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and more than 100 speakers to Chicago April.
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industry's top leaders and former president George W.
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visit beckershospitalreview.com
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here in Chicago.
Hello, everyone, and welcome to Becker's Healthcare Podcast.
I'm Scott King. Thrilled today to be joined
by a very special guest, Christy Spencer, vice
president of provider partnerships
with Elevent's Health. Christy, how are you? Thanks
so much for joining the podcast.
Yeah. I'm doing great. It's great to be
here with you today. You know, we have
a lot of big topics, new year, but
some some new topics and some old ones
to get into
in health care and with health plans. But
before I kinda jump into those, Christy, I
was wondering if you could please just share
a little bit about your background and your
career journey.
Yeah. Absolutely.
So as you said, I'm the vice president
for provider partnerships at EleventHealth.
In that role, I lead our national strategy
for provider partnerships and value based care across
our Medicare, Medicaid, and commercial lines of business.
So really focusing on improving cost, quality, and
our member experience.
I I bring a unique perspective to this
work because I've spent my career in health
care
viewing health care from multiple different angles. So
I've held leadership positions at hospital systems,
primary care organizations,
health plans.
I've run value based physician partnerships with full
P and L accountability.
I've worked directly with providers as they have
transitioned from fee for service into downside risk
models.
So that really that experience really shapes how
I approach the role.
So I've seen firsthand that value based care
only works when it's practical,
when incentives are aligned,
data is actionable, and providers are genuinely
supported and not overwhelmed.
So my focus at Allavance is on enabling
provider success,
reducing friction,
and building partnerships that deliver measurable outcomes for
providers,
members, and for the business.
Thank you, Christy. And I appreciate you sharing
all that background info. And, yeah, we're you
definitely have a unique perspective. And not only
are you gonna lean on that for your
with you, today in the podcast, but we're
really looking forward to having you speak at
our event, in April to spring payer issues
roundtable. So excited to have you there. And,
you you know, the first question I wanna
get to from your perspective
and something we hear about at our conferences
especially
is how relationships
are
changing a bit, evolving a little bit with
health plans and providers.
How are your relationship with providers changing as
both sides face, you know, right now, cost
pressure
and workforce shortages?
Yeah. That's such a great question. Those challenges
are real.
Provider relationships
are becoming more pragmatic
and interdependent.
As we look at the landscape costs,
workforce challenges, and just overall industry
complexity,
it's forcing us to shift away from transactional
contracting
to true partnerships.
At a high level, success from my provider
partnership background,
it really requires
three things working
together, effective provider engagement,
well designed incentives,
and connected actionable data.
When those elements are aligned, you can really
begin to create a connected care ecosystem.
So what's changing most is the conversation.
Providers don't need more measures or reporting requirements.
What they need is help removing friction in
their day to day operations,
as well as clarity on what actually drives
outcomes.
So that means designing incentives that are focused
that focus attention on
actions that matter most
and invest
in dedicated engagement teams that can meet providers
where they are and delivering data through unified
platforms that providers can actually use.
When you combine that with innovative use of
technology
and artificial intelligence,
you can really start to lower cost, improve
outcomes,
and reduce burden all at the same time.
Our strongest provider relationships today are the ones
that are built on trust and shared accountability
and a real commitment to making it easier
to deliver care, not making it more complex.
Absolutely. I I think those are a lot
of things that'll definitely strengthen that provider,
relationship with with health plans. And, Christy, do
you have is do you have an example
of of you you know, I I think
it was a great point you made. Do
you have an example of, like, an action
driven
incentive
that that you're trying to incorporate or have
incorporated?
Yeah. One of the things that we're doing
is really focusing around quality outcomes
and looking at how do we reward providers
for closing quality care gaps. So we in
in this year are beginning to
expand our reach
of inviting providers in to participate in our
pay for quality program
that really incentivizes
providers to
close care gaps and aligns and simplifies the
work for them to actually do that. So
we're super excited about being able to expand
that program this year.
Where do you see the biggest gap
right now between payer strategy and operational
execution?
Yeah. I I don't know that I would
describe it necessarily
as a gap,
maybe more as a moment of transition for
the industry.
Okay. The the future of health care really
has to be built around outcomes. We've focused
so much on transactions
in the past. And moving forward, I think
we really have to focus on
aligning around incentives that improve health
versus just
just focusing on delivery of services.
Value based care for Elevance Health, it isn't
a pilot. It's not a side initiative.
It's truly how we operate.
And you can see that embedded in our
provider
partnerships,
in the way that we're designing our products,
in how we're engaging our consumers.
And the results that we're seeing are real.
In 2024,
65.5%
of our total medical
spend was aligned to value based care, and
37%
of that was in shared risk, which is
an increase over the prior year.
And the impact,
of that, the outcomes are really impactful.
In our, Medicare Advantage plans, we're seeing that
value based providers
demonstrated
3.9%
lower MLR
compared to non value based providers,
and they've outperformed
year over year on nearly 74%
of our STARS quality measures.
Additionally,
76%
of our value based practices improved their overall
stars performance
in that same period.
So the strategy is right, yet it it
really only works
when it shows up simply and clearly. Ideally,
it's directly within the provider's work flow
where it can can really reduce complexity.
And so that's where the next phase of
operational excellence
really matters.
Along the same lines of reducing complexity, Christy,
what's one investment or initiative you believe will
most reshape how health plans operate over the
next two to three years?
