1 00:00:00,080 --> 00:00:02,319 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,319 --> 00:00:04,179 Becker's Payer Issues podcast. 3 00:00:04,559 --> 00:00:06,899 Thrilled today to be joined by Ellen Sexton, 4 00:00:06,960 --> 00:00:09,599 who serves as executive vice president and chief 5 00:00:09,599 --> 00:00:12,019 growth officer at Blue Shield of California. 6 00:00:12,505 --> 00:00:14,345 Ellen, thank you so much for taking the 7 00:00:14,345 --> 00:00:15,945 time to be with me on the podcast 8 00:00:15,945 --> 00:00:16,445 today. 9 00:00:16,745 --> 00:00:18,664 Hi, Jacob. It's great to be here. I'm 10 00:00:18,664 --> 00:00:21,464 looking forward to it. Likewise, Ellen. And before 11 00:00:21,464 --> 00:00:23,064 we dive into everything we wanna talk with 12 00:00:23,064 --> 00:00:24,824 you about today, can you first tell us 13 00:00:24,824 --> 00:00:26,984 a little bit more about yourself, your background 14 00:00:26,984 --> 00:00:28,829 in health care, and what it is that 15 00:00:28,829 --> 00:00:30,609 you do today at Blue Shield? 16 00:00:31,310 --> 00:00:32,929 Yes. Absolutely. So, 17 00:00:33,549 --> 00:00:36,270 Ellen Sexton again, and I'm the executive vice 18 00:00:36,270 --> 00:00:38,750 president and chief growth officer for Blue Shield 19 00:00:38,750 --> 00:00:39,409 of California, 20 00:00:40,125 --> 00:00:42,844 which means I oversee both the commercial and 21 00:00:42,844 --> 00:00:43,984 the government markets 22 00:00:44,445 --> 00:00:47,824 for the organization. And we serve 6,000,000 members 23 00:00:48,844 --> 00:00:50,545 both in and outside California. 24 00:00:51,164 --> 00:00:53,644 For our employer group, actually, a third of 25 00:00:53,644 --> 00:00:56,520 our 4,000,000 members are outside of California. California. 26 00:00:56,899 --> 00:00:59,619 And then in the government program business, we 27 00:00:59,619 --> 00:01:02,840 serve Covered California, which is the state exchange 28 00:01:02,899 --> 00:01:06,359 business here. We have Medicare Advantage and MedSup 29 00:01:06,420 --> 00:01:09,239 plans. And then we also have our Promise 30 00:01:09,379 --> 00:01:10,520 Blue Shield plan, 31 00:01:10,935 --> 00:01:12,875 which serves Medicaid beneficiaries 32 00:01:13,254 --> 00:01:16,555 in Los Angeles and San Diego Counties. So 33 00:01:16,775 --> 00:01:17,915 it's very diversified, 34 00:01:18,614 --> 00:01:19,435 high impact, 35 00:01:19,894 --> 00:01:21,754 and we like to lead with innovation 36 00:01:22,135 --> 00:01:22,954 in California, 37 00:01:23,599 --> 00:01:25,200 both I think as a health plan as 38 00:01:25,200 --> 00:01:27,039 well as a state, and that's really what 39 00:01:27,039 --> 00:01:29,679 attracted me to to joining Blue Shield of 40 00:01:29,679 --> 00:01:30,179 California. 41 00:01:31,039 --> 00:01:33,439 And my prior experience points to just a 42 00:01:33,439 --> 00:01:36,019 passion around serving in health care, 43 00:01:36,704 --> 00:01:39,424 over two decades of experience. It's hard to 44 00:01:39,424 --> 00:01:41,025 believe when I when I count back the 45 00:01:41,025 --> 00:01:41,525 years. 46 00:01:41,984 --> 00:01:42,965 I was at UnitedHealthcare 47 00:01:43,504 --> 00:01:46,644 for many, many years across all different capacities. 48 00:01:47,825 --> 00:01:50,325 I ran a Medicaid plan in Wisconsin 49 00:01:50,625 --> 00:01:53,369 for them. When part d was rolled out. 50 00:01:53,369 --> 00:01:56,170 I was one of the original pioneers in 51 00:01:56,170 --> 00:01:57,209 rolling that out. 52 00:01:57,689 --> 00:02:00,009 I had also the ability to lead their 53 00:02:00,009 --> 00:02:01,789 group retiree business. So 54 00:02:02,090 --> 00:02:04,569 I've seen a lot of different capacities and 55 00:02:04,569 --> 00:02:06,989 coverage areas across the health care landscape. 56 00:02:07,725 --> 00:02:10,125 I was also at Humana for a while. 57 00:02:10,125 --> 00:02:11,504 And then more recently, 58 00:02:11,805 --> 00:02:13,824 before I joined Blue Shield of California, 59 00:02:14,525 --> 00:02:17,245 I was at a startup called Curative, which 60 00:02:17,245 --> 00:02:19,264 was based out of Austin, Texas. 61 00:02:19,840 --> 00:02:22,180 And we were really trying to to revolutionize 62 00:02:22,560 --> 00:02:25,060 the employer group coverage business. So, 63 00:02:25,599 --> 00:02:27,519 I have a real passion for health care 64 00:02:27,519 --> 00:02:28,019 and, 65 00:02:28,479 --> 00:02:30,560 just enjoyed thinking through, you know, how do 66 00:02:30,560 --> 00:02:31,539 we improve it 67 00:02:31,865 --> 00:02:34,025 and how do we improve access as well 68 00:02:34,025 --> 00:02:35,245 as coverage and affordability. 