1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:12,179 payer and health plan executives 5 00:00:12,484 --> 00:00:16,504 and more than 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:34,049 --> 00:00:36,609 Hello, everyone. This is Elizabeth Caslow with the 14 00:00:36,609 --> 00:00:39,729 Becker's Payer Issues podcast. I'm thrilled today to 15 00:00:39,729 --> 00:00:41,109 be joined by Lila Benahoun, 16 00:00:41,565 --> 00:00:45,164 chief operating officer at MetroPlus Health. Lila, thanks 17 00:00:45,164 --> 00:00:47,245 so much for chatting with us today. Thank 18 00:00:47,245 --> 00:00:48,685 you so much for having me. Very excited 19 00:00:48,685 --> 00:00:49,744 to be here. Thank you. 20 00:00:50,284 --> 00:00:52,784 Great. So before we jump into the conversation, 21 00:00:52,924 --> 00:00:54,140 I would love to hear a bit more 22 00:00:54,140 --> 00:00:56,960 about you and your health care career background 23 00:00:57,340 --> 00:00:58,939 and just an overview of your current role 24 00:00:58,939 --> 00:01:00,239 at MetroPlus Health. 25 00:01:01,020 --> 00:01:03,179 Sure. I'm Lila Benyon. As and as you 26 00:01:03,179 --> 00:01:05,280 mentioned, I'm the chief operating officer at MetroPlus 27 00:01:05,420 --> 00:01:07,444 Health. We are a health plan that services 28 00:01:07,444 --> 00:01:08,965 approximately 700,000 29 00:01:08,965 --> 00:01:11,045 members in New York City in all five 30 00:01:11,045 --> 00:01:11,545 boroughs. 31 00:01:12,244 --> 00:01:13,924 I have been in the health care space 32 00:01:13,924 --> 00:01:15,144 for over twenty years, 33 00:01:15,604 --> 00:01:18,004 very specifically in managed care. And so it 34 00:01:18,004 --> 00:01:20,569 has been very interesting to see the managed 35 00:01:20,569 --> 00:01:23,689 care environment evolve over the span of twenty 36 00:01:23,689 --> 00:01:24,430 so years. 37 00:01:24,730 --> 00:01:26,569 And so it's pretty exciting to see the 38 00:01:26,569 --> 00:01:29,930 different regulatory environment shifting and changing and how 39 00:01:29,930 --> 00:01:31,630 that plays out to our members. 40 00:01:32,045 --> 00:01:33,024 I joined MetroPlus 41 00:01:33,325 --> 00:01:35,584 Health in 2021, 42 00:01:35,804 --> 00:01:38,685 and we really focus on various products to 43 00:01:38,685 --> 00:01:41,185 service our members. And I really focus on 44 00:01:41,405 --> 00:01:44,284 operational and service excellence. It's just always keeping 45 00:01:44,284 --> 00:01:46,364 the members and our providers at the center 46 00:01:46,364 --> 00:01:47,664 of everything that we do. 47 00:01:48,420 --> 00:01:50,420 And today, we wanted to have you on 48 00:01:50,420 --> 00:01:53,319 because your team recently released the CareCrunch Index. 49 00:01:53,780 --> 00:01:55,620 So what are some of the biggest takeaways 50 00:01:55,620 --> 00:01:58,420 for insurance leaders to take note of from 51 00:01:58,420 --> 00:01:59,159 this research? 52 00:02:00,194 --> 00:02:02,194 Yes. And so thank you for that question. 53 00:02:02,594 --> 00:02:04,515 One of the clearest takeaways is that health 54 00:02:04,515 --> 00:02:06,855 care affordability is no longer an abstract 55 00:02:07,234 --> 00:02:10,455 concern. It is actively reshaping household decision. 56 00:02:10,835 --> 00:02:12,354 So what we found was that forty two 57 00:02:12,354 --> 00:02:14,115 percent of New Yorkers told us that they 58 00:02:14,115 --> 00:02:16,090 have to cut back on leisure 59 00:02:16,389 --> 00:02:19,129 or lifestyle spending because of health care costs. 