Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast. Thrilled today to
be joined by doctor Sariya Cicoccio, who is
the chief medical officer at Essence Healthcare.
Doctor Cicoccio, thank you so much for taking
the time to be with me on the
podcast today. Yeah. Jacob, this is gonna be
a lot of fun. Looking forward to it.
Likewise. And and, Sareya, before we dive into
everything we wanna talk with you about, can
you first tell us a little bit more
about yourself, your background in health care, and
what it is that you do today at
Essence?
You bet. So in my role as the
CMO for Essence, I'm responsible for quality and
ensuring that our members receive an excellent experience
every time in every encounter.
So this includes population health management, care management,
certainly clinical
utilization
of the services we have and overall cost
of care. And as a family physician by
training, I've worn a few hats in the
past from being in solo practice, academics,
a CMO on the health system side to
truly understand how health care is delivered in
our communities, and, of course, on the health
plan space, which has been so enjoyable and
an opportunity to integrate all of these perspectives.
It can defocus on the patient, the members
that we serve.
Wonderful. Well, Sareal, like I said, we really
appreciate you taking the time to chat with
us today. I wanted to get started, by
talking a little bit about Medicare Advantage star
ratings. Of course, we're right in the middle
of the open enrollment period. Star ratings are
now out. Essence did fantastic. Once again, yeah,
you've got 80% of your members in four
and a half star plans for 2026.
So talk to us and our audience a
little bit about some of the strategies that
have been most effective internally for achieving that,
for maintaining
those high star ratings,
particularly given the fact that you operate in
multiple competitive markets like St. Louis, Chicago, Louisville.
What's what's gone into those ratings?
You bet. And, Jacob, I'll just say we
are so very proud. I am particularly proud
of our health plan that can consistently deliver
high quality care. So thank you for the
call out and the opportunity
to represent
why we do what we do. And most
importantly here is how we do it.
So how we do this is with strong
collaboration
and relationships.
That is critical.
Whether we're working with a multi
health system group that reaches across The US
or we're dealing with
local
independent physician
advisory or or association,
it's critical that we understand how they deliver
care.
First and foremost, aligning with processes and workflows
they have in place,
that's so important.
I call this the we see you piece
of the work that we do and understanding
that relationship.
We're one of many health plans out there,
and we will be ultimately successful if we
find ways to align with the best practices
that are already in play.
Now what we bring to the table as
a Medicare Advantage health plan is real time
data access.
We have partners
that have full risk.
And, of course, in a full risk relationship,
we're accountable for transparency
and that real time data for those gaps
in care to close
and sharing those best practices to help them
achieve those goals.
Because listen, at at the same time, they
care about the same thing we do, and
that's the patient receiving high quality of care.
So we embrace that. We take that forward
with a multidisciplinary
team on our end. So we know that
STARS is more than just HEDIS. It's more
than just the quality, the prevention,
the chronic disease that's important, but it's also
the medications that our members take and ensuring
that they have access to those when they
need them, how they need them. Health outcomes,
these are the other pieces of the puzzle
of what includes their exercise, their mental health,
and all the other pieces of that health
outcome survey that matters to us and matters
to our partners and certainly to our members.
And then finally with operations and improvement. And
I mentioned each one of these components within
STARS
because you can't do just one well. You
can't just do quality.
You have to take care of the entire
experience
and help these members navigate their path to
create the the highest quality of life possible.
So you can't do member care without the
members at the center,
and this is a complex
significant role in health care across the board,
and that includes member outreach.
But we're not the only ones as a
health plan. We ensure that we partner
with those health care providers
so that we're not duplicating messaging, but we're
aligning messages together. That includes a systematic and
also personalized
outreach in the work that we do. So
and finally, what I'll say in this section
of what helped us be most effective in
our higher star ratings
is aligning
the benefits with the needs of our members.
If you don't understand the communities in which
they live and where you're serving,
it creates a challenge in ensuring that the
benefits match
what the members need. And that's what we've
done really well.
Absolutely. And I I appreciate the detail there,
Sariyah, in terms of it's it's really understanding
the member. It's those strong provider partnerships and
then those really regimented processes,
that you talked about to really achieve these
ratings, which for any of our audience, our
audience that might not be familiar, you know,
a four and a half star rating or
having the majority of your members in in
such high rated plans is is very difficult,
as you know. There's really only a handful
of of health plans around the country that
have achieved this.
