1 00:00:00,160 --> 00:00:02,159 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,159 --> 00:00:04,960 Becker's Pay Your Issues podcast. Thrilled today to 3 00:00:04,960 --> 00:00:07,599 be joined by doctor Sariya Cicoccio, who is 4 00:00:07,599 --> 00:00:10,019 the chief medical officer at Essence Healthcare. 5 00:00:10,400 --> 00:00:12,559 Doctor Cicoccio, thank you so much for taking 6 00:00:12,559 --> 00:00:13,839 the time to be with me on the 7 00:00:13,839 --> 00:00:16,175 podcast today. Yeah. Jacob, this is gonna be 8 00:00:16,175 --> 00:00:18,195 a lot of fun. Looking forward to it. 9 00:00:18,335 --> 00:00:20,734 Likewise. And and, Sareya, before we dive into 10 00:00:20,734 --> 00:00:22,254 everything we wanna talk with you about, can 11 00:00:22,254 --> 00:00:23,695 you first tell us a little bit more 12 00:00:23,695 --> 00:00:26,335 about yourself, your background in health care, and 13 00:00:26,335 --> 00:00:28,094 what it is that you do today at 14 00:00:28,094 --> 00:00:28,594 Essence? 15 00:00:29,550 --> 00:00:31,949 You bet. So in my role as the 16 00:00:31,949 --> 00:00:35,630 CMO for Essence, I'm responsible for quality and 17 00:00:35,630 --> 00:00:38,770 ensuring that our members receive an excellent experience 18 00:00:39,309 --> 00:00:41,409 every time in every encounter. 19 00:00:41,734 --> 00:00:44,875 So this includes population health management, care management, 20 00:00:45,975 --> 00:00:46,795 certainly clinical 21 00:00:47,254 --> 00:00:47,754 utilization 22 00:00:48,215 --> 00:00:50,375 of the services we have and overall cost 23 00:00:50,375 --> 00:00:53,094 of care. And as a family physician by 24 00:00:53,094 --> 00:00:54,854 training, I've worn a few hats in the 25 00:00:54,854 --> 00:00:57,354 past from being in solo practice, academics, 26 00:00:57,870 --> 00:00:59,870 a CMO on the health system side to 27 00:00:59,870 --> 00:01:03,149 truly understand how health care is delivered in 28 00:01:03,149 --> 00:01:05,549 our communities, and, of course, on the health 29 00:01:05,549 --> 00:01:08,670 plan space, which has been so enjoyable and 30 00:01:08,670 --> 00:01:11,754 an opportunity to integrate all of these perspectives. 31 00:01:11,974 --> 00:01:14,534 It can defocus on the patient, the members 32 00:01:14,534 --> 00:01:15,275 that we serve. 33 00:01:15,734 --> 00:01:17,494 Wonderful. Well, Sareal, like I said, we really 34 00:01:17,494 --> 00:01:19,415 appreciate you taking the time to chat with 35 00:01:19,415 --> 00:01:21,894 us today. I wanted to get started, by 36 00:01:21,894 --> 00:01:24,134 talking a little bit about Medicare Advantage star 37 00:01:24,134 --> 00:01:26,150 ratings. Of course, we're right in the middle 38 00:01:26,150 --> 00:01:28,709 of the open enrollment period. Star ratings are 39 00:01:28,709 --> 00:01:32,150 now out. Essence did fantastic. Once again, yeah, 40 00:01:32,150 --> 00:01:34,310 you've got 80% of your members in four 41 00:01:34,310 --> 00:01:36,650 and a half star plans for 2026. 42 00:01:36,790 --> 00:01:39,030 So talk to us and our audience a 43 00:01:39,030 --> 00:01:40,885 little bit about some of the strategies that 44 00:01:40,885 --> 00:01:43,765 have been most effective internally for achieving that, 45 00:01:43,765 --> 00:01:44,424 for maintaining 46 00:01:44,724 --> 00:01:45,864 those high star ratings, 47 00:01:46,244 --> 00:01:48,724 particularly given the fact that you operate in 48 00:01:48,724 --> 00:01:52,025 multiple competitive markets like St. Louis, Chicago, Louisville. 49 00:01:52,965 --> 00:01:54,744 What's what's gone into those ratings? 50 00:01:55,650 --> 00:01:58,290 You bet. And, Jacob, I'll just say we 51 00:01:58,290 --> 00:02:01,650 are so very proud. I am particularly proud 52 00:02:01,650 --> 00:02:04,689 of our health plan that can consistently deliver 53 00:02:04,689 --> 00:02:06,849 high quality care. So thank you for the 54 00:02:06,849 --> 00:02:07,989 call out and the opportunity 55 00:02:08,610 --> 00:02:09,750 to represent 56 00:02:10,165 --> 00:02:11,925 why we do what we do. And most 57 00:02:11,925 --> 00:02:14,264 importantly here is how we do it. 58 00:02:14,564 --> 00:02:17,365 So how we do this is with strong 59 00:02:17,365 --> 00:02:17,865 collaboration 60 00:02:18,485 --> 00:02:19,224 and relationships. 