69 00:02:36,504 --> 00:02:38,344 Absolutely. So you've been in the industry for 70 00:02:38,344 --> 00:02:39,724 a long time, Ellen. 71 00:02:40,504 --> 00:02:42,365 Fair to say that you are an expert 72 00:02:42,585 --> 00:02:43,965 in your craft. And so 73 00:02:44,469 --> 00:02:45,990 I I wanted to get us started today 74 00:02:45,990 --> 00:02:47,290 by talking about, 75 00:02:47,590 --> 00:02:49,830 some of the legislative shifts we've seen this 76 00:02:49,830 --> 00:02:52,069 year. It has certainly been something that has 77 00:02:52,069 --> 00:02:54,550 been top of mind to all the the 78 00:02:54,550 --> 00:02:57,075 senior leaders we talked to at health plans 79 00:02:57,075 --> 00:02:59,575 and at hospital systems across the country. 80 00:03:00,754 --> 00:03:01,254 Specifically, 81 00:03:01,555 --> 00:03:03,415 the one big beautiful bill, 82 00:03:03,715 --> 00:03:04,694 HR one, 83 00:03:05,314 --> 00:03:07,175 you know, passed this summer, 84 00:03:07,635 --> 00:03:09,314 and and, you know, I know the bulk 85 00:03:09,314 --> 00:03:11,459 of a lot of this this legislation and 86 00:03:11,459 --> 00:03:13,139 the changes that will go into effect don't 87 00:03:13,139 --> 00:03:14,039 come into fruition, 88 00:03:14,819 --> 00:03:16,840 for for a little bit more time, 89 00:03:17,219 --> 00:03:18,259 2027. 90 00:03:18,259 --> 00:03:18,759 But 91 00:03:19,300 --> 00:03:21,080 I'd love to hear your immediate 92 00:03:21,379 --> 00:03:22,360 and and, 93 00:03:23,060 --> 00:03:25,139 long term thoughts in terms of the impact 94 00:03:25,139 --> 00:03:25,639 here, 95 00:03:26,155 --> 00:03:28,495 on on how you're thinking about this specifically 96 00:03:28,875 --> 00:03:31,455 for the Medicaid population that you serve. 97 00:03:32,474 --> 00:03:33,775 Sure. It's certainly, 98 00:03:34,715 --> 00:03:37,694 very impactful, the different changes and the policies 99 00:03:37,754 --> 00:03:38,974 that are coming down, 100 00:03:39,810 --> 00:03:40,709 from an implementation 101 00:03:41,009 --> 00:03:43,330 side. So first of all, on the Medicaid 102 00:03:43,330 --> 00:03:46,610 side, there's removal of ex parte or the 103 00:03:46,610 --> 00:03:47,110 expedited 104 00:03:47,409 --> 00:03:49,750 renewal process as well as an additional 105 00:03:50,530 --> 00:03:51,030 semiannual 106 00:03:51,489 --> 00:03:55,385 renewal requirement for Medicaid beneficiaries, and that just 107 00:03:55,385 --> 00:03:56,925 creates extra eligibility 108 00:03:57,224 --> 00:03:59,625 hurdles for them to have to get access 109 00:03:59,625 --> 00:04:00,284 to care. 110 00:04:00,825 --> 00:04:02,905 And, you know, from that, we see many 111 00:04:02,905 --> 00:04:04,825 of those members that that may not go 112 00:04:04,825 --> 00:04:07,965 through all those, challenging forms, if you will, 113 00:04:08,185 --> 00:04:09,629 and actually lose coverage. 114 00:04:10,189 --> 00:04:11,730 There's also the implementation 115 00:04:12,189 --> 00:04:14,750 of work requirements, and so how we work 116 00:04:14,750 --> 00:04:17,730 to to streamline that and make the eligibility 117 00:04:17,949 --> 00:04:19,410 requirements around that 118 00:04:19,870 --> 00:04:21,949 are type of top of mind. And then 119 00:04:21,949 --> 00:04:23,970 there's also impacts to members 120 00:04:24,535 --> 00:04:26,314 with on sack unsatisfactory 121 00:04:26,935 --> 00:04:27,435 immigration 122 00:04:27,735 --> 00:04:28,235 status, 123 00:04:29,014 --> 00:04:31,415 from right now and enrollment freeze for new 124 00:04:31,415 --> 00:04:35,175 members as well as decreased benefits for for 125 00:04:35,175 --> 00:04:37,495 members as far as maybe having to have 126 00:04:37,495 --> 00:04:39,355 co pays or additional premiums, 127 00:04:40,069 --> 00:04:42,949 which may extend also beyond into the the 128 00:04:42,949 --> 00:04:43,449 adult, 129 00:04:43,990 --> 00:04:44,490 expansion. 130 00:04:45,509 --> 00:04:47,529 And then there's possible nonrenewal 131 00:04:47,990 --> 00:04:49,370 of what California 132 00:04:49,670 --> 00:04:51,290 has as far as CalAIM. 