And so I wonder because it's been getting
more difficult year after year to maintain and
achieve
such high ratings,
what what are some of the biggest challenges
right now,
either this year or or as you think
about, years to come in achieving these ratings?
Because I know that's already starting and in
place.
What are some of the biggest challenges Essence
is navigating in this space right now?
Well, first and foremost, I could just say
repeat
when it comes to the challenges. So the
areas where we excel with the strong relationships
and the multidisciplinary
teams and that specialized message. We have to
continue to evolve and get better at the
work that we do and why we continuously
learn from what we did last year. What
we did for our work plan for 2025
has changed significantly
in 2025,
and our team knows in 2026,
it will continue
to look different. And that's because not only
are we striving for perfection, that's what's important
here, Every member deserves a 100% quality of
care and the experience that they deserve it,
and we'll have to keep changing. Now that
being said, everybody else is as well. That
means the cut points change on stars. This
we know, And that can be a frustrating
point, which I understand,
and I always reflect back to our board
and to our team members that this is
a good thing. Right? I I think we
would all agree that it's critical
that we continue to perform better. And not
only Essence Healthcare, all Medicare Advantage plans, and
in fact, every health plan and every provider,
it is imperative that we continue to look
for the best ways to deliver that care
because that's what our members deserve at the
end of the day. Absolutely. And speaking of
good things, I mean, these high ratings means
more funding for you to invest back into
better benefits.
So what does that mean moving forward? How
how does achieving these ratings,
so high, how does that influence benefit design
and member engagement moving forward for you all?
Well, I appreciate the insight, and you're absolutely
right. Year over year should indeed build on
top of a previous successful experience for members.
Now that does require money to invest back,
which means we've gotta put the right care
in the right place
at the right time.
Because in order to invest back in, you've
gotta be able to meet the the margins,
frankly.
Now that being said, what I am thrilled
about for 2025
for particularly
our low income subsidized members
is we went back and we asked the
physicians, physicians,
what do your patients need?
And what we heard loud and clear is
transportation
matters,
food matters, social determinants of health across the
board are what make a difference. So we
have dialed in with our care management team,
our social workers
to ask them, what are you hearing? What
are you experiencing?
And what are the members need? And I
think this will become more complex
as we hear. I mean, you can't
avoid listening regardless of if it's social media
or the news or wherever you get your
information.
People are struggling
and for many reasons. We need to make
sure they have food in their bellies because
they shouldn't have to make the decision
between medications
and their food because food is also medicine.
That means we also have to think about
cost effective
pharmacies that work and community engagement.
So, yes, we focus on official benefits, and
I named a few just a moment ago,
But we have connected
more deeply with our mission,
Jacob. We are so focused on the communities
in which our patients
and our members live. And for that reason,
we have identified community partners that are helping
us understand
how these members within their neighborhoods
receive the best care. And the best care,
as I mentioned, is not just medicine.
It's also food. It's shelter. It's security across
the board.
So those are things that we don't always
talk about, but I'm seeing more and more
in a very positive way that my peer
health plans are doing the same. Let's care
about community
and serve up an environment that is most
beneficial for our members.
Absolutely. Addressing those social determinants among your members
is is clearly crucial here, and it obviously
reflects in your ratings.
I wonder, Sariya, I I wanna ask your
perspective given that you've been in this industry
in different parts,
and leading such large organizations
or or in parts of them, how do
how are you thinking about the relevance
of star ratings right now in terms of
truly reflecting health plan quality? Do you think
that the existing methodology
is is effectively capturing the complexities of of
care delivery, of coverage,
especially for such vulnerable populations that you serve?
What's what's your perspective on on the star
ratings process right now?
Well, thank you for this question, Jacob. And,
frankly, we could do a whole podcast
on this alone. I'm considering it.
Right? How was it calculated and what we
shoot for here?
But it boils down to this for me.
And what I
try to inspire
my team members to consider and those that
we support,
at the end of the day, what CMS
is doing here and, frankly, other health plans
including us, is let's do what matters.
And you could take any of these measures
of all the components and relate it back
to why it matters for health.
Do I always agree with, gosh,
missing a star by minus
point four zero four? No. But I do
understand why we have to have cut points.
I do understand why we focus on prevention
of cancer.