61 00:02:19,844 --> 00:02:20,905 That is critical. 62 00:02:21,205 --> 00:02:23,544 Whether we're working with a multi 63 00:02:24,069 --> 00:02:27,210 health system group that reaches across The US 64 00:02:27,590 --> 00:02:28,889 or we're dealing with 65 00:02:29,669 --> 00:02:30,169 local 66 00:02:30,710 --> 00:02:31,689 independent physician 67 00:02:32,150 --> 00:02:33,849 advisory or or association, 68 00:02:34,790 --> 00:02:38,069 it's critical that we understand how they deliver 69 00:02:38,069 --> 00:02:38,569 care. 70 00:02:39,134 --> 00:02:42,334 First and foremost, aligning with processes and workflows 71 00:02:42,334 --> 00:02:43,395 they have in place, 72 00:02:43,775 --> 00:02:44,995 that's so important. 73 00:02:45,375 --> 00:02:47,875 I call this the we see you piece 74 00:02:47,935 --> 00:02:49,875 of the work that we do and understanding 75 00:02:49,935 --> 00:02:50,675 that relationship. 76 00:02:51,055 --> 00:02:53,474 We're one of many health plans out there, 77 00:02:53,710 --> 00:02:56,430 and we will be ultimately successful if we 78 00:02:56,430 --> 00:02:58,610 find ways to align with the best practices 79 00:02:58,669 --> 00:03:00,210 that are already in play. 80 00:03:00,510 --> 00:03:02,669 Now what we bring to the table as 81 00:03:02,669 --> 00:03:05,469 a Medicare Advantage health plan is real time 82 00:03:05,469 --> 00:03:06,370 data access. 83 00:03:06,909 --> 00:03:08,050 We have partners 84 00:03:08,514 --> 00:03:10,294 that have full risk. 85 00:03:10,834 --> 00:03:13,094 And, of course, in a full risk relationship, 86 00:03:13,794 --> 00:03:15,334 we're accountable for transparency 87 00:03:15,875 --> 00:03:18,034 and that real time data for those gaps 88 00:03:18,034 --> 00:03:19,174 in care to close 89 00:03:19,474 --> 00:03:21,715 and sharing those best practices to help them 90 00:03:21,715 --> 00:03:22,854 achieve those goals. 91 00:03:23,319 --> 00:03:25,879 Because listen, at at the same time, they 92 00:03:25,879 --> 00:03:28,120 care about the same thing we do, and 93 00:03:28,120 --> 00:03:30,780 that's the patient receiving high quality of care. 94 00:03:30,840 --> 00:03:33,400 So we embrace that. We take that forward 95 00:03:33,400 --> 00:03:34,219 with a multidisciplinary 96 00:03:34,840 --> 00:03:37,979 team on our end. So we know that 97 00:03:38,634 --> 00:03:40,794 STARS is more than just HEDIS. It's more 98 00:03:40,794 --> 00:03:42,495 than just the quality, the prevention, 99 00:03:42,875 --> 00:03:45,514 the chronic disease that's important, but it's also 100 00:03:45,514 --> 00:03:48,555 the medications that our members take and ensuring 101 00:03:48,555 --> 00:03:50,634 that they have access to those when they 102 00:03:50,634 --> 00:03:53,215 need them, how they need them. Health outcomes, 103 00:03:53,939 --> 00:03:56,500 these are the other pieces of the puzzle 104 00:03:56,500 --> 00:04:00,260 of what includes their exercise, their mental health, 105 00:04:00,260 --> 00:04:02,580 and all the other pieces of that health 106 00:04:02,580 --> 00:04:05,219 outcome survey that matters to us and matters 107 00:04:05,219 --> 00:04:07,400 to our partners and certainly to our members. 108 00:04:07,655 --> 00:04:10,455 And then finally with operations and improvement. And 109 00:04:10,455 --> 00:04:14,055 I mentioned each one of these components within 110 00:04:14,055 --> 00:04:14,555 STARS 111 00:04:14,935 --> 00:04:17,415 because you can't do just one well. You 112 00:04:17,415 --> 00:04:18,954 can't just do quality. 