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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

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payer and health plan executives and more than

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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 the Becker's Healthcare

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Podcast. I'm Scott King. Thrilled today to be

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joined by a very special guest, Karen Walker

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Johnson, chief executive officer of CleverCare Health Plan.

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Karen, how are you doing today? Thanks so

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much for joining us.

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Thank you. Good morning, Scott, and it's a

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pleasure to be here. Thank you. It's a

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privilege to have you. And, you know, we

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have a lot of big topics to get

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to with health plans and and health care

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as always, of course. But before I do

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that, Karen, I was wondering if you just

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kinda tell us a little bit about your

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background and your, career.

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Well, I'm happy to do that. First of

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all, I'm Karen. I'm the chief executive officer

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here at CleverCare.

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I started my career actually,

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in pediatric nursing back in in Detroit.

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And at that time, had the opportunity to

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see firsthand

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a lot of the systemic barriers and and

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just the lack of cultural understanding

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that was unfortunately harmful to families. And so

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since that time, I'm now leading CleverCare, and

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we are a Medicare Advantage Plan,

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which is,

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delivering care from a culturally sensitive

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and competent perspective. And for your readers who

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may not be as familiar with that, basically,

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what that is is that

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we really take into account understanding

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how patients' beliefs and their behaviors

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and their background really influence

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how they how they seek health and ultimately

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what their health come outcomes look like. And

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so as a growing plan we've got right

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now, we've got approximately about 46,000

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members.

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We just had some pretty significant growth,

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and, we are giving our members access to

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care that's delivered in their own language.

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We honor their unique cultural traditions,

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and it's all from a value based care

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model. So we're blending eastern and western medicine.

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Well, I appreciate you sharing your background info

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there, Karen. And it's great to hear about

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CleverCare's growth. That's outstanding.

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The the first the first topic I wanna

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get your perspective on is I wanna ask,

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how do you think

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relationships are or how how is CleverCare's relationships

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with providers changing, you know, as both sides

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kind of face cost pressure and workforce shortages?

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You know, we real realize and I realize

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that our providers are managing quite a bit

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right now, Scott.

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So the best way for us as a

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health plan

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really to think about our relationship

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is really to do it from what we've

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always done. And that is really showing up

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for them by being reliable,

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by being transparent,

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and at the end of the day, really

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being a trustworthy partner. And I've been in

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this business a very long time, and one

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of the things that I know, my experience

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has borne out, is that trust is so

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critically important between a health plan and its

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providers.

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And so we're doing everything we can to

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continue to build upon the trust we've already

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established.

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We are doing things like making sure that

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the benefits that we offer

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are stable and they're reliable and that our

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providers can count on them being that way.

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We know that it's really important that we

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make sure that they get paid on time,

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that they're paid accurately, that we are adjudicating

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claims appropriately.

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All of those things really

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build and and just continue to build upon

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that trust.

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And for us, that that's what it means

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to really help our providers manage through a

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lot of the the cost pressures that you

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mentioned and and some of what we're seeing

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just around workforce. If we're one less thing

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they have to worry about and they can

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rely upon us, we believe that that's very

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helpful.

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Well, do you think on the other side

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of that relationship, do you think that providers

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also feel like health plans have a lot

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going on right now too and they're they're

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kinda understanding of that? Is that a two

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way street right now? Yeah. I do believe

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that. And and, again, I think that's based

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on

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developing that trusting and mutual and respectful

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relationship.

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And so my providers, you know, they say

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sit down with us and say, what can

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we do collaboratively

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to address some of these these these, you

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know, headwinds that we all see. One of

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the examples would be, we employ

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people on our teams who reach out and

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do outreach to our members. You know, what

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we're trying to do with our providers and

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our providers recognize that that's a benefit for

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them. Right? That we're reaching out to their

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patients. We're doing it in collaboration with them,

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and we're doing it in alignment with what

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the physician thinks is important for their patient.

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But that's one way that we are helping

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each other.

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And so

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they may not have that that,

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that person, if you will, on their payroll,

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but

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we do. And so we are sharing the

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responsibility

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and the accountability

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all within mind, making sure that that member

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and their patient gets the best outcome.

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Yeah. I think that collaboration and and understanding

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goes a long way right now with both

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sides. And, Taryn, I also want to ask

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you, where do you see the biggest gap

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today between payer strategy and operational execution?

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Well, one of the ones that I would

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identify is just,

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goes back to, like, the core of what

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CleverCare is, and that is

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not

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viewing

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the cultural needs

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of their membership

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as something more than just an extra.

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So for example, our, you know, our members

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have access to providers who speak their language,

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and they understand their cultural traditions.

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That's essential

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for them to get the care.

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And so it's fundamental to our model of

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care. So we have this very large network

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that includes, you know,

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the top provider facilities and hospitals.

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We have bilingual physicians.

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We've got,

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acupuncturists that we directly contract with. And so

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all of that is something that is addressing

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that gap where plans that are not

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viewing the cultural needs of their members as

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something that's essential.

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Another example I would say is the partnerships

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that you have with with your vendors. And

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and in our case, I'm gonna use nation's

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benefits as an example.

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That's one where we are able to

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through our work with nations, we've added

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culturally tailored supermarket benefits.

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And that's important because it supports the needs

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of our local communities.

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You know, when when they think about the

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foods that they wanna cook and and the

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herbal medicines,

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etcetera, that they want to take.

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By us enhancing

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the

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access through nation's benefit with these national stores

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like a Costco or

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ninety nine Ranch market, which may not be

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as familiar to your listeners. But it is

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a very

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big national chain for us in our communities.