133 00:04:51,990 --> 00:04:53,670 We'll be trying to figure out how to 134 00:04:53,670 --> 00:04:56,555 cover all of those with these federal cuts. 135 00:04:57,095 --> 00:05:00,295 And the Cal AIM waivers really looked at 136 00:05:00,295 --> 00:05:02,475 areas like enhanced care management 137 00:05:03,014 --> 00:05:06,375 and other flexible community support services like housing 138 00:05:06,375 --> 00:05:08,339 and nutrition and behavioral health 139 00:05:08,819 --> 00:05:09,959 that really extended 140 00:05:10,259 --> 00:05:13,300 in the community and and improved health outcomes. 141 00:05:13,300 --> 00:05:13,800 So 142 00:05:14,100 --> 00:05:16,360 all of these are are really big impacts 143 00:05:16,500 --> 00:05:19,220 to Medicaid. And then I would lift up 144 00:05:19,220 --> 00:05:21,079 as far as covered California 145 00:05:21,914 --> 00:05:24,074 the fact that the extension of the enhanced 146 00:05:24,074 --> 00:05:25,615 tax credits is still, 147 00:05:26,875 --> 00:05:30,634 being considered, although probably not too likely. It's 148 00:05:30,634 --> 00:05:33,194 got a real impact across the Medicaid because 149 00:05:33,194 --> 00:05:35,375 some of those members, of course, flip in 150 00:05:35,699 --> 00:05:38,419 and out of either the exchange coverage or 151 00:05:38,419 --> 00:05:40,740 Medicaid. And so, you know, we've had to 152 00:05:40,740 --> 00:05:43,300 file two rates with the state whether or 153 00:05:43,300 --> 00:05:44,599 not the tax subsidies 154 00:05:44,899 --> 00:05:47,459 are approved or not, and it just creates 155 00:05:47,459 --> 00:05:49,240 a lot of confusion in the system 156 00:05:49,654 --> 00:05:52,215 for members as well as as thinking about 157 00:05:52,215 --> 00:05:52,955 their eligibility. 158 00:05:53,335 --> 00:05:55,495 And so, you know, we're really lifting up 159 00:05:55,495 --> 00:05:58,395 programs that can help people meet these eligibility 160 00:05:58,694 --> 00:06:02,715 requirements. And so the 28 page Medicaid eligibility 161 00:06:03,095 --> 00:06:03,595 form, 162 00:06:03,910 --> 00:06:05,829 We've thought through, you know, how do we 163 00:06:05,829 --> 00:06:06,329 apply 164 00:06:06,949 --> 00:06:10,250 artificial intelligence to try and prepopulate 165 00:06:10,629 --> 00:06:13,350 parts of it to help identify these members 166 00:06:13,350 --> 00:06:13,850 sooner. 167 00:06:14,470 --> 00:06:17,605 We've also lifted up a GED program to 168 00:06:17,605 --> 00:06:20,665 help people actually go back and get their, 169 00:06:21,444 --> 00:06:22,585 high school diploma. 170 00:06:23,285 --> 00:06:25,944 And and so, you know, the promise Medicaid 171 00:06:26,485 --> 00:06:28,405 plan that we have within Blue Shield, they're 172 00:06:28,405 --> 00:06:29,384 just so creative, 173 00:06:29,750 --> 00:06:31,430 Jacob, and they come up with all these 174 00:06:31,430 --> 00:06:34,069 different areas to really extend, you know, what 175 00:06:34,069 --> 00:06:36,389 I would call beyond insurance and help people 176 00:06:36,389 --> 00:06:37,529 continue their coverage. 177 00:06:38,870 --> 00:06:41,669 Understood. I mean, there's there's so much going 178 00:06:41,669 --> 00:06:42,949 on here in terms of what you just 179 00:06:42,949 --> 00:06:45,375 talked about, Alan, between the work requirements, 180 00:06:46,954 --> 00:06:48,414 the changes with with CalAIM, 181 00:06:48,714 --> 00:06:49,774 and then, of course, 182 00:06:50,235 --> 00:06:52,974 you know, in in extension, all the the 183 00:06:53,194 --> 00:06:55,935 the changes around the enhanced ACA subsidies, 184 00:06:56,474 --> 00:06:58,399 and what may or may not happen as 185 00:06:58,399 --> 00:07:00,240 we go into next year. I know it's 186 00:07:00,240 --> 00:07:02,959 been, like you mentioned, pretty difficult for insurers 187 00:07:02,959 --> 00:07:05,439 all over the country, trying to prepare different 188 00:07:05,439 --> 00:07:08,160 rates, depending on on what happens over these 189 00:07:08,160 --> 00:07:09,060 next few weeks. 190 00:07:09,604 --> 00:07:11,444 I I wonder then how does a company 191 00:07:11,444 --> 00:07:13,384 as large as Blue Shield of California 192 00:07:13,925 --> 00:07:16,485 respond to these policy changes? How do you 193 00:07:16,485 --> 00:07:18,584 prepare and prep for, 194 00:07:19,444 --> 00:07:22,004 uncertain situations that might not even come to 195 00:07:22,004 --> 00:07:22,504 fruition? 196 00:07:23,444 --> 00:07:25,125 And, ultimately, what are you doing, 197 00:07:25,740 --> 00:07:27,819 from where you sit, Ellen, to ensure that 198 00:07:27,819 --> 00:07:29,439 your members, whether it's, 199 00:07:29,819 --> 00:07:32,480 currently insured by Medicaid or or ACA, 200 00:07:33,019 --> 00:07:35,420 or even commercial, that they still receive that 201 00:07:35,420 --> 00:07:37,360 that quality coverage that you all provide? 