113 00:04:19,334 --> 00:04:21,035 You have to take care of the entire 114 00:04:21,095 --> 00:04:21,595 experience 115 00:04:22,000 --> 00:04:25,519 and help these members navigate their path to 116 00:04:25,519 --> 00:04:28,660 create the the highest quality of life possible. 117 00:04:29,279 --> 00:04:32,240 So you can't do member care without the 118 00:04:32,240 --> 00:04:33,459 members at the center, 119 00:04:33,759 --> 00:04:35,894 and this is a complex 120 00:04:40,774 --> 00:04:43,115 significant role in health care across the board, 121 00:04:43,495 --> 00:04:45,354 and that includes member outreach. 122 00:04:45,654 --> 00:04:47,334 But we're not the only ones as a 123 00:04:47,334 --> 00:04:49,990 health plan. We ensure that we partner 124 00:04:50,529 --> 00:04:52,229 with those health care providers 125 00:04:52,769 --> 00:04:55,649 so that we're not duplicating messaging, but we're 126 00:04:55,649 --> 00:04:59,410 aligning messages together. That includes a systematic and 127 00:04:59,410 --> 00:05:00,310 also personalized 128 00:05:00,849 --> 00:05:02,884 outreach in the work that we do. So 129 00:05:02,964 --> 00:05:04,964 and finally, what I'll say in this section 130 00:05:04,964 --> 00:05:07,285 of what helped us be most effective in 131 00:05:07,285 --> 00:05:08,584 our higher star ratings 132 00:05:09,045 --> 00:05:09,944 is aligning 133 00:05:10,324 --> 00:05:12,584 the benefits with the needs of our members. 134 00:05:12,644 --> 00:05:15,365 If you don't understand the communities in which 135 00:05:15,365 --> 00:05:17,629 they live and where you're serving, 136 00:05:18,090 --> 00:05:20,490 it creates a challenge in ensuring that the 137 00:05:20,490 --> 00:05:21,550 benefits match 138 00:05:21,930 --> 00:05:24,009 what the members need. And that's what we've 139 00:05:24,009 --> 00:05:24,910 done really well. 140 00:05:25,529 --> 00:05:27,870 Absolutely. And I I appreciate the detail there, 141 00:05:27,930 --> 00:05:30,254 Sariyah, in terms of it's it's really understanding 142 00:05:30,314 --> 00:05:32,954 the member. It's those strong provider partnerships and 143 00:05:32,954 --> 00:05:34,814 then those really regimented processes, 144 00:05:35,435 --> 00:05:37,035 that you talked about to really achieve these 145 00:05:37,035 --> 00:05:38,954 ratings, which for any of our audience, our 146 00:05:38,954 --> 00:05:40,555 audience that might not be familiar, you know, 147 00:05:40,555 --> 00:05:42,350 a four and a half star rating or 148 00:05:42,350 --> 00:05:44,110 having the majority of your members in in 149 00:05:44,110 --> 00:05:46,850 such high rated plans is is very difficult, 150 00:05:46,910 --> 00:05:49,149 as you know. There's really only a handful 151 00:05:49,149 --> 00:05:50,750 of of health plans around the country that 152 00:05:50,750 --> 00:05:51,730 have achieved this. 153 00:05:52,270 --> 00:05:55,084 And so I wonder because it's been getting 154 00:05:55,084 --> 00:05:57,644 more difficult year after year to maintain and 155 00:05:57,644 --> 00:05:58,144 achieve 156 00:05:58,524 --> 00:05:59,425 such high ratings, 157 00:05:59,805 --> 00:06:01,504 what what are some of the biggest challenges 158 00:06:01,805 --> 00:06:02,444 right now, 159 00:06:02,764 --> 00:06:04,845 either this year or or as you think 160 00:06:04,845 --> 00:06:07,165 about, years to come in achieving these ratings? 161 00:06:07,165 --> 00:06:09,165 Because I know that's already starting and in 162 00:06:09,165 --> 00:06:09,665 place. 