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And so those are the types of things

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that we're focused on. Again, you know, when

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you get back to your question about what

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is a gap that you're we're seeing with

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payer strategies in their operational excellence,

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It is thinking about

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those benefits that are key to meet their

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members, where their members are, and it's also

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making sure that that strategy that you're doing

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is aligned

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with how you execute in practice. And for

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us, again, it is being able to offer

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things like

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the foods that,

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are important

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to our membership

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because we're recognizing those cultural needs that they

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have.

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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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I think it's how we continue to engage

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members

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and knowing and recognizing that engagement really drives

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everything.

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So for us, it, you know, it means

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that

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members are able to access their care in

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their own language.

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It means that they're able to be engaged

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in a way that they are getting that

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care that coincides with the way they're actually

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living.

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We've got, for example, these community centers. We've

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got four community centers. And those community centers,

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Scott, are in

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communities that we're serving, but those community centers

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are built around cultural competence.

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They help to connect our members with the

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communities so that

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those members feel that they can stay in

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control of their health.

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Those those centers, they have and offer a

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blend of of western approaches to wellness as

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well as eastern. And so our members can

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go into those into those centers, and they

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can do things like take a tai chi

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class, for example. Right. And,

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participate in in a course on dental health.

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We do things that build the community. So

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we invite people to come in for things

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like a book club or a birthday celebration.

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All of that, again, is time to engagement,

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and that's an investment and an initiative that's

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really important for a health plan. It allows

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that health plan to to continue to grow,

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but more importantly, it allows them to continue

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to help their members get the best health

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outcomes.

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You know, we recently as I think about

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it, we recently brought on two new provider

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partners,

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one being,

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Blue Zones Health, and the other is is

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CareMore Health. And the reason we did that

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is because both of those groups

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really align with our philosophy around the blend

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of eastern and western medicine,

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around holistic care. Blue Zones, for example, you

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know, is really focused on lifestyle changes and

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longevity practices, and that's fairly important

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in in in our membership.

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CareMore, for example, is, you know, a very

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large primary care practice, but they really are

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committed to some of the core values that

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CleverCare is. That is caring for people from

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a whole person perspective

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and not just whatever their ultimate condition is.

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And so our our members

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are benefiting by these initiatives and these investments

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that we're making in the community, and I

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think that's something that other health plans will

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have to do as well.

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Yeah. I think they might have to adjust.

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Now, Karen, if you could change one

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regulatory or industry industry practice tomorrow to improve

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affordability and access,

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what would it be and why?

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Wow.

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That's a great question.

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You know?

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I I guess I would say that if

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if I if I only had one thing.

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You can you can throw out two if

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you want. But, yeah, let's let's hit one

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first if you can.

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Well, if I go back to my, you

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know, my start in in my career as

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a nurse,

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you know, one of the priorities that I

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found and I was a public health nurse

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as well, Scott. One of the things that

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was really important was what could we do

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to help keep our patients healthy even when

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they had lots of challenges?

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So when I think about something that would

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be, I think, a really beneficial change, it

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would be you know, this we have the

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STARS program, and it's really a helpful way

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to help ensure that health plans are are

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delivering on the promise to focus on the

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right thing. But

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those star programs don't measure cultural competence.

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And so what I'd like to see would

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be a quality metric in star ratings that

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accounts for

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the the additional resources that a plan like

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ours uses. If, for example, our community centers,

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I'd like to see that be something that's

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measured

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so that we could

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ensure that resources are there to serve, you

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know, diverse and linguistically

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isolated populations like ours,

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that we have the ability to continue to

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make sure that we have bilingual providers in

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our network,

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that we can offer

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health education that really is tailored to

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populations that have maybe different needs.

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So if I could have a crystal ball

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and say that's something that could be,

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a a change or an ad, that would

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be it. Okay. I think that's a good

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one.

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And the last the last question I have

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for you, Karen,

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what issue do you think is putting the

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most pressure

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on health plan margins right now,

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and how are you responding differently in 2026?

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Well, I I can't speak for the industry

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as a whole, but I can say that,

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you know, we've seen cost cost, excuse me,

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grow up across the industry. You know?

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Everyone is is aware of that. And the

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way we've been able to deal with that,

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Scott, is by doing, you know, what we've

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been doing best and that's

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providing, you know, cost effective

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care. So, you know, we work very closely

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with our members. We're making sure that they're

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getting the right care, that they they can

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stay healthy,

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and all of that will help to reduce

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cost.

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And it also, more importantly, I think, improves

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health outcomes.

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You know, this year, we're investing in in

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strengthening our our provider partnerships. We think that's

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a really important investment.

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We're investing in clinical programs that help us

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to identify and engage our high risk members.

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You know, that's that gets back to population

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health and really looking at populations

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as opposed to just looking at, you know,

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your membership, you know, from a a very,

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myopic way.

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We're also,

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really keeping in mind that rather than kinda

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cutting our benefits or narrowing our network

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in response to some of those margin pressures,

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we're able to maintain our commitment to those

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stable benefits. Gets back to what I said

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to you earlier about the trust that we've

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established with providers. We've also established trust in

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the marketplace

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as a whole despite the fact that we

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know that there are some, you know,

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some pressures around around cost and margins,

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but we're still maintaining and staying true to,

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you know, our North Star. And that being

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that we wanna be able to provide stable

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benefits.

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We wanna make sure that we can continue

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to expand so that we can provide access

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to culturally appropriate care. And, ultimately, we think

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that gives

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and fosters healthier communities.

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Absolutely. I think that focus will go a

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long way, and and hopefully others can adapt

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like that. Karen, thank you so much for

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joining the podcast and and for a great

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conversation. I look forward to working with you

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again soon. Thank you as well, Scott. You

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have a really good day. You too.