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. Welcome to Becker's Healthcare Podcast. I'm
Scott King. Thrilled today to be joined by
a very special guest, Sareya Sacaccio,
chief medical officer, Essence Healthcare. Sariya, how are
you doing today?
I am doing well, Scott. Thanks so much
for the opportunity to join you today.
It's gonna be great. We have a lot
of big topics and and talking points to
to get to here, but we're really looking
forward to having you speak at our spring
payer issues roundtable in April as well. Can't
wait. So before we get to the questions
and topics, Sariya, I wanted to ask just
kind of about your background. If you could
please share, you know, a little bit about
your your journey into, health care with us.
You bet, Scott. I'm a family physician by
training, and I have worked across the gamut
of clinical care, whether it was in solo
practice, teaching residency programs, and academic institutions.
I've served as a chief medical officer in
several different health systems
and have been on the health plan side
of the industry for the last several years.
I so enjoy the work that we do,
serving our members and ensuring everybody gets the
right care, right place, right time, and has
the right experience
on their journey for health.
Thank you for sharing that. And you the
the first topic I wanted to get to
with your perspective
is how are your relationships
with providers changing? You know, obviously,
both sides are facing regulatory pressures, but specifically
when you you look at cost pressure and
and work for for shortages.
Well, first of all, I am so
glad that we're starting with relationships.
This is the most critical part of the
work that we do. And at the end
of the day, we're in this together.
We are here to provide exceptional care to
patients and those who deserve
that access to care.
And so while perhaps it hasn't changed, there
certainly is a palpable shift and that shift
would be a deepening
of collaboration.
I can't overemphasize
just how important that is and there are
a number of ways that we do that
in our business and with our partners.
First of all, it starts with real time
data.
Everybody needs this accurate data. This is what
I hear asked for the most and the
appreciation
that we have been able to deliver
down to the member level. The data that
impacts the care that our health systems and
providers deliver
in a way that is actionable
so that we can impact that health.
And transparency of strategy. We roll up our
sleeves together
as partners to address the cost of care
of what we do, whether it's determining
the appropriate prior authorizations,
our pharmacy spend and the challenges there, as
we know, we've all struggled with that recently,
or expanding products within our health
plan. That is so important to us. And
finally, I'll say
this is the most important part of this
relationship.
It's listening first,
being curious about the current workflows and expectations
that exist
with our health system providers
so that we can align with the work
already being done. Because this is what we
know. Whether a health system has 17 different
contracts or 27 contracts,
we have got to be a part of
the solution
in developing efficiency
and reliability
so that care is delivered consistently regardless of
who the health payer is.
Yeah. You know, that's really interesting. I I've
heard from a lot of people on the
payer side that that relationship
has changed. Like you said, it's got more
collaborative.
I've heard some some people say it's because,
you know, they think that just both sides
are up against so many regulatory pressures that
both are just trying to figure out a
way to get things done. But your perspective
is interesting because you think it's coming from
a a data perspective, a need for both
sides to kinda share and utilize data. Is
that right? Well, sure. It's a huge part
of the equation here because without information,
you can't drive a strategy that delivers results.
That is critical in the work that we
do. And the more information available,
it's part of our responsibility to make sure
it's delivered in a way that we can
do something with it.
Sariya, where do you see the biggest gap
today between payer strategy and operational execution?
Goodness. There are so many gaps, and I'll
say it's so many solutions
that have developed. I will say what is
most heated
at the moment and the two challenges that
I'm seeing here is
member access
to resources that they need when they need
it. What I mean by that is more
ambulatory access. So Scott, it's rather interesting to
me, not surprising as we're all trying to
shore up margins these days after COVID,
but we saw
a significant
departure in ambulatory
services
and access to resources to health care.
So and I'll give my mother as an
example. She's Medicare Advantage age and has her
own plan she works with, and I say,
mom, the first thing you gotta do is
find out where you can receive these services
at an ambulatory
site. And here's why,
it hits the pocketbook of every member and
frankly at every health plan when services that
can be delivered in an ambulatory space
is turned around, the lights turned out, literally
lights turned out, and shifted back to a
hospital with a huge parking lot, an overwhelming
pathway just to get to the site of
service you need with a significant
price tag.
I do recognize having been on the health
system side
historically
that that's where margins are often shored up,
is in an inpatient facility
structure.
And we feel the pressure from an administration.
We know there's a change. We've got to
get to a point where regardless of the
site of care, that the service delivered that's
the same, cost the same. So that's one
piece. The other,
I'll talk a little bit specifically about pharmacy
gap, the cost of medications
and the member responsibility
and the health plan responsibility.
