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, and welcome to the Becker's Healthcare
Podcast. I'm Scott King. Thrilled today to be
joined by a very special guest, Karen Walker
Johnson, chief executive officer of CleverCare Health Plan.
Karen, how are you doing today? Thanks so
much for joining us.
Thank you. Good morning, Scott, and it's a
pleasure to be here. Thank you. It's a
privilege to have you. And, you know, we
have a lot of big topics to get
to with health plans and and health care
as always, of course. But before I do
that, Karen, I was wondering if you just
kinda tell us a little bit about your
background and your, career.
Well, I'm happy to do that. First of
all, I'm Karen. I'm the chief executive officer
here at CleverCare.
I started my career actually,
in pediatric nursing back in in Detroit.
And at that time, had the opportunity to
see firsthand
a lot of the systemic barriers and and
just the lack of cultural understanding
that was unfortunately harmful to families. And so
since that time, I'm now leading CleverCare, and
we are a Medicare Advantage Plan,
which is,
delivering care from a culturally sensitive
and competent perspective. And for your readers who
may not be as familiar with that, basically,
what that is is that
we really take into account understanding
how patients' beliefs and their behaviors
and their background really influence
how they how they seek health and ultimately
what their health come outcomes look like. And
so as a growing plan we've got right
now, we've got approximately about 46,000
members.
We just had some pretty significant growth,
and, we are giving our members access to
care that's delivered in their own language.
We honor their unique cultural traditions,
and it's all from a value based care
model. So we're blending eastern and western medicine.
Well, I appreciate you sharing your background info
there, Karen. And it's great to hear about
CleverCare's growth. That's outstanding.
The the first the first topic I wanna
get your perspective on is I wanna ask,
how do you think
relationships are or how how is CleverCare's relationships
with providers changing, you know, as both sides
kind of face cost pressure and workforce shortages?
You know, we real realize and I realize
that our providers are managing quite a bit
right now, Scott.
So the best way for us as a
health plan
really to think about our relationship
is really to do it from what we've
always done. And that is really showing up
for them by being reliable,
by being transparent,
and at the end of the day, really
being a trustworthy partner. And I've been in
this business a very long time, and one
of the things that I know, my experience
has borne out, is that trust is so
critically important between a health plan and its
providers.
And so we're doing everything we can to
continue to build upon the trust we've already
established.
We are doing things like making sure that
the benefits that we offer
are stable and they're reliable and that our
providers can count on them being that way.
We know that it's really important that we
make sure that they get paid on time,
that they're paid accurately, that we are adjudicating
claims appropriately.
All of those things really
build and and just continue to build upon
that trust.
And for us, that that's what it means
to really help our providers manage through a
lot of the the cost pressures that you
mentioned and and some of what we're seeing
just around workforce. If we're one less thing
they have to worry about and they can
rely upon us, we believe that that's very
helpful.
Well, do you think on the other side
of that relationship, do you think that providers
also feel like health plans have a lot
going on right now too and they're they're
kinda understanding of that? Is that a two
way street right now? Yeah. I do believe
that. And and, again, I think that's based
on
developing that trusting and mutual and respectful
relationship.
And so my providers, you know, they say
sit down with us and say, what can
we do collaboratively
to address some of these these these, you
know, headwinds that we all see. One of
the examples would be, we employ
people on our teams who reach out and
do outreach to our members. You know, what
we're trying to do with our providers and
our providers recognize that that's a benefit for
them. Right? That we're reaching out to their
patients. We're doing it in collaboration with them,
and we're doing it in alignment with what
the physician thinks is important for their patient.
But that's one way that we are helping
each other.
And so
they may not have that that,
that person, if you will, on their payroll,
but
we do. And so we are sharing the
responsibility
and the accountability
all within mind, making sure that that member
and their patient gets the best outcome.
Yeah. I think that collaboration and and understanding
goes a long way right now with both
sides. And, Taryn, I also want to ask
you, where do you see the biggest gap
today between payer strategy and operational execution?
Well, one of the ones that I would
identify is just,
goes back to, like, the core of what
CleverCare is, and that is
not
viewing
the cultural needs
of their membership
as something more than just an extra.
So for example, our, you know, our members
have access to providers who speak their language,
and they understand their cultural traditions.
That's essential
for them to get the care.
And so it's fundamental to our model of
care. So we have this very large network
that includes, you know,
the top provider facilities and hospitals.
We have bilingual physicians.
We've got,
acupuncturists that we directly contract with. And so
all of that is something that is addressing
that gap where plans that are not
viewing the cultural needs of their members as
something that's essential.
Another example I would say is the partnerships
that you have with with your vendors. And
and in our case, I'm gonna use nation's
benefits as an example.
That's one where we are able to
through our work with nations, we've added
culturally tailored supermarket benefits.
And that's important because it supports the needs
of our local communities.
You know, when when they think about the
foods that they wanna cook and and the
herbal medicines,
etcetera, that they want to take.
By us enhancing
the
access through nation's benefit with these national stores
like a Costco or
ninety nine Ranch market, which may not be
as familiar to your listeners. But it is
a very
big national chain for us in our communities.