163 00:06:10,120 --> 00:06:12,040 What are some of the biggest challenges Essence 164 00:06:12,040 --> 00:06:14,139 is navigating in this space right now? 165 00:06:14,680 --> 00:06:16,939 Well, first and foremost, I could just say 166 00:06:17,079 --> 00:06:17,579 repeat 167 00:06:18,040 --> 00:06:19,959 when it comes to the challenges. So the 168 00:06:19,959 --> 00:06:23,100 areas where we excel with the strong relationships 169 00:06:23,794 --> 00:06:24,615 and the multidisciplinary 170 00:06:25,154 --> 00:06:27,794 teams and that specialized message. We have to 171 00:06:27,794 --> 00:06:29,794 continue to evolve and get better at the 172 00:06:29,794 --> 00:06:32,454 work that we do and why we continuously 173 00:06:32,675 --> 00:06:34,754 learn from what we did last year. What 174 00:06:34,754 --> 00:06:37,740 we did for our work plan for 2025 175 00:06:37,899 --> 00:06:38,720 has changed significantly 176 00:06:39,419 --> 00:06:40,639 in 2025, 177 00:06:40,779 --> 00:06:43,180 and our team knows in 2026, 178 00:06:43,180 --> 00:06:44,160 it will continue 179 00:06:44,539 --> 00:06:47,180 to look different. And that's because not only 180 00:06:47,180 --> 00:06:50,220 are we striving for perfection, that's what's important 181 00:06:50,220 --> 00:06:54,125 here, Every member deserves a 100% quality of 182 00:06:54,125 --> 00:06:57,185 care and the experience that they deserve it, 183 00:06:57,485 --> 00:06:59,805 and we'll have to keep changing. Now that 184 00:06:59,805 --> 00:07:02,125 being said, everybody else is as well. That 185 00:07:02,125 --> 00:07:04,764 means the cut points change on stars. This 186 00:07:04,764 --> 00:07:07,069 we know, And that can be a frustrating 187 00:07:07,069 --> 00:07:08,289 point, which I understand, 188 00:07:08,669 --> 00:07:10,909 and I always reflect back to our board 189 00:07:10,909 --> 00:07:13,229 and to our team members that this is 190 00:07:13,229 --> 00:07:15,389 a good thing. Right? I I think we 191 00:07:15,389 --> 00:07:17,409 would all agree that it's critical 192 00:07:17,794 --> 00:07:20,194 that we continue to perform better. And not 193 00:07:20,194 --> 00:07:23,714 only Essence Healthcare, all Medicare Advantage plans, and 194 00:07:23,714 --> 00:07:26,615 in fact, every health plan and every provider, 195 00:07:27,074 --> 00:07:30,035 it is imperative that we continue to look 196 00:07:30,035 --> 00:07:31,634 for the best ways to deliver that care 197 00:07:31,634 --> 00:07:33,819 because that's what our members deserve at the 198 00:07:33,819 --> 00:07:36,220 end of the day. Absolutely. And speaking of 199 00:07:36,220 --> 00:07:38,540 good things, I mean, these high ratings means 200 00:07:38,540 --> 00:07:41,199 more funding for you to invest back into 201 00:07:41,340 --> 00:07:42,160 better benefits. 202 00:07:42,939 --> 00:07:45,420 So what does that mean moving forward? How 203 00:07:45,420 --> 00:07:47,584 how does achieving these ratings, 204 00:07:47,884 --> 00:07:50,285 so high, how does that influence benefit design 205 00:07:50,285 --> 00:07:53,245 and member engagement moving forward for you all? 206 00:07:53,245 --> 00:07:55,425 Well, I appreciate the insight, and you're absolutely 207 00:07:55,485 --> 00:07:58,990 right. Year over year should indeed build on 208 00:07:58,990 --> 00:08:02,370 top of a previous successful experience for members. 209 00:08:02,589 --> 00:08:05,069 Now that does require money to invest back, 210 00:08:05,069 --> 00:08:07,069 which means we've gotta put the right care 211 00:08:07,069 --> 00:08:08,209 in the right place 212 00:08:08,669 --> 00:08:09,970 at the right time. 213 00:08:10,350 --> 00:08:13,310 Because in order to invest back in, you've 214 00:08:13,310 --> 00:08:15,365 gotta be able to meet the the margins, 215 00:08:15,665 --> 00:08:16,165 frankly. 216 00:08:16,545 --> 00:08:19,025 Now that being said, what I am thrilled 217 00:08:19,025 --> 00:08:20,545 about for 2025 218 00:08:20,545 --> 00:08:21,764 for particularly 219 00:08:22,305 --> 00:08:24,564 our low income subsidized members 220 00:08:24,944 --> 00:08:26,865 is we went back and we asked the 221 00:08:26,865 --> 00:08:28,165 physicians, physicians, 222 00:08:28,819 --> 00:08:30,759 what do your patients need? 223 00:08:31,379 --> 00:08:33,139 And what we heard loud and clear is 224 00:08:33,139 --> 00:08:33,639 transportation 225 00:08:34,019 --> 00:08:34,519 matters, 226 00:08:35,059 --> 00:08:37,940 food matters, social determinants of health across the 227 00:08:37,940 --> 00:08:40,659 board are what make a difference. So we 228 00:08:40,659 --> 00:08:43,625 have dialed in with our care management team, 229 00:08:43,684 --> 00:08:44,745 our social workers 230 00:08:45,125 --> 00:08:47,205 to ask them, what are you hearing? What 231 00:08:47,205 --> 00:08:48,105 are you experiencing? 