It's a significant cost of care, but it
is ultimately an impact on the quality of
life that we have on this earth. In
chronic disease management for the same reason, if
you know or have diabetes yourself, you know
that that is a challenging disease that it
it is incumbent upon us to make sure
that we're delivering comprehensive care.
Now that being said, the experience is just
as important and every member
matters.
And I oftentimes think of my own mother.
I call her Mimi because that's what my
kids call her, and she is in her
seventies. She is the prime Medicare Advantage patient.
And I often ask her, Mimi, what does
this mean to you? How would you respond
to this type of situation?
When you go to speak to your family
doctor, what do you ask? What do you
need to know? What do you need to
hear from them? And it has given me
an incredible
and realistic view
of how difficult it is to navigate care.
Because every one of us is different, and
not all patients with diabetes respond the same,
need the same care plan. And we could
walk through health equity for the same reason.
Every member voice matters, and what's critical for
us is that
we do focus on every voice that comes
in. But that's what CMS wants to do.
It's challenging to do population health when at
the same time, it's critical to personalize that
care.
But at the end of the day, I
think that's what you would want for your
care. That's what you would want for family
and what I certainly expect for mine.
Absolutely. And I appreciate you sharing that personal
anecdote, with your mother,
Soria. It's a it's a great example. And
I and I think that leads me into
my my last question for you in terms
of,
how are you perceiving members' actual awareness and
utilization
of these ratings when they're selecting these plans?
Because as you just explained,
the the methodology, the the cut points, for
example, it's it's very important to somebody in
a role like yours, but that, you know,
the person on the ground, the Medicare Advantage
enrollee likely doesn't know, anything about cut points
and how that trickles down to a final
star rating. So what are what are you
hearing out there about how members are engaging
with these ratings today?
Well well said. We have to bring it
back to the language that matters to them.
If you straight out give a star performance,
that doesn't mean a whole lot. But when
you can reflect back in your communication of
why it matters,
that your diabetes is controlled and we're able
to save your eyesight, when we can focus
on
your blood pressure and why that matters and
finding a health plan that also believes that
that's important. We know that we've reduced heart
attacks and strokes, and everybody understands the impact
of cancer because you've either had it yourself
or you know someone personally
who has been on that journey.
So this is part of understanding what the
individual expects
and what members are wanting.
I have tuned in very closely to our
members at this time of year as, of
course, we're in the annual enrollment period, and
they're telling us. They told us what they
care about pharmacy plans. They wanna know that
they're remaining stable.
When it comes to the benefits available to
them or let's say a flex card, they
wanna know that it's gonna be consistent next
year. And as we see tremendous
disruption
across the market
during this annual enrollment period,
it's because
members have become more educated
and know what they want. And, frankly, they
know what they've had most recently.
And whenever we pull back benefits,
it pullbacks pulls back the benefit to the
member.
And that's what we need to be mindful
of, being stable because that's what they want
from us. I don't believe members choose
to change plans every year, but their experience
is guiding their way. So let's keep it
simple in language they understand
and language that we understand together and drive
back to what impacts their quality of life
and their ease of accessing their benefits.
Well, Sareya, but before we go, you've got
the ears of a lot of other industry
leaders listening in from all over the country.
Any final thoughts for them? Final bits of
advice you wanna share as they navigate,
similar challenges
in the year ahead?
Sure thing. And I'll keep it simple.
At the end of the day,
people want to be heard,
and it's incumbent upon us
to listen
and then to respond appropriately.
And so as I've joined SSENSE and it
brings a huge smile to my face when
I hear repetitively
across departments now, we use the language,
you spoke, we listened, here's what's happening.
Hearing people out,
listening and processing what matters most, and then
reflecting back what's changed because of their input
creates the strongest relationships
and what we're committed to. And I'm very
proud of our team for that. It takes
the entire team. We also say teamwork truly
makes that dream work. So I'm grateful for
our teams
for the opportunity to celebrate their success
and share that message with our members as
well.
A simple message, but a very impactful
one. Doctor Sacoccio, thank you so much for
taking the time to join us on the
podcast today and for sharing your insights with
our listeners. We really appreciate it.
My pleasure. And thank you, and be well.
You as well. And to our listeners, if
you'd like to listen to more podcasts from
Becker's Healthcare, you can visit beckershospitalreview.com.