60 00:02:19,509 --> 00:02:21,270 And nearly half of them said that they 61 00:02:21,270 --> 00:02:23,669 cannot afford a thousand dollar medical bill without 62 00:02:23,669 --> 00:02:25,590 going into debt. So so it is a 63 00:02:25,590 --> 00:02:27,669 major concern in terms of cost and and 64 00:02:27,669 --> 00:02:28,330 the impacts 65 00:02:28,709 --> 00:02:29,610 of New Yorkers. 66 00:02:29,995 --> 00:02:32,795 Another important signal for insurance leaders is that 67 00:02:32,795 --> 00:02:33,295 affordability 68 00:02:33,675 --> 00:02:34,575 pressure is widespread. 69 00:02:34,955 --> 00:02:37,115 So it's not just limited to to the 70 00:02:37,115 --> 00:02:39,675 lowest income bracket, but it's also we're seeing 71 00:02:39,675 --> 00:02:41,435 that blend over and bleed over to the 72 00:02:41,435 --> 00:02:43,969 middle income earners, which is telling us that 73 00:02:43,969 --> 00:02:46,229 it's really important for us to consider, 74 00:02:46,930 --> 00:02:48,150 the benefit design, 75 00:02:48,610 --> 00:02:51,169 making sure that the information that we, 76 00:02:51,650 --> 00:02:54,550 deliver to our members have clear and concise 77 00:02:55,055 --> 00:02:57,295 and that we are mindful of any out 78 00:02:57,295 --> 00:02:57,875 of pocket, 79 00:02:58,415 --> 00:03:00,594 cost of expenditure so that the predictability 80 00:03:00,895 --> 00:03:03,295 is there so that when our members are 81 00:03:03,295 --> 00:03:05,555 budgeting, they they know how to better budget. 82 00:03:06,175 --> 00:03:06,915 And finally, 83 00:03:07,870 --> 00:03:10,530 there is a disconnect between confidence and clarity. 84 00:03:10,830 --> 00:03:12,930 Many people feel that they understand insurance, 85 00:03:13,310 --> 00:03:15,629 but when when when push comes to shove, 86 00:03:15,629 --> 00:03:17,730 they still struggle with a very basic, 87 00:03:18,349 --> 00:03:20,909 time sensitive moments like open enrollment. And so 88 00:03:20,909 --> 00:03:23,409 that was eye opening to us as well. 89 00:03:24,405 --> 00:03:26,245 So to follow-up, you know, based on your 90 00:03:26,245 --> 00:03:28,504 role as COO, how do you translate 91 00:03:28,884 --> 00:03:30,905 survey data showing these affordability 92 00:03:31,205 --> 00:03:31,705 concerns 93 00:03:32,164 --> 00:03:33,384 into concrete changes? 94 00:03:34,164 --> 00:03:36,485 So for us, for Measure Plus, we use 95 00:03:36,485 --> 00:03:38,310 data like a road map, 96 00:03:38,870 --> 00:03:41,030 and sort of illuminates a path forward to 97 00:03:41,030 --> 00:03:43,189 us in making decisions on how we can 98 00:03:43,189 --> 00:03:44,729 better service our members, 99 00:03:45,349 --> 00:03:47,189 and making sure that we are true value 100 00:03:47,189 --> 00:03:49,270 to them. And so when we see that 101 00:03:49,270 --> 00:03:52,074 people are worried about unexpected costs, we look 102 00:03:52,074 --> 00:03:54,235 at where we can reduce that friction and 103 00:03:54,235 --> 00:03:55,055 that surprise. 104 00:03:55,754 --> 00:03:57,995 Meaning, we look at the way we design 105 00:03:57,995 --> 00:04:00,074 our plans, making sure it's low to no 106 00:04:00,074 --> 00:04:00,574 premium, 107 00:04:01,275 --> 00:04:04,794 predictable co pays, and benefits that support everyday 108 00:04:04,794 --> 00:04:06,735 needs, not and not just clinical care. 109 00:04:07,460 --> 00:04:10,340 Where health plans often fall short is assuming 110 00:04:10,340 --> 00:04:12,120 that access equals understanding. 