232 00:08:48,644 --> 00:08:50,565 And what are the members need? And I 233 00:08:50,565 --> 00:08:52,424 think this will become more complex 234 00:08:52,725 --> 00:08:54,504 as we hear. I mean, you can't 235 00:08:54,899 --> 00:08:57,860 avoid listening regardless of if it's social media 236 00:08:57,860 --> 00:08:59,779 or the news or wherever you get your 237 00:08:59,779 --> 00:09:00,279 information. 238 00:09:01,220 --> 00:09:02,279 People are struggling 239 00:09:02,740 --> 00:09:04,579 and for many reasons. We need to make 240 00:09:04,579 --> 00:09:06,259 sure they have food in their bellies because 241 00:09:06,259 --> 00:09:07,879 they shouldn't have to make the decision 242 00:09:08,179 --> 00:09:09,079 between medications 243 00:09:09,804 --> 00:09:12,465 and their food because food is also medicine. 244 00:09:12,684 --> 00:09:14,524 That means we also have to think about 245 00:09:14,524 --> 00:09:15,345 cost effective 246 00:09:15,804 --> 00:09:18,625 pharmacies that work and community engagement. 247 00:09:18,925 --> 00:09:21,485 So, yes, we focus on official benefits, and 248 00:09:21,485 --> 00:09:23,425 I named a few just a moment ago, 249 00:09:23,789 --> 00:09:25,330 But we have connected 250 00:09:25,870 --> 00:09:27,970 more deeply with our mission, 251 00:09:28,669 --> 00:09:31,649 Jacob. We are so focused on the communities 252 00:09:32,190 --> 00:09:33,330 in which our patients 253 00:09:33,709 --> 00:09:36,029 and our members live. And for that reason, 254 00:09:36,029 --> 00:09:39,144 we have identified community partners that are helping 255 00:09:39,205 --> 00:09:39,785 us understand 256 00:09:40,404 --> 00:09:42,825 how these members within their neighborhoods 257 00:09:43,285 --> 00:09:45,524 receive the best care. And the best care, 258 00:09:45,524 --> 00:09:48,184 as I mentioned, is not just medicine. 259 00:09:48,565 --> 00:09:52,245 It's also food. It's shelter. It's security across 260 00:09:52,245 --> 00:09:52,904 the board. 261 00:09:53,399 --> 00:09:55,000 So those are things that we don't always 262 00:09:55,000 --> 00:09:57,240 talk about, but I'm seeing more and more 263 00:09:57,240 --> 00:10:00,299 in a very positive way that my peer 264 00:10:00,360 --> 00:10:02,279 health plans are doing the same. Let's care 265 00:10:02,279 --> 00:10:03,019 about community 266 00:10:03,399 --> 00:10:05,959 and serve up an environment that is most 267 00:10:05,959 --> 00:10:07,419 beneficial for our members. 268 00:10:08,315 --> 00:10:11,595 Absolutely. Addressing those social determinants among your members 269 00:10:11,595 --> 00:10:13,595 is is clearly crucial here, and it obviously 270 00:10:13,595 --> 00:10:15,134 reflects in your ratings. 271 00:10:15,514 --> 00:10:17,995 I wonder, Sariya, I I wanna ask your 272 00:10:17,995 --> 00:10:20,075 perspective given that you've been in this industry 273 00:10:20,075 --> 00:10:21,054 in different parts, 274 00:10:22,220 --> 00:10:23,839 and leading such large organizations 275 00:10:24,620 --> 00:10:26,700 or or in parts of them, how do 276 00:10:26,779 --> 00:10:29,839 how are you thinking about the relevance 277 00:10:30,139 --> 00:10:32,220 of star ratings right now in terms of 278 00:10:32,220 --> 00:10:35,084 truly reflecting health plan quality? Do you think 279 00:10:35,084 --> 00:10:36,704 that the existing methodology 280 00:10:37,084 --> 00:10:40,044 is is effectively capturing the complexities of of 281 00:10:40,044 --> 00:10:41,584 care delivery, of coverage, 282 00:10:42,125 --> 00:10:45,264 especially for such vulnerable populations that you serve? 