202 00:07:38,475 --> 00:07:40,634 Yes. We I mean, we are preparing for 203 00:07:40,634 --> 00:07:41,134 implementation 204 00:07:41,675 --> 00:07:44,795 and interpretation of it on all all fronts. 205 00:07:44,795 --> 00:07:46,555 And I think one of the first things 206 00:07:46,555 --> 00:07:47,295 is to be 207 00:07:47,675 --> 00:07:50,395 really close partners with your state agencies and 208 00:07:50,395 --> 00:07:50,819 with 209 00:07:51,300 --> 00:07:53,160 other providers in the community 210 00:07:54,020 --> 00:07:56,520 and some of the organizations that help members. 211 00:07:57,300 --> 00:07:59,460 That goes beyond just the doctor's office, if 212 00:07:59,460 --> 00:08:01,620 you will. And so a first focus for 213 00:08:01,620 --> 00:08:03,620 us is gonna be ensuring the access and 214 00:08:03,620 --> 00:08:04,759 care for our members 215 00:08:05,295 --> 00:08:07,555 while ensuring overall population health, 216 00:08:08,254 --> 00:08:08,754 emergency 217 00:08:09,134 --> 00:08:09,634 emergency 218 00:08:10,014 --> 00:08:13,055 care, and and continuity of care. And so 219 00:08:13,055 --> 00:08:15,314 one of the things we have are community 220 00:08:15,455 --> 00:08:18,014 resource centers, and they serve everyone in the 221 00:08:18,014 --> 00:08:20,514 communities, not not just our health plan members. 222 00:08:20,769 --> 00:08:23,110 And they provide really high impact services 223 00:08:23,810 --> 00:08:24,310 reinforcing 224 00:08:24,689 --> 00:08:27,589 the benefits of health care coverage and enrollment. 225 00:08:27,729 --> 00:08:30,529 And we offer these in partnership with with 226 00:08:30,529 --> 00:08:32,610 LA care in LA County, and we have 227 00:08:32,610 --> 00:08:34,870 14 different community resource centers. 228 00:08:35,235 --> 00:08:37,075 And they offer support to people on health 229 00:08:37,075 --> 00:08:37,975 care, eligibility, 230 00:08:38,355 --> 00:08:40,674 and other social determinants of health. And they're 231 00:08:40,674 --> 00:08:42,754 just real difference makers in the lives of 232 00:08:42,754 --> 00:08:44,834 many and and just go one step beyond 233 00:08:44,834 --> 00:08:46,454 in this situation. So 234 00:08:46,834 --> 00:08:49,174 I think you also have to think about 235 00:08:50,639 --> 00:08:53,519 continuity of care, and that is really top 236 00:08:53,519 --> 00:08:55,440 of mind for me. So how do you 237 00:08:55,440 --> 00:08:57,840 ensure that members that might be in the 238 00:08:57,840 --> 00:09:01,059 middle of oncology treatment for cancer 239 00:09:01,519 --> 00:09:03,075 or think about an expectant 240 00:09:04,274 --> 00:09:07,095 mother who is in her last trimester. You 241 00:09:07,154 --> 00:09:07,894 know, making sure that we identify 242 00:09:08,274 --> 00:09:08,934 those members 243 00:09:09,634 --> 00:09:12,154 and ensure that they're not losing eligibility during 244 00:09:12,154 --> 00:09:14,294 this time period is just really 245 00:09:14,634 --> 00:09:15,134 important. 246 00:09:15,475 --> 00:09:17,634 And you can imagine if you're somebody in 247 00:09:17,634 --> 00:09:18,294 that situation, 248 00:09:18,740 --> 00:09:20,980 you know, losing your your health care coverage 249 00:09:20,980 --> 00:09:23,399 during those times would be just really stressful. 250 00:09:23,459 --> 00:09:25,860 So that's one of the things, that we're 251 00:09:25,860 --> 00:09:28,019 definitely trying to do is ensure continuity of 252 00:09:28,019 --> 00:09:30,039 care through all of these policy changes. 253 00:09:30,975 --> 00:09:33,375 Understood. And and and and, to your point, 254 00:09:33,375 --> 00:09:35,534 I I appreciate the acknowledgment that it is 255 00:09:35,534 --> 00:09:37,214 a stressful time for a lot of people. 256 00:09:37,214 --> 00:09:39,054 It's it's an emotional issue as much as 257 00:09:39,054 --> 00:09:41,134 it is a a political and a financial 258 00:09:41,134 --> 00:09:43,214 one. So I I think a really great 259 00:09:43,214 --> 00:09:44,679 point there, Helen. 