111 00:04:12,740 --> 00:04:15,459 Coverage can be technically affordable, but if members 112 00:04:15,459 --> 00:04:17,379 do not know how to use it, when 113 00:04:17,379 --> 00:04:19,379 to enroll, or where to go with questions, 114 00:04:19,379 --> 00:04:21,560 the system will still fail them. And so 115 00:04:21,704 --> 00:04:23,865 we have to be very, very aware of 116 00:04:23,865 --> 00:04:25,164 who our members are, 117 00:04:25,865 --> 00:04:28,104 and just making sure that we're meeting them 118 00:04:28,104 --> 00:04:29,964 at their level so that they understand 119 00:04:31,224 --> 00:04:33,625 certain important events like open enrollment so they 120 00:04:33,625 --> 00:04:35,324 get the health insurance that they need. 121 00:04:35,699 --> 00:04:37,560 Operationally, we focus on simplicity, 122 00:04:38,019 --> 00:04:39,079 high touch support. 123 00:04:40,019 --> 00:04:41,939 We try to go to where members are. 124 00:04:41,939 --> 00:04:44,339 Right? We have community offices throughout the five 125 00:04:44,339 --> 00:04:44,839 boroughs. 126 00:04:45,300 --> 00:04:46,759 We're we're at facilities. 127 00:04:47,539 --> 00:04:49,459 We're one phone call away. And so we 128 00:04:49,459 --> 00:04:50,974 really wanna make sure that 129 00:04:51,435 --> 00:04:53,914 our members know that we are there to 130 00:04:53,914 --> 00:04:55,774 support them and their life changes. 131 00:04:56,634 --> 00:04:58,394 That makes a lot of sense. And speaking 132 00:04:58,394 --> 00:05:01,194 about knowing your members, the survey did highlight 133 00:05:01,194 --> 00:05:03,214 racial and ethnic disparities with affordability. 134 00:05:03,870 --> 00:05:06,209 So what are the biggest operational challenges 135 00:05:06,829 --> 00:05:09,250 in delivering truly low cost care to populations 136 00:05:09,470 --> 00:05:11,250 that are more likely to face these concerns? 137 00:05:11,790 --> 00:05:13,949 Right. So one of the biggest challenges is 138 00:05:13,949 --> 00:05:16,449 that cost pressure does not exist in isolation. 139 00:05:17,115 --> 00:05:19,935 Communities that are more likely to report affordability 140 00:05:20,235 --> 00:05:23,214 concerns are also navigating language barriers, 141 00:05:23,915 --> 00:05:24,735 work schedules, 142 00:05:25,194 --> 00:05:26,495 that limit flexibility, 143 00:05:27,035 --> 00:05:28,254 transportation challenges, 144 00:05:29,089 --> 00:05:31,170 and just a lower trust and confidence in 145 00:05:31,170 --> 00:05:32,470 health care system overall, 146 00:05:33,250 --> 00:05:35,250 making sure that they have access to care 147 00:05:35,250 --> 00:05:36,470 when they need the care. 148 00:05:36,930 --> 00:05:40,290 From an operation standpoint, delivering low cost care 149 00:05:40,290 --> 00:05:43,350 means investing beyond the traditional insurance model. 150 00:05:43,774 --> 00:05:47,694 It means culturally competent outreach, multilingual support, and 151 00:05:47,694 --> 00:05:50,095 benefits that address social needs like food and 152 00:05:50,095 --> 00:05:50,595 transportation. 153 00:05:51,134 --> 00:05:53,055 So we wanna make sure that a good 154 00:05:53,055 --> 00:05:54,274 portion of our workforce 155 00:05:54,895 --> 00:05:57,055 speak various languages so that when a member 156 00:05:57,055 --> 00:05:59,519 calls, we could really communicate with them at 157 00:05:59,519 --> 00:06:01,379 their level. That's such an important, 158 00:06:01,839 --> 00:06:03,220 way that we operate. 159 00:06:04,240 --> 00:06:06,959 And also requires sustained engagement. So you cannot 160 00:06:06,959 --> 00:06:09,519 solve disparities with a single enrollment period or 161 00:06:09,519 --> 00:06:12,399 campaign. We need to continue to be a 162 00:06:12,399 --> 00:06:14,180 presence in the in the communities, 163 00:06:14,884 --> 00:06:16,884 making sure that our members know that we're 164 00:06:16,884 --> 00:06:19,205 available in there and letting them know where 165 00:06:19,205 --> 00:06:20,805 they can where and how they can reach 166 00:06:20,805 --> 00:06:21,545 out to us. 167 00:06:22,245 --> 00:06:24,185 And so that's very important to us. 168 00:06:25,045 --> 00:06:26,725 How have you built out just to follow-up, 169 00:06:26,725 --> 00:06:28,560 how have you built out those community efforts 170 00:06:28,800 --> 00:06:30,980 in recent times, and what languages 171 00:06:31,919 --> 00:06:32,740 are you placing 172 00:06:33,040 --> 00:06:35,620 the most investment in right now? You're seeing 173 00:06:35,680 --> 00:06:36,720 a lot of your members, 174 00:06:37,040 --> 00:06:38,100 needing those resources. 