We have these pressures for the right reasons.
I say that because
we know this. Medications are too expensive today
and they're too expensive for everyone. So those
are two gaps that we have got to
find solutions for and find them quickly.
In terms of finding solutions, what's one investment
or initiative you believe
will will most reshape how health plans operate
over the next two to three years?
Well, I'm gonna shift gears and think more
global
when it comes to an overall investment. And
as a family physician, I'm gonna think population
health first. And, Scott, this is what we
know. More people die of heart disease
than any other condition,
both men and women. We know this. And
in the spirit
of February is heart month and we are
in February,
cardiometabolic
investment is critical
to the future in the quality of life
for all Americans.
So it's not just the medications. That's a
piece of it. We know a driver of
cardiometabolic
impact is obesity. It often starts there. In
fact, it's starting in the pediatric
space and where it used to be in
adulthood that we had to be concerned. So
across that age span, we have got to
be thinking about the investment of lifestyle benefits.
Do people have safe places to walk? Is
it part of the workplace,
the employer space?
How are we involving behavioral health? We know
when people are less active, when they have
chronic conditions such as
diabetes,
heart disease,
heart failure,
they are more likely
to suffer from depression, anxiety,
and other mental health challenges that make it
even harder for their over health to overall
health to improve.
And then finally, those medication barriers.
First one that usually comes to mind for
folks are those GLP one agonists,
and that is because they help reduce,
the weight,
but they also increase the cost of care.
Addressing the barriers in all of these spaces,
investing in a comprehensive approach is something that
we have to do in partnership
across the entire industry.
If you could change
one regulatory
or industry practice tomorrow to improve a 4,000,000,000
access,
what would it be and why?
Well, I hinted at this just a moment
ago. In fact, it was probably more than
a hint. It was an obvious nudge. Site
neutrality
is what's frankly best for our patients
and for overall Americans.
Receiving
the same care at the same price regardless
of the address
really matters to people and really matters to
the increasing cost of care that we see
today. The other is pharmacy,
flattening the cost. How do we identify those
biosimilars
for these fantastic
new life saving and life changing drugs
for these diseases where people have struggled for
so many years? We've got to be quicker
to
provide those biosimilars
for generics to be available and for specialty
cost drugs out of the gate. We have
some therapies now that cost a million dollars
a year.
Now, as we know, fewer and fewer people
will have access to health care
and more people will be uninsured in 2026
and onward.
There will be more people who cannot afford
that million dollar therapy. Again, that can be
life saving, life changing. So those are the
two things, site neutrality and pharmacy flattening of
costs, and we would see a healthier America.
A 100%. And there's certainly a lot more
work to do with with pharmacy costs as
you're alluding alluding to. Another thing is gonna
be a big topic at our Spring Payer
Issues Roundtable.
The last thing I wanted to ask you,
what issue
do you think is putting the most pressure
on health plan margins right now,
and how are you responding differently, for 2026?
Well, for us at Essence and for me
as a clinician,
it always ends with
quality. Quality of care, so I think of
star performance.
There's a tremendous amount of pressure to maintain
where we are. We're a four and a
half star HMO plan. In fact, in all
of our markets, we're the highest rated plan,
very proud of that because that is the
care that our members are receiving and can
rely upon that they will receive by our
providers. It's because that strong relationship and collaboration
we have with our partners. Now that being
said, the bar will continue to rise
in a good way. I remind folks of
this all the time.
We should not be practicing medicine the way
we did five years, ten years ago. We
should get better year after year after year.
What will continue to challenge us
are the social conditions that people are experiencing,
less money in their pocket,
less,
food on the table that's healthy for them
in a way that people can afford these
medications
and their
nourishment.
That's really important. And the investment in services
that close-up all of those gaps in care.
So so many folks forget that
STAR includes
the gaps in care, the operations of the
business, the improvement year over year, and that
finally the experience.
I mentioned my mother a moment ago, and
I always consider what would Mimi do, how
would Mimi feel if she was in a
situation
needed help to health care? And did she
have someone to hold her hand
through the process? And that's what we're here
to do. That's what we should all be
doing is holding the hands of our patients
and ensuring they have an exceptional experience,
know that they're taken care of and can
receive the highest level of care, again, regardless
of location, because at the end of the
day, this is what we do and we
do it together
in health care.
Saree, thank you so much for joining us
on the podcast and for a great conversation.
And, again, we're really looking forward to you
speaking with us in April. Thank you, Scott.
This is important work, and I am grateful
to do it every day.