260 00:09:45,699 --> 00:09:47,539 I do wanna switch gears and ask a 261 00:09:47,539 --> 00:09:49,139 little bit about some of the trends that 262 00:09:49,139 --> 00:09:52,259 you're seeing right now in the commercial employer 263 00:09:52,259 --> 00:09:54,600 market, especially as we go into next year. 264 00:09:54,819 --> 00:09:55,799 We we've heard, 265 00:09:56,419 --> 00:09:56,919 numbers 266 00:09:57,384 --> 00:09:59,964 from from employer groups all over the country, 267 00:10:00,504 --> 00:10:02,024 predicting that 2026 268 00:10:02,024 --> 00:10:03,245 might be one of the largest 269 00:10:03,704 --> 00:10:04,204 increases 270 00:10:04,504 --> 00:10:05,485 in in rates, 271 00:10:06,024 --> 00:10:07,944 in in the last few years, maybe even 272 00:10:07,944 --> 00:10:08,845 up to a decade, 273 00:10:09,464 --> 00:10:11,970 on average. And and we've heard things, you 274 00:10:11,970 --> 00:10:13,750 know, increased utilization 275 00:10:14,050 --> 00:10:15,990 overall, more chronic conditions, 276 00:10:16,929 --> 00:10:18,929 but then, you know, there's the GLP one 277 00:10:18,929 --> 00:10:19,429 factor, 278 00:10:20,050 --> 00:10:22,290 that that's contributing to all of this. And 279 00:10:22,290 --> 00:10:23,970 we've also we've heard a lot about the 280 00:10:23,970 --> 00:10:25,735 growth of stop loss insurance, 281 00:10:26,195 --> 00:10:27,254 in in contextually 282 00:10:27,714 --> 00:10:30,054 as part of this conversation as well. So 283 00:10:30,115 --> 00:10:32,034 would would love your take in terms of 284 00:10:32,034 --> 00:10:33,815 what you're seeing from where you sit. 285 00:10:34,995 --> 00:10:37,495 Yes. I mean, employers want stability 286 00:10:37,875 --> 00:10:41,149 and predictability in their solutions. Right? And so 287 00:10:41,529 --> 00:10:42,509 all of those 288 00:10:42,970 --> 00:10:45,450 areas that you just mentioned, you know, really 289 00:10:45,450 --> 00:10:48,089 start to increase what we're seeing, you know, 290 00:10:48,089 --> 00:10:49,950 a pressured employer group coverage 291 00:10:50,809 --> 00:10:51,309 marketplace. 292 00:10:51,945 --> 00:10:54,904 We are seeing that rising utilization that you're 293 00:10:54,904 --> 00:10:57,225 talking about that's, you know, resulting in these 294 00:10:57,225 --> 00:10:57,965 double digit, 295 00:10:59,144 --> 00:11:02,024 increases, and it's happening in both medical and 296 00:11:02,024 --> 00:11:02,524 pharmacy. 297 00:11:03,065 --> 00:11:05,610 You mentioned GLP one. So, you know, one 298 00:11:05,610 --> 00:11:07,570 of the biggest areas is, you know, how 299 00:11:07,570 --> 00:11:10,049 you decide to cover that with with the 300 00:11:10,049 --> 00:11:12,370 employer group at hand. And I think you 301 00:11:12,370 --> 00:11:14,549 also see some of these amazing 302 00:11:15,169 --> 00:11:18,149 new cell and gene therapies and their tremendous 303 00:11:18,370 --> 00:11:21,004 innovation and results, but they can also come 304 00:11:21,004 --> 00:11:23,644 at a cost of 2 to 3,000,000 for 305 00:11:23,644 --> 00:11:25,725 a treatment. And so how we think about 306 00:11:25,725 --> 00:11:27,584 making those affordable affordable 307 00:11:28,845 --> 00:11:31,964 and stratify the financial risk of coverage is 308 00:11:31,964 --> 00:11:32,944 is really imperative. 309 00:11:34,029 --> 00:11:36,750 I think many employer groups, you know, as 310 00:11:36,750 --> 00:11:38,929 they look, they're trying to find solutions 311 00:11:39,629 --> 00:11:41,250 to still offer their employees 312 00:11:41,629 --> 00:11:44,370 great access but at an affordable price. 313 00:11:44,909 --> 00:11:46,909 And many times to do this, I think 314 00:11:46,909 --> 00:11:47,889 you'll see employers 315 00:11:48,269 --> 00:11:50,074 and us as health payers 316 00:11:50,454 --> 00:11:52,774 looking to engage their employees in their own 317 00:11:52,774 --> 00:11:55,894 health and help them help us select the 318 00:11:55,894 --> 00:11:59,735 best, highest performing providers. And so how we 319 00:11:59,735 --> 00:12:02,454 modernize our health plans to give incentives and 320 00:12:02,454 --> 00:12:04,139 provide the right digital tools 321 00:12:04,540 --> 00:12:07,019 so that their employees can actually make good 322 00:12:07,019 --> 00:12:09,500 decisions, and their health care selections is key 323 00:12:09,500 --> 00:12:10,639 as we go forward. 324 00:12:11,420 --> 00:12:13,660 The other areas that I see as far 325 00:12:13,660 --> 00:12:16,220 as programs for employer groups that are really 326 00:12:16,220 --> 00:12:19,464 picking up in in need is, first of 327 00:12:19,464 --> 00:12:22,245 all, behavioral health. And I think you see 328 00:12:23,024 --> 00:12:26,384 workforce stress as well as burnout and people 329 00:12:26,384 --> 00:12:28,884 just really looking at their own behavioral health 330 00:12:29,345 --> 00:12:31,285 as far as a big need, but also 331 00:12:31,585 --> 00:12:33,205 the the employees' children. 