283 00:10:46,125 --> 00:10:48,125 What's what's your perspective on on the star 284 00:10:48,125 --> 00:10:49,504 ratings process right now? 285 00:10:49,980 --> 00:10:52,459 Well, thank you for this question, Jacob. And, 286 00:10:52,459 --> 00:10:54,959 frankly, we could do a whole podcast 287 00:10:55,339 --> 00:10:58,159 on this alone. I'm considering it. 288 00:10:59,019 --> 00:11:01,500 Right? How was it calculated and what we 289 00:11:01,500 --> 00:11:02,480 shoot for here? 290 00:11:02,945 --> 00:11:04,725 But it boils down to this for me. 291 00:11:05,264 --> 00:11:06,884 And what I 292 00:11:07,584 --> 00:11:08,485 try to inspire 293 00:11:08,865 --> 00:11:11,424 my team members to consider and those that 294 00:11:11,424 --> 00:11:12,164 we support, 295 00:11:12,784 --> 00:11:15,044 at the end of the day, what CMS 296 00:11:15,105 --> 00:11:18,290 is doing here and, frankly, other health plans 297 00:11:18,290 --> 00:11:21,350 including us, is let's do what matters. 298 00:11:21,730 --> 00:11:23,910 And you could take any of these measures 299 00:11:24,290 --> 00:11:26,610 of all the components and relate it back 300 00:11:26,610 --> 00:11:28,710 to why it matters for health. 301 00:11:29,264 --> 00:11:31,444 Do I always agree with, gosh, 302 00:11:31,745 --> 00:11:33,444 missing a star by minus 303 00:11:33,745 --> 00:11:36,384 point four zero four? No. But I do 304 00:11:36,384 --> 00:11:38,485 understand why we have to have cut points. 305 00:11:38,625 --> 00:11:41,204 I do understand why we focus on prevention 306 00:11:41,345 --> 00:11:42,004 of cancer. 307 00:11:42,379 --> 00:11:45,019 It's a significant cost of care, but it 308 00:11:45,019 --> 00:11:47,740 is ultimately an impact on the quality of 309 00:11:47,740 --> 00:11:50,139 life that we have on this earth. In 310 00:11:50,139 --> 00:11:53,019 chronic disease management for the same reason, if 311 00:11:53,019 --> 00:11:55,820 you know or have diabetes yourself, you know 312 00:11:55,820 --> 00:11:58,504 that that is a challenging disease that it 313 00:11:58,504 --> 00:12:00,904 it is incumbent upon us to make sure 314 00:12:00,904 --> 00:12:03,164 that we're delivering comprehensive care. 315 00:12:03,625 --> 00:12:06,504 Now that being said, the experience is just 316 00:12:06,504 --> 00:12:08,524 as important and every member 317 00:12:08,904 --> 00:12:09,404 matters. 318 00:12:09,784 --> 00:12:12,610 And I oftentimes think of my own mother. 319 00:12:12,610 --> 00:12:14,370 I call her Mimi because that's what my 320 00:12:14,370 --> 00:12:16,610 kids call her, and she is in her 321 00:12:16,610 --> 00:12:20,389 seventies. She is the prime Medicare Advantage patient. 322 00:12:20,610 --> 00:12:23,250 And I often ask her, Mimi, what does 323 00:12:23,250 --> 00:12:25,674 this mean to you? How would you respond 324 00:12:25,674 --> 00:12:27,695 to this type of situation? 325 00:12:28,475 --> 00:12:30,875 When you go to speak to your family 326 00:12:30,875 --> 00:12:32,554 doctor, what do you ask? What do you 327 00:12:32,554 --> 00:12:33,995 need to know? What do you need to 328 00:12:33,995 --> 00:12:36,654 hear from them? And it has given me 329 00:12:36,794 --> 00:12:37,695 an incredible 330 00:12:39,350 --> 00:12:40,810 and realistic view 331 00:12:41,269 --> 00:12:43,509 of how difficult it is to navigate care. 332 00:12:43,509 --> 00:12:45,750 Because every one of us is different, and 333 00:12:45,750 --> 00:12:48,389 not all patients with diabetes respond the same, 334 00:12:48,389 --> 00:12:50,629 need the same care plan. And we could 335 00:12:50,629 --> 00:12:53,210 walk through health equity for the same reason. 