This is where health insurance leadership comes together.
Becker's fourth annual spring payer issues roundtable brings
together over 400
payer and health plan executives
and more than 100 speakers to Chicago April.
This year's event includes keynote conversations with the
industry's top leaders and former president George w
Bush. For the full agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. This is Elizabeth Caslow with the
Becker's Payer Issues podcast. I'm thrilled today to
be joined by Lila Benahoun,
chief operating officer at MetroPlus Health. Lila, thanks
so much for chatting with us today. Thank
you so much for having me. Very excited
to be here. Thank you.
Great. So before we jump into the conversation,
I would love to hear a bit more
about you and your health care career background
and just an overview of your current role
at MetroPlus Health.
Sure. I'm Lila Benyon. As and as you
mentioned, I'm the chief operating officer at MetroPlus
Health. We are a health plan that services
approximately 700,000
members in New York City in all five
boroughs.
I have been in the health care space
for over twenty years,
very specifically in managed care. And so it
has been very interesting to see the managed
care environment evolve over the span of twenty
so years.
And so it's pretty exciting to see the
different regulatory environment shifting and changing and how
that plays out to our members.
I joined MetroPlus
Health in 2021,
and we really focus on various products to
service our members. And I really focus on
operational and service excellence. It's just always keeping
the members and our providers at the center
of everything that we do.
And today, we wanted to have you on
because your team recently released the CareCrunch Index.
So what are some of the biggest takeaways
for insurance leaders to take note of from
this research?
Yes. And so thank you for that question.
One of the clearest takeaways is that health
care affordability is no longer an abstract
concern. It is actively reshaping household decision.
So what we found was that forty two
percent of New Yorkers told us that they
have to cut back on leisure
or lifestyle spending because of health care costs.
And nearly half of them said that they
cannot afford a thousand dollar medical bill without
going into debt. So so it is a
major concern in terms of cost and and
the impacts
of New Yorkers.
Another important signal for insurance leaders is that
affordability
pressure is widespread.
So it's not just limited to to the
lowest income bracket, but it's also we're seeing
that blend over and bleed over to the
middle income earners, which is telling us that
it's really important for us to consider,
the benefit design,
making sure that the information that we,
deliver to our members have clear and concise
and that we are mindful of any out
of pocket,
cost of expenditure so that the predictability
is there so that when our members are
budgeting, they they know how to better budget.
And finally,
there is a disconnect between confidence and clarity.
Many people feel that they understand insurance,
but when when when push comes to shove,
they still struggle with a very basic,
time sensitive moments like open enrollment. And so
that was eye opening to us as well.
So to follow-up, you know, based on your
role as COO, how do you translate
survey data showing these affordability
concerns
into concrete changes?
So for us, for Measure Plus, we use
data like a road map,
and sort of illuminates a path forward to
us in making decisions on how we can
better service our members,
and making sure that we are true value
to them. And so when we see that
people are worried about unexpected costs, we look
at where we can reduce that friction and
that surprise.
Meaning, we look at the way we design
our plans, making sure it's low to no
premium,
predictable co pays, and benefits that support everyday
needs, not and not just clinical care.
Where health plans often fall short is assuming
that access equals understanding.
Coverage can be technically affordable, but if members
do not know how to use it, when
to enroll, or where to go with questions,
the system will still fail them. And so
we have to be very, very aware of
who our members are,
and just making sure that we're meeting them
at their level so that they understand
certain important events like open enrollment so they
get the health insurance that they need.
Operationally, we focus on simplicity,
high touch support.
We try to go to where members are.
Right? We have community offices throughout the five
boroughs.
We're we're at facilities.
We're one phone call away. And so we
really wanna make sure that
our members know that we are there to
support them and their life changes.
That makes a lot of sense. And speaking
about knowing your members, the survey did highlight
racial and ethnic disparities with affordability.
So what are the biggest operational challenges
in delivering truly low cost care to populations
that are more likely to face these concerns?