175 00:06:38,959 --> 00:06:39,860 Sure. So 176 00:06:40,160 --> 00:06:41,699 we are trying to have 177 00:06:42,194 --> 00:06:43,814 Spanish speaking individuals, 178 00:06:44,995 --> 00:06:46,055 Mandarin and Chinese, 179 00:06:46,435 --> 00:06:48,854 Urdu. So we we identify the top 180 00:06:49,235 --> 00:06:51,714 five or so languages that are commonly spoken 181 00:06:51,714 --> 00:06:52,615 in our population. 182 00:06:53,714 --> 00:06:56,194 And then also those individuals that are in 183 00:06:56,194 --> 00:06:58,669 the community, we have community office locations throughout 184 00:06:58,669 --> 00:06:59,569 all five boroughs, 185 00:07:00,029 --> 00:07:02,370 and, we let the our members and consumers 186 00:07:02,430 --> 00:07:04,290 know that we are there for them. 187 00:07:04,750 --> 00:07:07,649 And we also let the language speaking individuals 188 00:07:07,709 --> 00:07:08,930 there as well so that 189 00:07:09,389 --> 00:07:12,235 they're not timid or intimidated to come over 190 00:07:12,235 --> 00:07:12,975 to MetroPlus 191 00:07:13,355 --> 00:07:14,415 and ask the questions, 192 00:07:14,875 --> 00:07:17,915 and that we are a valued partner in 193 00:07:17,915 --> 00:07:20,074 their life and and that we want to 194 00:07:20,074 --> 00:07:22,095 make sure that they can rely on MetroPlus 195 00:07:22,475 --> 00:07:24,314 in supporting them in their times of needs, 196 00:07:24,314 --> 00:07:26,069 health care, whatever the case may be. 197 00:07:26,790 --> 00:07:28,949 So another thing you mentioned earlier with the 198 00:07:28,949 --> 00:07:31,830 general findings was the survey found that seventy 199 00:07:31,830 --> 00:07:34,410 nine percent of respondents feel they understand insurance, 200 00:07:34,470 --> 00:07:35,930 but only 60% 201 00:07:36,149 --> 00:07:37,770 know when open enrollment happens. 202 00:07:38,084 --> 00:07:40,745 So what's the hardest part about that simplification 203 00:07:41,125 --> 00:07:42,425 you talked about earlier 204 00:07:42,725 --> 00:07:44,884 with open enrollment, especially when it comes to 205 00:07:44,884 --> 00:07:46,824 younger and lower income populations? 206 00:07:47,285 --> 00:07:49,604 Yeah. That's a really good question. So open 207 00:07:49,604 --> 00:07:51,604 enrollment is one of the most important moments 208 00:07:51,604 --> 00:07:52,904 in the insurance experience, 209 00:07:53,550 --> 00:07:55,310 but it's also one of the most complex. 210 00:07:55,310 --> 00:07:57,550 You're competing. We have all this information coming 211 00:07:57,550 --> 00:07:59,649 at you, and it's very hard to decipher 212 00:08:00,189 --> 00:08:02,750 which one would would be the best fit 213 00:08:02,750 --> 00:08:03,649 for the individual. 214 00:08:04,189 --> 00:08:07,665 Also, timelines vary. Terminology is confusing. The process 215 00:08:07,665 --> 00:08:10,064 often assumes people have the time and the 216 00:08:10,064 --> 00:08:11,904 bandwidth to navigate this on top of their 217 00:08:11,904 --> 00:08:14,064 day to day activities. Right? And so for 218 00:08:14,064 --> 00:08:15,925 younger and lower income populations, 219 00:08:16,225 --> 00:08:18,485 competing priorities are a real barrier. 