complex, 517 00:18:54,204 --> 00:18:56,784 high financial matters in these 518 00:18:57,085 --> 00:18:58,704 managed care organization roles. 519 00:18:59,089 --> 00:19:00,130 But at the end of the day, what 520 00:19:00,130 --> 00:19:00,789 I find, 521 00:19:01,410 --> 00:19:03,349 uniformly across my colleagues 522 00:19:03,890 --> 00:19:05,730 is that most of us love what we 523 00:19:05,730 --> 00:19:06,950 do, and 524 00:19:07,250 --> 00:19:08,470 we have this passion 525 00:19:08,769 --> 00:19:10,470 and that aligns to a mission. 526 00:19:11,170 --> 00:19:11,670 And 527 00:19:12,995 --> 00:19:15,394 everybody I know, I think, we we love 528 00:19:15,394 --> 00:19:17,955 that we're able to do something good for 529 00:19:17,955 --> 00:19:18,535 the communities 530 00:19:19,154 --> 00:19:20,775 that we serve and our neighbors 531 00:19:21,154 --> 00:19:23,634 that you know, what I encourage us all 532 00:19:23,634 --> 00:19:25,394 to do is continue to double down on 533 00:19:25,394 --> 00:19:26,134 that passion, 534 00:19:26,995 --> 00:19:28,910 keep leaning into it, and, 535 00:19:29,690 --> 00:19:32,590 sort of allow our industry to reinvent itself, 536 00:19:33,049 --> 00:19:35,390 become more consumer focused, more agile, 537 00:19:36,570 --> 00:19:38,509 more digitally and data enabled. 538 00:19:38,890 --> 00:19:41,289 The consumer focused thing is interesting. I I 539 00:19:41,289 --> 00:19:44,105 sometimes quote, it's probably a few years dated 540 00:19:44,105 --> 00:19:46,684 now, but there was net promoter score, 541 00:19:47,464 --> 00:19:48,845 results by industry, 542 00:19:49,625 --> 00:19:51,964 and it had cable companies 543 00:19:52,424 --> 00:19:54,505 as the worst ranking at the time. I 544 00:19:54,505 --> 00:19:55,944 have no idea if that's today, by the 545 00:19:55,944 --> 00:19:57,804 way. So I hope cable company 546 00:19:58,109 --> 00:19:59,630 leaders don't reach out to me at the 547 00:19:59,630 --> 00:20:00,930 time some years ago. 548 00:20:01,470 --> 00:20:02,450 Next to last, 549 00:20:03,069 --> 00:20:03,809 guess what? 550 00:20:04,109 --> 00:20:04,930 Health insurance. 551 00:20:05,390 --> 00:20:07,470 So we need to do better from a 552 00:20:07,470 --> 00:20:07,970 consumer 553 00:20:08,349 --> 00:20:08,849 perspective 554 00:20:09,630 --> 00:20:11,730 and need to make sure it's a priority. 555 00:20:12,394 --> 00:20:15,355 It's understandable that the time that somebody has 556 00:20:15,355 --> 00:20:16,894 to engage with the health insurance 557 00:20:17,835 --> 00:20:19,434 is a time of need and a time 558 00:20:19,434 --> 00:20:21,855 of stress, either for themselves or for 559 00:20:22,234 --> 00:20:23,294 a family member 560 00:20:23,914 --> 00:20:26,210 or somebody else close to them. So it's 561 00:20:26,210 --> 00:20:28,369 a stressful situation, and it makes it really 562 00:20:28,369 --> 00:20:28,869 hard. 563 00:20:29,170 --> 00:20:31,349 But we have to take on the responsibility, 564 00:20:31,650 --> 00:20:33,089 put that passion to work that we all 565 00:20:33,089 --> 00:20:33,589 have, 566 00:20:33,890 --> 00:20:35,730 and move the ball down the field in 567 00:20:35,730 --> 00:20:37,750 terms of doing better on consumerism 568 00:20:38,210 --> 00:20:39,750 and reinventing the business. 569 00:20:40,785 --> 00:20:42,625 Absolutely. I mean, it's a great and and 570 00:20:42,625 --> 00:20:45,184 timely call to action for all those listening 571 00:20:45,184 --> 00:20:47,664 in. So, Michael, I wanna thank you for 572 00:20:47,664 --> 00:20:49,664 taking the time to sit down with us 573 00:20:49,664 --> 00:20:51,825 and for sharing your insights with us and 574 00:20:51,825 --> 00:20:54,244 with our listeners. We really appreciate it. 575 00:20:54,710 --> 00:20:56,470 Thank you very much, Jacob. And to our 576 00:20:56,470 --> 00:20:58,390 listeners, if you'd like to listen to more 577 00:20:58,390 --> 00:21:00,549 podcasts from Becker's Health Care, you can visit 578 00:21:00,549 --> 00:21:02,809 beckershospitalreview.com. 579 00:21:05,430 --> 00:21:08,309 At athena Health, we know your ambulatory practice 580 00:21:08,309 --> 00:21:09,194 wants healthier, 581 00:21:09,674 --> 00:21:12,554 A healthier business, healthier care teams, and healthier 582 00:21:12,554 --> 00:21:13,054 patients. 583 00:21:13,434 --> 00:21:15,914 But the complexities of modern healthcare tech make 584 00:21:15,914 --> 00:21:17,914 it hard for you and your care teams 585 00:21:17,914 --> 00:21:19,534 to focus on what matters most. 586 00:21:19,914 --> 00:21:22,554 That's where athena Health can help. Our AI 587 00:21:22,554 --> 00:21:25,170 native all in one solutions reduce administrative burdens, 588 00:21:41,625 --> 00:21:45,565 health. See how simpler is healthier at athenahealth.com.