336 00:12:53,684 --> 00:12:56,644 Every member voice matters, and what's critical for 337 00:12:56,644 --> 00:12:57,705 us is that 338 00:12:58,085 --> 00:13:00,325 we do focus on every voice that comes 339 00:13:00,325 --> 00:13:03,125 in. But that's what CMS wants to do. 340 00:13:03,125 --> 00:13:05,684 It's challenging to do population health when at 341 00:13:05,684 --> 00:13:08,884 the same time, it's critical to personalize that 342 00:13:08,884 --> 00:13:09,384 care. 343 00:13:09,899 --> 00:13:11,659 But at the end of the day, I 344 00:13:11,659 --> 00:13:13,259 think that's what you would want for your 345 00:13:13,259 --> 00:13:14,940 care. That's what you would want for family 346 00:13:14,940 --> 00:13:16,959 and what I certainly expect for mine. 347 00:13:17,419 --> 00:13:19,839 Absolutely. And I appreciate you sharing that personal 348 00:13:19,899 --> 00:13:21,519 anecdote, with your mother, 349 00:13:21,820 --> 00:13:23,820 Soria. It's a it's a great example. And 350 00:13:23,820 --> 00:13:25,264 I and I think that leads me into 351 00:13:25,264 --> 00:13:27,745 my my last question for you in terms 352 00:13:27,745 --> 00:13:28,225 of, 353 00:13:29,184 --> 00:13:32,544 how are you perceiving members' actual awareness and 354 00:13:32,544 --> 00:13:33,044 utilization 355 00:13:33,664 --> 00:13:36,225 of these ratings when they're selecting these plans? 356 00:13:36,225 --> 00:13:38,084 Because as you just explained, 357 00:13:38,789 --> 00:13:40,950 the the methodology, the the cut points, for 358 00:13:40,950 --> 00:13:42,870 example, it's it's very important to somebody in 359 00:13:42,870 --> 00:13:44,789 a role like yours, but that, you know, 360 00:13:44,789 --> 00:13:46,629 the person on the ground, the Medicare Advantage 361 00:13:46,629 --> 00:13:49,750 enrollee likely doesn't know, anything about cut points 362 00:13:49,750 --> 00:13:51,509 and how that trickles down to a final 363 00:13:51,509 --> 00:13:53,445 star rating. So what are what are you 364 00:13:53,445 --> 00:13:55,605 hearing out there about how members are engaging 365 00:13:55,605 --> 00:13:56,825 with these ratings today? 366 00:13:57,365 --> 00:13:59,044 Well well said. We have to bring it 367 00:13:59,044 --> 00:14:01,144 back to the language that matters to them. 368 00:14:01,365 --> 00:14:03,625 If you straight out give a star performance, 369 00:14:03,845 --> 00:14:05,740 that doesn't mean a whole lot. But when 370 00:14:05,740 --> 00:14:08,139 you can reflect back in your communication of 371 00:14:08,139 --> 00:14:09,040 why it matters, 372 00:14:09,580 --> 00:14:12,540 that your diabetes is controlled and we're able 373 00:14:12,540 --> 00:14:14,940 to save your eyesight, when we can focus 374 00:14:14,940 --> 00:14:15,440 on 375 00:14:15,740 --> 00:14:17,899 your blood pressure and why that matters and 376 00:14:17,899 --> 00:14:20,445 finding a health plan that also believes that 377 00:14:20,445 --> 00:14:22,925 that's important. We know that we've reduced heart 378 00:14:22,925 --> 00:14:26,045 attacks and strokes, and everybody understands the impact 379 00:14:26,045 --> 00:14:28,205 of cancer because you've either had it yourself 380 00:14:28,205 --> 00:14:29,665 or you know someone personally 381 00:14:30,045 --> 00:14:31,425 who has been on that journey. 382 00:14:31,805 --> 00:14:34,285 So this is part of understanding what the 383 00:14:34,285 --> 00:14:35,585 individual expects 384 00:14:36,000 --> 00:14:37,700 and what members are wanting. 385 00:14:38,320 --> 00:14:40,799 I have tuned in very closely to our 386 00:14:40,799 --> 00:14:42,559 members at this time of year as, of 387 00:14:42,559 --> 00:14:45,120 course, we're in the annual enrollment period, and 388 00:14:45,120 --> 00:14:47,200 they're telling us. They told us what they 389 00:14:47,200 --> 00:14:49,440 care about pharmacy plans. They wanna know that 390 00:14:49,440 --> 00:14:50,820 they're remaining stable. 391 00:14:51,154 --> 00:14:53,075 When it comes to the benefits available to 392 00:14:53,075 --> 00:14:54,995 them or let's say a flex card, they 393 00:14:54,995 --> 00:14:56,995 wanna know that it's gonna be consistent next 394 00:14:56,995 --> 00:14:59,014 year. And as we see tremendous 395 00:14:59,715 --> 00:15:00,215 disruption 396 00:15:00,835 --> 00:15:01,975 across the market 397 00:15:02,355 --> 00:15:04,934 during this annual enrollment period, 398 00:15:05,315 --> 00:15:05,975 it's because 399 00:15:06,389 --> 00:15:08,330 members have become more educated 400 00:15:08,870 --> 00:15:10,710 and know what they want. And, frankly, they 401 00:15:10,710 --> 00:15:12,649 know what they've had most recently. 