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This is where health insurance leadership comes together.

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Becker's fourth annual spring payer issues roundtable brings

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together over 400 payer and health plan executives

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and more than 100 speakers to Chicago April.

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This year's event includes keynote conversations with the

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industry's top leaders and former president George W.

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Bush. For the full agenda and event details,

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visit beckershospitalreview.com

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and click on the events tab in the

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upper right. We're looking forward to hosting you

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here in Chicago.

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Hello, everyone, and welcome to Becker's Healthcare Podcast.

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I'm Scott King. Thrilled today to be joined

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by a very special guest, Christy Spencer, vice

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president of provider partnerships

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with Elevent's Health. Christy, how are you? Thanks

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so much for joining the podcast.

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Yeah. I'm doing great. It's great to be

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here with you today. You know, we have

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a lot of big topics, new year, but

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some some new topics and some old ones

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to get into

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in health care and with health plans. But

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before I kinda jump into those, Christy, I

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was wondering if you could please just share

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a little bit about your background and your

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career journey.

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Yeah. Absolutely.

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So as you said, I'm the vice president

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for provider partnerships at EleventHealth.

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In that role, I lead our national strategy

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for provider partnerships and value based care across

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our Medicare, Medicaid, and commercial lines of business.

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So really focusing on improving cost, quality, and

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our member experience.

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I I bring a unique perspective to this

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work because I've spent my career in health

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care

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viewing health care from multiple different angles. So

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I've held leadership positions at hospital systems,

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primary care organizations,

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health plans.

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I've run value based physician partnerships with full

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P and L accountability.

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I've worked directly with providers as they have

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transitioned from fee for service into downside risk

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models.

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So that really that experience really shapes how

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I approach the role.

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So I've seen firsthand that value based care

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only works when it's practical,

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when incentives are aligned,

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data is actionable, and providers are genuinely

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supported and not overwhelmed.

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So my focus at Allavance is on enabling

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provider success,

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reducing friction,

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and building partnerships that deliver measurable outcomes for

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providers,

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members, and for the business.

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Thank you, Christy. And I appreciate you sharing

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all that background info. And, yeah, we're you

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definitely have a unique perspective. And not only

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are you gonna lean on that for your

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with you, today in the podcast, but we're

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really looking forward to having you speak at

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our event, in April to spring payer issues

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roundtable. So excited to have you there. And,

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you you know, the first question I wanna

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get to from your perspective

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and something we hear about at our conferences

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especially

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is how relationships

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are

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changing a bit, evolving a little bit with

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health plans and providers.

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How are your relationship with providers changing as

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both sides face, you know, right now, cost

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pressure

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and workforce shortages?

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Yeah. That's such a great question. Those challenges

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are real.

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Provider relationships

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are becoming more pragmatic

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and interdependent.

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As we look at the landscape costs,

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workforce challenges, and just overall industry

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complexity,

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it's forcing us to shift away from transactional

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contracting

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to true partnerships.

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At a high level, success from my provider

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partnership background,

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it really requires

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three things working

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together, effective provider engagement,

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well designed incentives,

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and connected actionable data.

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When those elements are aligned, you can really

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begin to create a connected care ecosystem.

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So what's changing most is the conversation.

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Providers don't need more measures or reporting requirements.

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What they need is help removing friction in

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their day to day operations,

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as well as clarity on what actually drives

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outcomes.

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So that means designing incentives that are focused

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that focus attention on

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actions that matter most

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and invest

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in dedicated engagement teams that can meet providers

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where they are and delivering data through unified

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platforms that providers can actually use.

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When you combine that with innovative use of

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technology

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and artificial intelligence,

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you can really start to lower cost, improve

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outcomes,

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and reduce burden all at the same time.

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Our strongest provider relationships today are the ones

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that are built on trust and shared accountability

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and a real commitment to making it easier

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to deliver care, not making it more complex.

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Absolutely. I I think those are a lot

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of things that'll definitely strengthen that provider,

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relationship with with health plans. And, Christy, do

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you have is do you have an example

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of of you you know, I I think

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it was a great point you made. Do

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you have an example of, like, an action

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driven

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incentive

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that that you're trying to incorporate or have

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incorporated?