That's a great question. As I stated in
my intro, I've worked across
multiple,
components of the health care ecosystem, hospitals,
physician groups, health plans.
And that's that perspective has reinforced one thing
for me. Partnerships have been done well or
one of the most powerful levers that we
have.
Many providers,
particularly smaller and independent groups,
are operating in constrained environments.
They have the ability to succeed in value
based care, but they often just don't have
the scale, the infrastructure, or the support that's
needed
to make that transition effectively.
That's where our national value partners play a
really critical role. So we work with these
partners to extend capabilities
to smaller provider groups,
and they help those smaller provider groups standardize
data
flows, close care gaps, and prioritize
interventions that actually move outcomes at a clinical
level.
The goal isn't
to favor larger providers. It's really about lifting
performance
across the overall ecosystem
to make value based care accessible and sustainable
for providers of all sizes.
So when when payers and these national
value partners
team up with our local providers and share
knowledge
and operate in an integrated system,
everyone benefits, providers get the tools and support
they need,
health plans see better cost and quality performance,
and members receive more coordinated and proactive care.
So it's a true partnership model that's focused
on enabling.
That's really what's gonna help reshape
how health plans operate over the next few
years.
Yeah. I really like that point about lifting
performance across the board and kind of focusing
there and not just, you know, it's just
not just about paying attention to the big
ones. I think, yeah, everyone benefits from that,
and that it's such a great, you know,
use of time and effort to focus on
that.
If you could change one
regulatory or industry practice tomorrow to improve affordability
and access,
what would it be and why?
Yeah. That's another great question. Yeah. I think
there's such a need for simplification
in the industry. So I would simplify
and standardize administrative requirements across the industry,
particularly
around two areas, prior authorization
and quality reporting.
Traditionally, health plans have focused on paying for
care, managing costs, and ensuring quality.
Today, though, we recognize that most of the
drivers of health happen outside of the clinical
setting.
In
excessive administrative burden, it really pulls time and
resources away from where it matters most.
At Elevent's Health, we're using advanced digital tools
and artificial intelligence to make health care simpler
and more affordable and more personalized.
This empowers our care providers to enhance health
outcomes.
So, for example,
we're using digital tools to help identify care
gaps quickly
and support treatment decisions,
and that really is helping improve health outcomes.
We're also appropriately
leveraging
digital technologies
for tasks like
claims review and provider data updates,
and it's helping us to ensure smoother and
faster service.
So as a result,
AI enabled tools are cutting down on time
consuming tasks
so care providers can focus
more time with patients.
So my hope is that a more holistic
and streamlined approach becomes the norm,
one where digital advances are used to personalize
care and eliminate friction, not not add to
it. We have enough adding to friction in
the industry.
So so again, success really, really comes back
to those three key elements working together in
concert.
Effective provider engagement,
well designed incentives,
and connected data working together.
So the big picture is then a connected
care ecosystem.
Yeah. I think digital tools are obviously making
a huge difference for health plans right now
in so many regards.
What digital tool do you think has helped
the LVNs the most?
Yeah. I think that that we're really focused
on there's there's several digital tools that we're
work working through. One of them is that
we are using digital technologies to automate
our post call,
wrap up summaries,
and we're incorporating
issue detection and smart routing into each of
those calls that which really helps to improve
our associates' ability to manage large call volumes
and enhance the customer experience.
So each month, we're averaging about 1,000,000
post call
wrap up summaries, which translates into really meaningful
time savings and better experience.
And then we're using those same capabilities
externally
to help providers spend less time on administrative
work and more time with patients. So that
whether it's
time spent reviewing claims or processing provider data
updates or identifying care gaps, the goal is
really the same. We're simplifying how we work,
we're
personalizing
experience,
and really empowering
providers to enhance health outcomes.
That's incredible. Not only think about how much
time was is saved with with that, but
what people can do with that time. That's
I think it's phenomenal.
The last question I have for you, Christy,
what issue is putting the most pressure
on health plan margins right now, and how
are you responding differently or how will you
respond differently in in 2026
here? Yeah. And we we touch on that
a little bit. Yeah.
Health care costs, they're shaped by many forces.
Hospital prices, pharmaceutical
costs, health insurance costs,
advances in technology,
changing regulations.
We we all have a role to play,
across the entire health care ecosystem
to help make sure that members are receiving
the care that they need at the most
affordable cost. It's it's a really important
focus for Elevance.
In 2026,
my provider partnership team is focused on
optimizing our value based portfolio
and scaling
risk where providers are ready and investing in
enablement to really truly drive health care,
outcomes and affordability.
And as we've talked about previously,
technology and AI are such a critical part
of that.
And it's not about creating tech for tech's
sake. The main goal really is about improving
the health care experience
for both providers and members.
So I talked a little bit about internal
automation and how much time we're able to
spend
or how much time we're able
to save by removing those manual tasks and
allowing greater focus, for our members and for
their experiences.
And we're deploying those,
same capabilities
for our care providers to really do the
same and and really in enabling them to
focus their time with patients.
So margin improvement,
from my view, comes from
enabling the right partnerships
at the right level of risk with the
right support
and measuring success by outcome and not activity.
So again, success comes from
those three elements working together:
effective provider engagement,
well designed incentives, and connected actionable data. When
those elements are aligned,
you can really start to create a connected
care ecosystem
that produces better outcomes and affordability for our
members.
Christy, thanks so much for joining the podcast.
It was a great conversation. I look forward
to working with you again soon.
Likewise. Thank you so much for your time
and for having me today.