Right. So one of the biggest challenges is
that cost pressure does not exist in isolation.
Communities that are more likely to report affordability
concerns are also navigating language barriers,
work schedules,
that limit flexibility,
transportation challenges,
and just a lower trust and confidence in
health care system overall,
making sure that they have access to care
when they need the care.
From an operation standpoint, delivering low cost care
means investing beyond the traditional insurance model.
It means culturally competent outreach, multilingual support, and
benefits that address social needs like food and
transportation.
So we wanna make sure that a good
portion of our workforce
speak various languages so that when a member
calls, we could really communicate with them at
their level. That's such an important,
way that we operate.
And also requires sustained engagement. So you cannot
solve disparities with a single enrollment period or
campaign. We need to continue to be a
presence in the in the communities,
making sure that our members know that we're
available in there and letting them know where
they can where and how they can reach
out to us.
And so that's very important to us.
How have you built out just to follow-up,
how have you built out those community efforts
in recent times, and what languages
are you placing
the most investment in right now? You're seeing
a lot of your members,
needing those resources.
Sure. So
we are trying to have
Spanish speaking individuals,
Mandarin and Chinese,
Urdu. So we we identify the top
five or so languages that are commonly spoken
in our population.
And then also those individuals that are in
the community, we have community office locations throughout
all five boroughs,
and, we let the our members and consumers
know that we are there for them.
And we also let the language speaking individuals
there as well so that
they're not timid or intimidated to come over
to MetroPlus
and ask the questions,
and that we are a valued partner in
their life and and that we want to
make sure that they can rely on MetroPlus
in supporting them in their times of needs,
health care, whatever the case may be.
So another thing you mentioned earlier with the
general findings was the survey found that seventy
nine percent of respondents feel they understand insurance,
but only 60%
know when open enrollment happens.
So what's the hardest part about that simplification
you talked about earlier
with open enrollment, especially when it comes to
younger and lower income populations?
Yeah. That's a really good question. So open
enrollment is one of the most important moments
in the insurance experience,
but it's also one of the most complex.
You're competing. We have all this information coming
at you, and it's very hard to decipher
which one would would be the best fit
for the individual.
Also, timelines vary. Terminology is confusing. The process
often assumes people have the time and the
bandwidth to navigate this on top of their
day to day activities. Right? And so for
younger and lower income populations,
competing priorities are a real barrier.
Health insurance
may not feel urgent until something goes wrong.
Add add adding in the digital fatigue or
lack of clear reminders,
it's very easy to miss the open enrollment
period. And so crucial that individuals
select their insurance carrier during that open enrollment
period. So we really have
to set the reminders, making sure that the
individuals understand this very important event.
The hardest part is cutting through the noise
with clear,
repeated, and human communication.
So at MetroPlus,
we focus on making enrollment feel approachable, not
intimidating, and ensuring members know there is a
real person that they can talk to whenever
they need,
and get their questions answered.
Absolutely.
I I love the point about digital fatigue.
I think that's something that we see so
often, especially with those younger populations.
I was just wondering if you have any
final thoughts or advice for industry leaders
and how you recommend translating these findings beyond
the New York market. Yeah. So it's really
important to know and remember that our members
are the center of everything that we do.
And so we need to listen
and pause and recalibrate our approach and service
offerings so that we are meeting the needs
of our member at that point in time.
And so and that and that we need
to consider not just the demography of the
members, the income level of members, but also
the the various life stages of the member,
and we have to meet them there.
And so that's an important, I think, an
important lesson that we've learned,
and that we carry through in our day
to day operations. And so I just think
in general, it's important for us to take
pause and really listen to what our members
need.
Well, Lila, thank you so much for joining
us today. It was great having you. It
was a pleasure. Thank you for having me.
Awesome. Well, to our listeners, if you'd like
to listen to more podcasts from Becker's Healthcare,
you can visit beckershospitalreview.com.
Thank you.