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Yeah. One of the things that we're doing

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is really focusing around quality outcomes

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and looking at how do we reward providers

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for closing quality care gaps. So we in

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in this year are beginning to

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expand our reach

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of inviting providers in to participate in our

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pay for quality program

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that really incentivizes

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providers to

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close care gaps and aligns and simplifies the

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work for them to actually do that. So

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we're super excited about being able to expand

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that program this year.

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Where do you see the biggest gap

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right now between payer strategy and operational

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execution?

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Yeah. I I don't know that I would

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describe it necessarily

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as a gap,

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maybe more as a moment of transition for

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the industry.

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Okay. The the future of health care really

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has to be built around outcomes. We've focused

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so much on transactions

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in the past. And moving forward, I think

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we really have to focus on

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aligning around incentives that improve health

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versus just

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just focusing on delivery of services.

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Value based care for Elevance Health, it isn't

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a pilot. It's not a side initiative.

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It's truly how we operate.

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And you can see that embedded in our

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provider

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partnerships,

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in the way that we're designing our products,

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in how we're engaging our consumers.

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And the results that we're seeing are real.

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In 2024,

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65.5%

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of our total medical

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spend was aligned to value based care, and

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37%

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of that was in shared risk, which is

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an increase over the prior year.

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And the impact,

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of that, the outcomes are really impactful.

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In our, Medicare Advantage plans, we're seeing that

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value based providers

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demonstrated

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3.9%

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lower MLR

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compared to non value based providers,

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and they've outperformed

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year over year on nearly 74%

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of our STARS quality measures.

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Additionally,

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76%

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of our value based practices improved their overall

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stars performance

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in that same period.

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So the strategy is right, yet it it

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really only works

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when it shows up simply and clearly. Ideally,

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it's directly within the provider's work flow

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where it can can really reduce complexity.

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And so that's where the next phase of

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operational excellence

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really matters.

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Along the same lines of reducing complexity, Christy,

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what's one investment or initiative you believe will

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most reshape how health plans operate over the

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next two to three years?

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That's a great question. As I stated in

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my intro, I've worked across

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multiple,

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components of the health care ecosystem, hospitals,

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physician groups, health plans.

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And that's that perspective has reinforced one thing

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for me. Partnerships have been done well or

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one of the most powerful levers that we

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have.

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Many providers,

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particularly smaller and independent groups,

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are operating in constrained environments.

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They have the ability to succeed in value

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based care, but they often just don't have

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the scale, the infrastructure, or the support that's

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needed

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to make that transition effectively.

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That's where our national value partners play a

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really critical role. So we work with these

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partners to extend capabilities

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to smaller provider groups,

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and they help those smaller provider groups standardize

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data

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flows, close care gaps, and prioritize

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interventions that actually move outcomes at a clinical

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level.

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The goal isn't

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to favor larger providers. It's really about lifting

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performance

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across the overall ecosystem

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to make value based care accessible and sustainable

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for providers of all sizes.

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So when when payers and these national

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value partners

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team up with our local providers and share

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knowledge

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and operate in an integrated system,

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everyone benefits, providers get the tools and support

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they need,

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health plans see better cost and quality performance,

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and members receive more coordinated and proactive care.

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So it's a true partnership model that's focused

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on enabling.

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That's really what's gonna help reshape

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how health plans operate over the next few

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years.

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Yeah. I really like that point about lifting

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performance across the board and kind of focusing

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there and not just, you know, it's just

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not just about paying attention to the big

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ones. I think, yeah, everyone benefits from that,

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and that it's such a great, you know,

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use of time and effort to focus on

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that.

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If you could change one

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regulatory or industry practice tomorrow to improve affordability

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and access,

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what would it be and why?

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Yeah. That's another great question. Yeah. I think

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there's such a need for simplification

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in the industry. So I would simplify

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and standardize administrative requirements across the industry,

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particularly

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around two areas, prior authorization

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and quality reporting.

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Traditionally, health plans have focused on paying for

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care, managing costs, and ensuring quality.