332 00:12:33,750 --> 00:12:36,710 There's more and more access issues as far 333 00:12:36,710 --> 00:12:39,129 as behavioral health and really trying to help 334 00:12:39,509 --> 00:12:42,090 employers with this big need in the market. 335 00:12:42,629 --> 00:12:44,629 And then, one that's near and dear to 336 00:12:44,629 --> 00:12:47,565 my heart is just solutions around women's health 337 00:12:47,804 --> 00:12:49,884 and really thinking about some of the specific 338 00:12:49,884 --> 00:12:52,605 treatment conditions that come through and just haven't 339 00:12:52,605 --> 00:12:54,945 been as much of a focus sometimes. 340 00:12:56,125 --> 00:12:57,105 And then overall, 341 00:12:57,565 --> 00:13:00,384 you know, employers are also looking for convenience 342 00:13:00,524 --> 00:13:03,490 for their employees. And so whether that's through 343 00:13:03,490 --> 00:13:04,870 virtual or telehealth, 344 00:13:06,049 --> 00:13:08,370 or also a solution that we just rolled 345 00:13:08,370 --> 00:13:11,750 out with Zocdoc, which is online appointment booking. 346 00:13:11,970 --> 00:13:14,210 And we had over one million hours on 347 00:13:14,210 --> 00:13:16,370 care able to be booked online. And I 348 00:13:16,370 --> 00:13:17,269 think consumers 349 00:13:17,975 --> 00:13:19,735 are just looking for the same way that 350 00:13:19,735 --> 00:13:22,615 they can go forward and, you know, order 351 00:13:22,615 --> 00:13:23,115 something, 352 00:13:23,495 --> 00:13:25,975 a package from Amazon or order their meals. 353 00:13:25,975 --> 00:13:27,754 They wanna be able to do things online. 354 00:13:27,975 --> 00:13:30,134 And and so I think how health care 355 00:13:30,134 --> 00:13:32,070 is delivered in that similar matter is just 356 00:13:32,149 --> 00:13:34,090 gonna be coming to the forefront. But 357 00:13:34,789 --> 00:13:36,309 all of these things are gonna get at, 358 00:13:36,309 --> 00:13:38,330 you know, how do we create some predictability 359 00:13:38,629 --> 00:13:41,190 and how do we actually get ahead of 360 00:13:41,190 --> 00:13:42,410 these rising core 361 00:13:42,789 --> 00:13:44,894 rising costs for employer groups is just gonna 362 00:13:44,894 --> 00:13:46,754 be really important for the future, 363 00:13:47,774 --> 00:13:49,794 sustainability of employer group offerings. 364 00:13:51,134 --> 00:13:53,294 Absolutely. And that and that really does reflect 365 00:13:53,294 --> 00:13:55,294 what we are hearing from leaders all over 366 00:13:55,294 --> 00:13:57,394 the country of really trying to support 367 00:13:57,799 --> 00:13:59,019 their employer clients, 368 00:13:59,559 --> 00:14:00,539 with stability 369 00:14:01,079 --> 00:14:02,440 and then, you know, trying to meet that 370 00:14:02,440 --> 00:14:02,940 demand, 371 00:14:03,320 --> 00:14:06,679 for behavioral care, for more women's focused health 372 00:14:06,679 --> 00:14:07,179 care. 373 00:14:07,559 --> 00:14:09,480 That is has been top of mind from 374 00:14:09,480 --> 00:14:10,860 what we're hearing as well. 375 00:14:11,694 --> 00:14:13,615 I wonder if we if we shift towards 376 00:14:13,615 --> 00:14:16,174 a little bit more, toward your role and 377 00:14:16,174 --> 00:14:17,454 some of the work you're doing in the 378 00:14:17,454 --> 00:14:18,834 day to day, Helen. 379 00:14:19,294 --> 00:14:20,414 What would you say are some of the 380 00:14:20,414 --> 00:14:23,054 biggest priorities for you right now, for for 381 00:14:23,054 --> 00:14:24,034 your role specifically, 382 00:14:24,690 --> 00:14:26,769 for the health plan as a whole in 383 00:14:26,769 --> 00:14:29,009 the year ahead? I mean, really, what are 384 00:14:29,009 --> 00:14:31,649 you trying to achieve as chief growth officer 385 00:14:31,649 --> 00:14:32,950 for Blue Shield of California? 386 00:14:34,049 --> 00:14:36,769 Yep. One of my biggest priorities is how 387 00:14:36,769 --> 00:14:38,955 do we not only come up with great 388 00:14:38,955 --> 00:14:42,075 ideas to innovate, but also implement those ideas? 