220 00:08:19,149 --> 00:08:19,889 Health insurance 221 00:08:20,189 --> 00:08:22,769 may not feel urgent until something goes wrong. 222 00:08:23,229 --> 00:08:26,269 Add add adding in the digital fatigue or 223 00:08:26,269 --> 00:08:27,729 lack of clear reminders, 224 00:08:28,189 --> 00:08:30,349 it's very easy to miss the open enrollment 225 00:08:30,349 --> 00:08:32,769 period. And so crucial that individuals 226 00:08:33,309 --> 00:08:35,925 select their insurance carrier during that open enrollment 227 00:08:35,925 --> 00:08:37,785 period. So we really have 228 00:08:38,325 --> 00:08:40,965 to set the reminders, making sure that the 229 00:08:40,965 --> 00:08:43,465 individuals understand this very important event. 230 00:08:44,325 --> 00:08:46,565 The hardest part is cutting through the noise 231 00:08:46,565 --> 00:08:47,384 with clear, 232 00:08:47,764 --> 00:08:49,545 repeated, and human communication. 233 00:08:50,100 --> 00:08:51,000 So at MetroPlus, 234 00:08:51,459 --> 00:08:54,339 we focus on making enrollment feel approachable, not 235 00:08:54,339 --> 00:08:57,139 intimidating, and ensuring members know there is a 236 00:08:57,139 --> 00:08:58,980 real person that they can talk to whenever 237 00:08:58,980 --> 00:08:59,720 they need, 238 00:09:00,179 --> 00:09:02,039 and get their questions answered. 239 00:09:03,254 --> 00:09:03,754 Absolutely. 240 00:09:04,535 --> 00:09:06,955 I I love the point about digital fatigue. 241 00:09:07,254 --> 00:09:09,014 I think that's something that we see so 242 00:09:09,014 --> 00:09:11,274 often, especially with those younger populations. 243 00:09:12,055 --> 00:09:13,415 I was just wondering if you have any 244 00:09:13,415 --> 00:09:15,675 final thoughts or advice for industry leaders 245 00:09:16,120 --> 00:09:19,259 and how you recommend translating these findings beyond 246 00:09:19,319 --> 00:09:22,439 the New York market. Yeah. So it's really 247 00:09:22,439 --> 00:09:25,000 important to know and remember that our members 248 00:09:25,000 --> 00:09:26,919 are the center of everything that we do. 249 00:09:26,919 --> 00:09:28,539 And so we need to listen 250 00:09:28,894 --> 00:09:31,855 and pause and recalibrate our approach and service 251 00:09:31,855 --> 00:09:33,934 offerings so that we are meeting the needs 252 00:09:33,934 --> 00:09:35,794 of our member at that point in time. 253 00:09:36,575 --> 00:09:38,095 And so and that and that we need 254 00:09:38,095 --> 00:09:40,335 to consider not just the demography of the 255 00:09:40,335 --> 00:09:42,830 members, the income level of members, but also 256 00:09:42,830 --> 00:09:45,070 the the various life stages of the member, 257 00:09:45,070 --> 00:09:46,610 and we have to meet them there. 258 00:09:47,070 --> 00:09:49,149 And so that's an important, I think, an 259 00:09:49,149 --> 00:09:50,929 important lesson that we've learned, 260 00:09:51,230 --> 00:09:52,990 and that we carry through in our day 261 00:09:52,990 --> 00:09:55,394 to day operations. And so I just think 262 00:09:55,394 --> 00:09:57,475 in general, it's important for us to take 263 00:09:57,475 --> 00:10:00,754 pause and really listen to what our members 264 00:10:00,754 --> 00:10:01,254 need. 265 00:10:01,794 --> 00:10:03,634 Well, Lila, thank you so much for joining 266 00:10:03,634 --> 00:10:05,394 us today. It was great having you. It 267 00:10:05,394 --> 00:10:07,133 was a pleasure. Thank you for having me. 268 00:10:07,373 --> 00:10:09,453 Awesome. Well, to our listeners, if you'd like 269 00:10:09,453 --> 00:10:11,713 to listen to more podcasts from Becker's Healthcare, 270 00:10:11,773 --> 00:10:14,513 you can visit beckershospitalreview.com. 271 00:10:14,573 --> 00:10:15,313 Thank you.