And so those are the types of things
that we're focused on. Again, you know, when
you get back to your question about what
is a gap that you're we're seeing with
payer strategies in their operational excellence,
It is thinking about
those benefits that are key to meet their
members, where their members are, and it's also
making sure that that strategy that you're doing
is aligned
with how you execute in practice. And for
us, again, it is being able to offer
things like
the foods that,
are important
to our membership
because we're recognizing those cultural needs that they
have.
What's one investment or initiative you believe will
most reshape how health plans operate over the
next two to three years?
I think it's how we continue to engage
members
and knowing and recognizing that engagement really drives
everything.
So for us, it, you know, it means
that
members are able to access their care in
their own language.
It means that they're able to be engaged
in a way that they are getting that
care that coincides with the way they're actually
living.
We've got, for example, these community centers. We've
got four community centers. And those community centers,
Scott, are in
communities that we're serving, but those community centers
are built around cultural competence.
They help to connect our members with the
communities so that
those members feel that they can stay in
control of their health.
Those those centers, they have and offer a
blend of of western approaches to wellness as
well as eastern. And so our members can
go into those into those centers, and they
can do things like take a tai chi
class, for example. Right. And,
participate in in a course on dental health.
We do things that build the community. So
we invite people to come in for things
like a book club or a birthday celebration.
All of that, again, is time to engagement,
and that's an investment and an initiative that's
really important for a health plan. It allows
that health plan to to continue to grow,
but more importantly, it allows them to continue
to help their members get the best health
outcomes.
You know, we recently as I think about
it, we recently brought on two new provider
partners,
one being,
Blue Zones Health, and the other is is
CareMore Health. And the reason we did that
is because both of those groups
really align with our philosophy around the blend
of eastern and western medicine,
around holistic care. Blue Zones, for example, you
know, is really focused on lifestyle changes and
longevity practices, and that's fairly important
in in in our membership.
CareMore, for example, is, you know, a very
large primary care practice, but they really are
committed to some of the core values that
CleverCare is. That is caring for people from
a whole person perspective
and not just whatever their ultimate condition is.
And so our our members
are benefiting by these initiatives and these investments
that we're making in the community, and I
think that's something that other health plans will
have to do as well.
Yeah. I think they might have to adjust.
Now, Karen, if you could change one
regulatory or industry industry practice tomorrow to improve
affordability and access,
what would it be and why?
Wow.
That's a great question.
You know?
I I guess I would say that if
if I if I only had one thing.
You can you can throw out two if
you want. But, yeah, let's let's hit one
first if you can.
Well, if I go back to my, you
know, my start in in my career as
a nurse,
you know, one of the priorities that I
found and I was a public health nurse
as well, Scott. One of the things that
was really important was what could we do
to help keep our patients healthy even when
they had lots of challenges?
So when I think about something that would
be, I think, a really beneficial change, it
would be you know, this we have the
STARS program, and it's really a helpful way
to help ensure that health plans are are
delivering on the promise to focus on the
right thing. But
those star programs don't measure cultural competence.
And so what I'd like to see would
be a quality metric in star ratings that
accounts for
the the additional resources that a plan like
ours uses. If, for example, our community centers,
I'd like to see that be something that's
measured
so that we could
ensure that resources are there to serve, you
know, diverse and linguistically
isolated populations like ours,
that we have the ability to continue to
make sure that we have bilingual providers in
our network,
that we can offer
health education that really is tailored to
populations that have maybe different needs.
So if I could have a crystal ball
and say that's something that could be,
a a change or an ad, that would
be it. Okay. I think that's a good
one.
And the last the last question I have
for you, Karen,
what issue do you think is putting the
most pressure
on health plan margins right now,
and how are you responding differently in 2026?
Well, I I can't speak for the industry
as a whole, but I can say that,
you know, we've seen cost cost, excuse me,
grow up across the industry. You know?
Everyone is is aware of that. And the
way we've been able to deal with that,
Scott, is by doing, you know, what we've
been doing best and that's
providing, you know, cost effective
care. So, you know, we work very closely
with our members. We're making sure that they're
getting the right care, that they they can
stay healthy,
and all of that will help to reduce
cost.
And it also, more importantly, I think, improves
health outcomes.
You know, this year, we're investing in in
strengthening our our provider partnerships. We think that's
a really important investment.
We're investing in clinical programs that help us
to identify and engage our high risk members.
You know, that's that gets back to population
health and really looking at populations
as opposed to just looking at, you know,
your membership, you know, from a a very,
myopic way.
We're also,
really keeping in mind that rather than kinda
cutting our benefits or narrowing our network
in response to some of those margin pressures,
we're able to maintain our commitment to those
stable benefits. Gets back to what I said
to you earlier about the trust that we've
established with providers. We've also established trust in
the marketplace
as a whole despite the fact that we
know that there are some, you know,
some pressures around around cost and margins,
but we're still maintaining and staying true to,
you know, our North Star. And that being
that we wanna be able to provide stable
benefits.
We wanna make sure that we can continue
to expand so that we can provide access
to culturally appropriate care. And, ultimately, we think
that gives
and fosters healthier communities.
Absolutely. I think that focus will go a
long way, and and hopefully others can adapt
like that. Karen, thank you so much for
joining the podcast and and for a great
conversation. I look forward to working with you
again soon. Thank you as well, Scott. You
have a really good day. You too.