389 00:14:42,075 --> 00:14:44,075 I always say to my team, great ideas 390 00:14:44,075 --> 00:14:46,475 are great, but implemented ideas are are even 391 00:14:46,475 --> 00:14:48,654 better, and it's what the market's looking for. 392 00:14:48,875 --> 00:14:50,554 And I think as we come up across 393 00:14:50,554 --> 00:14:52,710 this year, how we come up with joint 394 00:14:52,710 --> 00:14:54,649 efforts with providers to actually 395 00:14:55,190 --> 00:14:57,350 actually good at the cost of of health 396 00:14:57,350 --> 00:14:58,330 care that's rising, 397 00:14:58,710 --> 00:15:01,690 but then also create stability for our members 398 00:15:01,830 --> 00:15:04,009 and employer groups and plan sponsors 399 00:15:04,865 --> 00:15:06,704 so that we can lead through all of 400 00:15:06,704 --> 00:15:08,004 these policy changes 401 00:15:08,625 --> 00:15:11,105 and and really bring the right outcomes to 402 00:15:11,105 --> 00:15:11,684 the market. 403 00:15:12,384 --> 00:15:14,065 And to do that, I think you have 404 00:15:14,065 --> 00:15:16,004 to really instill some resiliency 405 00:15:16,544 --> 00:15:18,784 in your teams right now because there's many 406 00:15:18,784 --> 00:15:19,284 challenges 407 00:15:19,879 --> 00:15:21,100 that they're taking 408 00:15:21,480 --> 00:15:23,500 taking on and these policy changes, 409 00:15:24,200 --> 00:15:26,220 a lot of times, are actually in conflict, 410 00:15:26,360 --> 00:15:28,840 right, with our mission. And our mission has 411 00:15:28,840 --> 00:15:31,559 been to actually increase care and coverage. And 412 00:15:31,559 --> 00:15:34,620 so to think about, you know, millions of 413 00:15:34,835 --> 00:15:36,914 people across the country that may be losing 414 00:15:36,914 --> 00:15:37,735 coverage is 415 00:15:38,035 --> 00:15:40,274 is really hard, I think, for sometimes the 416 00:15:40,355 --> 00:15:41,735 for the teams to fathom. 417 00:15:42,754 --> 00:15:45,394 And as a nonprofit health plan, we're focused 418 00:15:45,394 --> 00:15:46,535 on providing more 419 00:15:46,929 --> 00:15:50,129 comprehensive coverage that's reflective of community needs. So 420 00:15:50,129 --> 00:15:52,290 so the policy changes can fly in the 421 00:15:52,290 --> 00:15:53,110 face of that. 422 00:15:53,809 --> 00:15:55,730 We'll be working really closely, as I said, 423 00:15:55,730 --> 00:15:56,470 with providers 424 00:15:56,850 --> 00:15:59,475 to interpret and implement and then ensure that 425 00:15:59,634 --> 00:16:01,654 continuity of care, that's definitely 426 00:16:02,194 --> 00:16:03,014 at the forefront. 427 00:16:03,714 --> 00:16:06,375 And these changes are gonna hit not only 428 00:16:06,514 --> 00:16:08,834 urban areas, but also rural. And so how 429 00:16:08,834 --> 00:16:11,414 we support providers is gonna be really important. 430 00:16:12,115 --> 00:16:14,274 And and for us, you know, we don't 431 00:16:14,274 --> 00:16:14,774 look 432 00:16:15,299 --> 00:16:16,899 to change how we show up in the 433 00:16:16,899 --> 00:16:17,399 market. 434 00:16:17,860 --> 00:16:20,360 We serve people in every county in California, 435 00:16:20,740 --> 00:16:22,840 and we were the first to do so 436 00:16:23,299 --> 00:16:25,460 on the exchange, and and we'll continue to 437 00:16:25,460 --> 00:16:27,860 be doing that. And I think as we 438 00:16:27,860 --> 00:16:29,960 all reflect across the system, 439 00:16:30,654 --> 00:16:33,054 as more and more people become uninsured because 440 00:16:33,054 --> 00:16:34,434 of these policy implications, 441 00:16:34,894 --> 00:16:37,294 there's gonna be a ripple effect. And people 442 00:16:37,294 --> 00:16:39,634 end up in the ER with more pervasive 443 00:16:39,695 --> 00:16:40,835 conditions, and 444 00:16:41,294 --> 00:16:44,089 that could really end up stretching the capacity 445 00:16:44,149 --> 00:16:44,889 in hospitals, 446 00:16:45,429 --> 00:16:47,589 and the cost then just ends up being 447 00:16:47,589 --> 00:16:50,070 spread back to employer groups. And so how 448 00:16:50,070 --> 00:16:52,389 we prevent that is is really at the 449 00:16:52,389 --> 00:16:52,889 forefront 450 00:16:53,509 --> 00:16:54,490 of our mission 451 00:16:54,950 --> 00:16:56,629 and, you know, one that the team and 452 00:16:56,629 --> 00:16:58,330 I are working really hard on. 453 00:16:59,225 --> 00:17:00,664 Yeah. And I I think that's such an 454 00:17:00,664 --> 00:17:01,804 interesting point, 455 00:17:02,664 --> 00:17:05,164 of what you just said there, Alan, that, 456 00:17:05,704 --> 00:17:07,785 that health plan leaders all over the country 457 00:17:07,785 --> 00:17:09,545 typically are in this work because they wanna 458 00:17:09,545 --> 00:17:11,859 make a difference. And it is tough for 459 00:17:11,859 --> 00:17:13,900 for many to see some of these some 460 00:17:13,900 --> 00:17:15,240 of these uninsured rates 461 00:17:15,539 --> 00:17:16,359 go back up, 462 00:17:16,819 --> 00:17:18,179 in the face of the work that so 463 00:17:18,179 --> 00:17:20,099 many do in the day to day. So 464 00:17:20,099 --> 00:17:21,700 I, you know, I I think that's such 465 00:17:21,700 --> 00:17:23,559 a interesting point that you made there. 