402 00:15:13,029 --> 00:15:15,370 And whenever we pull back benefits, 403 00:15:15,990 --> 00:15:18,710 it pullbacks pulls back the benefit to the 404 00:15:18,710 --> 00:15:19,210 member. 405 00:15:19,914 --> 00:15:21,355 And that's what we need to be mindful 406 00:15:21,355 --> 00:15:23,434 of, being stable because that's what they want 407 00:15:23,434 --> 00:15:25,934 from us. I don't believe members choose 408 00:15:26,554 --> 00:15:29,294 to change plans every year, but their experience 409 00:15:29,434 --> 00:15:31,995 is guiding their way. So let's keep it 410 00:15:31,995 --> 00:15:33,934 simple in language they understand 411 00:15:34,429 --> 00:15:37,709 and language that we understand together and drive 412 00:15:37,709 --> 00:15:40,610 back to what impacts their quality of life 413 00:15:40,829 --> 00:15:43,490 and their ease of accessing their benefits. 414 00:15:44,509 --> 00:15:46,845 Well, Sareya, but before we go, you've got 415 00:15:46,845 --> 00:15:48,924 the ears of a lot of other industry 416 00:15:48,924 --> 00:15:51,345 leaders listening in from all over the country. 417 00:15:51,964 --> 00:15:53,964 Any final thoughts for them? Final bits of 418 00:15:53,964 --> 00:15:56,544 advice you wanna share as they navigate, 419 00:15:57,404 --> 00:15:58,384 similar challenges 420 00:15:58,924 --> 00:15:59,985 in the year ahead? 421 00:16:00,809 --> 00:16:02,590 Sure thing. And I'll keep it simple. 422 00:16:02,970 --> 00:16:04,269 At the end of the day, 423 00:16:05,210 --> 00:16:06,830 people want to be heard, 424 00:16:07,210 --> 00:16:09,389 and it's incumbent upon us 425 00:16:09,769 --> 00:16:10,509 to listen 426 00:16:11,210 --> 00:16:12,830 and then to respond appropriately. 427 00:16:14,144 --> 00:16:16,464 And so as I've joined SSENSE and it 428 00:16:16,464 --> 00:16:18,705 brings a huge smile to my face when 429 00:16:18,705 --> 00:16:19,684 I hear repetitively 430 00:16:20,464 --> 00:16:23,205 across departments now, we use the language, 431 00:16:23,584 --> 00:16:26,565 you spoke, we listened, here's what's happening. 432 00:16:27,320 --> 00:16:28,620 Hearing people out, 433 00:16:29,080 --> 00:16:32,200 listening and processing what matters most, and then 434 00:16:32,200 --> 00:16:35,500 reflecting back what's changed because of their input 435 00:16:35,799 --> 00:16:37,580 creates the strongest relationships 436 00:16:38,120 --> 00:16:40,274 and what we're committed to. And I'm very 437 00:16:40,274 --> 00:16:42,195 proud of our team for that. It takes 438 00:16:42,195 --> 00:16:45,174 the entire team. We also say teamwork truly 439 00:16:45,235 --> 00:16:48,595 makes that dream work. So I'm grateful for 440 00:16:48,595 --> 00:16:49,254 our teams 441 00:16:49,634 --> 00:16:52,695 for the opportunity to celebrate their success 442 00:16:53,075 --> 00:16:55,235 and share that message with our members as 443 00:16:55,235 --> 00:16:55,735 well. 444 00:16:56,330 --> 00:16:58,830 A simple message, but a very impactful 445 00:16:59,210 --> 00:17:01,929 one. Doctor Sacoccio, thank you so much for 446 00:17:01,929 --> 00:17:03,769 taking the time to join us on the 447 00:17:03,769 --> 00:17:06,250 podcast today and for sharing your insights with 448 00:17:06,250 --> 00:17:08,174 our listeners. We really appreciate it. 449 00:17:08,575 --> 00:17:11,315 My pleasure. And thank you, and be well. 450 00:17:11,695 --> 00:17:13,535 You as well. And to our listeners, if 451 00:17:13,535 --> 00:17:15,215 you'd like to listen to more podcasts from 452 00:17:15,215 --> 00:17:18,914 Becker's Healthcare, you can visit beckershospitalreview.com.