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Today, though, we recognize that most of the

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drivers of health happen outside of the clinical

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setting.

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In

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excessive administrative burden, it really pulls time and

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resources away from where it matters most.

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At Elevent's Health, we're using advanced digital tools

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and artificial intelligence to make health care simpler

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and more affordable and more personalized.

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This empowers our care providers to enhance health

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outcomes.

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So, for example,

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we're using digital tools to help identify care

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gaps quickly

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and support treatment decisions,

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and that really is helping improve health outcomes.

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We're also appropriately

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leveraging

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digital technologies

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for tasks like

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claims review and provider data updates,

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and it's helping us to ensure smoother and

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faster service.

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So as a result,

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AI enabled tools are cutting down on time

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consuming tasks

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so care providers can focus

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more time with patients.

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So my hope is that a more holistic

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and streamlined approach becomes the norm,

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one where digital advances are used to personalize

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care and eliminate friction, not not add to

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it. We have enough adding to friction in

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the industry.

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So so again, success really, really comes back

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to those three key elements working together in

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concert.

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Effective provider engagement,

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well designed incentives,

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and connected data working together.

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So the big picture is then a connected

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care ecosystem.

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Yeah. I think digital tools are obviously making

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a huge difference for health plans right now

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in so many regards.

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What digital tool do you think has helped

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the LVNs the most?

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Yeah. I think that that we're really focused

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on there's there's several digital tools that we're

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work working through. One of them is that

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we are using digital technologies to automate

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our post call,

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wrap up summaries,

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and we're incorporating

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issue detection and smart routing into each of

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those calls that which really helps to improve

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our associates' ability to manage large call volumes

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and enhance the customer experience.

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So each month, we're averaging about 1,000,000

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post call

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wrap up summaries, which translates into really meaningful

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time savings and better experience.

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And then we're using those same capabilities

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externally

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to help providers spend less time on administrative

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work and more time with patients. So that

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whether it's

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time spent reviewing claims or processing provider data

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updates or identifying care gaps, the goal is

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really the same. We're simplifying how we work,

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we're

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personalizing

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experience,

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and really empowering

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providers to enhance health outcomes.

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That's incredible. Not only think about how much

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time was is saved with with that, but

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what people can do with that time. That's

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I think it's phenomenal.

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The last question I have for you, Christy,

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what issue is putting the most pressure

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on health plan margins right now, and how

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are you responding differently or how will you

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respond differently in in 2026

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here? Yeah. And we we touch on that

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a little bit. Yeah.

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Health care costs, they're shaped by many forces.

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Hospital prices, pharmaceutical

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costs, health insurance costs,

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advances in technology,

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changing regulations.

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We we all have a role to play,

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across the entire health care ecosystem

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to help make sure that members are receiving

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the care that they need at the most

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affordable cost. It's it's a really important

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focus for Elevance.

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In 2026,

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my provider partnership team is focused on

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optimizing our value based portfolio

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and scaling

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risk where providers are ready and investing in

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enablement to really truly drive health care,

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outcomes and affordability.

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And as we've talked about previously,

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technology and AI are such a critical part

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of that.

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And it's not about creating tech for tech's

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sake. The main goal really is about improving

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the health care experience

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for both providers and members.

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So I talked a little bit about internal

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automation and how much time we're able to

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spend

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or how much time we're able

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to save by removing those manual tasks and

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allowing greater focus, for our members and for

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their experiences.

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And we're deploying those,

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same capabilities

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for our care providers to really do the

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same and and really in enabling them to

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focus their time with patients.

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So margin improvement,

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from my view, comes from

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enabling the right partnerships

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at the right level of risk with the

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right support

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and measuring success by outcome and not activity.

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So again, success comes from

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those three elements working together:

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effective provider engagement,

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well designed incentives, and connected actionable data. When

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those elements are aligned,

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you can really start to create a connected

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care ecosystem

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that produces better outcomes and affordability for our

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members.

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Christy, thanks so much for joining the podcast.

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It was a great conversation. I look forward

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to working with you again soon.

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Likewise. Thank you so much for your time

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and for having me today.