466 00:17:24,099 --> 00:17:26,039 And in that vein, I I would ask, 467 00:17:26,375 --> 00:17:28,535 is there anything that you would wanna share 468 00:17:28,535 --> 00:17:29,674 with the other 469 00:17:29,975 --> 00:17:32,695 insurance leaders listening in right now from all 470 00:17:32,695 --> 00:17:35,755 over the country? Any any final thoughts or 471 00:17:35,815 --> 00:17:37,575 final bits of advice that you would wanna 472 00:17:37,575 --> 00:17:39,335 share with them as we close out the 473 00:17:39,335 --> 00:17:39,835 year? 474 00:17:40,480 --> 00:17:42,000 I think it's gonna take all of our 475 00:17:42,000 --> 00:17:45,440 collective efforts working together. And I think how 476 00:17:45,440 --> 00:17:48,659 we put forward solid plans and and consistent 477 00:17:49,200 --> 00:17:50,500 consistency in those, 478 00:17:51,200 --> 00:17:53,299 you know, we're doing a lot of scenario 479 00:17:53,440 --> 00:17:53,940 planning, 480 00:17:54,434 --> 00:17:56,434 of course, and and that's to bring the 481 00:17:56,434 --> 00:17:57,815 right kind of stability 482 00:17:58,115 --> 00:18:00,514 to the market and and also how we 483 00:18:00,514 --> 00:18:03,414 deliver high quality care with our partners. And 484 00:18:03,634 --> 00:18:05,474 so you can't stay in a vacuum. You 485 00:18:05,474 --> 00:18:06,855 really have to get out there 486 00:18:07,200 --> 00:18:09,460 and work with your local state policymakers 487 00:18:10,079 --> 00:18:10,579 because, 488 00:18:10,960 --> 00:18:13,440 you know, as these policy changes come down, 489 00:18:13,440 --> 00:18:15,839 they're not always all fully vetted. And so 490 00:18:15,839 --> 00:18:18,159 how we carefully plan, I think, across all 491 00:18:18,159 --> 00:18:18,819 our different 492 00:18:19,894 --> 00:18:21,274 partners and providers 493 00:18:21,575 --> 00:18:23,494 and and even with other health plans is 494 00:18:23,494 --> 00:18:25,815 gonna be really important. And so, you know, 495 00:18:25,815 --> 00:18:27,034 I like to think about 496 00:18:27,335 --> 00:18:29,494 particular how we deliver in the health care 497 00:18:29,494 --> 00:18:31,034 space as more of a partnership 498 00:18:31,750 --> 00:18:34,009 that's focused on that and less transactional. 499 00:18:34,950 --> 00:18:37,269 And being in health care always has its 500 00:18:37,269 --> 00:18:40,549 challenges. As you referenced, we're we're generally the 501 00:18:40,549 --> 00:18:42,789 leaders in it, very mission focused. And I 502 00:18:42,789 --> 00:18:45,049 think if we keep the mission at hand 503 00:18:46,224 --> 00:18:47,524 first and the forefront, 504 00:18:48,224 --> 00:18:50,164 we're gonna be successful together. 505 00:18:50,704 --> 00:18:53,585 And, you know, there's millions of Americans depending 506 00:18:53,585 --> 00:18:55,044 on us to do that, and 507 00:18:55,504 --> 00:18:57,345 I sure wanna be be the ones that 508 00:18:57,345 --> 00:18:58,404 help leave a legacy 509 00:18:58,940 --> 00:19:00,480 that really help bring, 510 00:19:01,019 --> 00:19:02,240 the coverage and affordability 511 00:19:02,859 --> 00:19:05,039 that that's worthy of our friends and families. 512 00:19:05,740 --> 00:19:07,420 That's our mission here at Blue Shield of 513 00:19:07,420 --> 00:19:09,660 California, and I know many of my fellow 514 00:19:09,660 --> 00:19:10,559 leaders across, 515 00:19:11,579 --> 00:19:14,400 health plans across America feel that same way. 516 00:19:15,474 --> 00:19:18,194 Wonderful. Well, Ellen, I wanna thank you for 517 00:19:18,194 --> 00:19:19,794 taking the time to sit down with us 518 00:19:19,794 --> 00:19:22,194 on the podcast today and for sharing your 519 00:19:22,194 --> 00:19:25,015 insights with our audience. We really appreciate it. 520 00:19:25,554 --> 00:19:28,054 Thanks, Jacob. I really enjoyed the conversation. 521 00:19:28,980 --> 00:19:31,700 Likewise. And to our listeners, if you'd like 522 00:19:31,700 --> 00:19:34,019 to listen to more podcasts from Becker's Health 523 00:19:34,019 --> 00:19:37,079 Care, you can visit beckershospitalreview.com.