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 --> 00:00:13,015 payer and health plan executives and more than 5 00:00:13,015 --> 00:00:16,475 100 speakers to Chicago April. 6 00:00:16,855 --> 00:00:19,734 This year's event includes keynote conversations with the 7 00:00:19,734 --> 00:00:23,015 industry's top leaders and former president George w 8 00:00:23,015 --> 00:00:25,654 Bush. For the full agenda and event details, 9 00:00:25,654 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,170 and click on the events tab in the 11 00:00:29,170 --> 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 00:00:33,969 --> 00:00:36,369 Hello, everyone, and welcome to Becker's HealthCare podcast. 14 00:00:36,369 --> 00:00:38,530 I'm Scott King. Thrilled today to be joined 15 00:00:38,530 --> 00:00:41,265 by a very special guest, Jennifer Kowalski, vice 16 00:00:41,265 --> 00:00:44,385 president, Public Policy Institute over at Eleventh Health. 17 00:00:44,385 --> 00:00:46,065 Jennifer, thanks so much for joining us. How 18 00:00:46,065 --> 00:00:48,065 are you doing today? Good. Thanks for having 19 00:00:48,065 --> 00:00:49,984 me, Scott. Of course. You know, we have 20 00:00:49,984 --> 00:00:51,585 a lot of of big topics to to 21 00:00:51,585 --> 00:00:53,825 get to, and we're definitely very excited for 22 00:00:53,825 --> 00:00:55,420 you to be speaking with us at our 23 00:00:55,420 --> 00:00:58,299 spring payer issues roundtable in April. But, before 24 00:00:58,299 --> 00:00:59,500 we get to some of those topics I 25 00:00:59,500 --> 00:01:00,780 wanted to ask you about now, I was 26 00:01:00,780 --> 00:01:02,460 wondering if you could please tell us a 27 00:01:02,460 --> 00:01:04,540 little about your background, your career in health 28 00:01:04,540 --> 00:01:05,040 care. 29 00:01:05,579 --> 00:01:07,500 Sure. Well, as you mentioned, I'm currently the 30 00:01:07,500 --> 00:01:09,944 vice president of the Elevant Health Public Policy 31 00:01:10,185 --> 00:01:11,564 Institute, or PPI, 32 00:01:12,025 --> 00:01:14,265 where I've led a team of policy experts 33 00:01:14,265 --> 00:01:16,444 and researchers for over eleven years. 34 00:01:16,745 --> 00:01:19,644 And PPI's role is to conduct and publish 35 00:01:20,265 --> 00:01:22,984 policy relevant and data driven research that helps 36 00:01:22,984 --> 00:01:24,284 to inform health policy 37 00:01:24,665 --> 00:01:25,165 discussions. 38 00:01:25,939 --> 00:01:28,260 And prior to my career at Elevance Health, 39 00:01:28,260 --> 00:01:30,340 I spent about a dozen years in health 40 00:01:30,340 --> 00:01:31,560 care policy consulting, 41 00:01:32,020 --> 00:01:33,640 advising a range of, 42 00:01:34,739 --> 00:01:38,200 companies, health plans, pharmaceutical manufacturers, and so forth 43 00:01:38,420 --> 00:01:40,200 on health care policy and strategy. 44 00:01:41,255 --> 00:01:41,755 So 45 00:01:42,135 --> 00:01:44,775 to follow-up your your background there, Jennifer, you 46 00:01:44,775 --> 00:01:46,215 know, we always hear about how much how 47 00:01:46,215 --> 00:01:48,694 important data is to health plans. But with 48 00:01:48,694 --> 00:01:50,454 your role with all events, it it sounds 49 00:01:50,454 --> 00:01:52,295 like it's it's extra important. Is that fair 50 00:01:52,295 --> 00:01:54,454 to say? Yeah. I think that's exactly fair 51 00:01:54,454 --> 00:01:56,340 to say. You know, that that is part 52 00:01:56,340 --> 00:01:58,819 of, what my team brings to the company. 53 00:01:58,819 --> 00:01:59,560 I sometimes 54 00:01:59,939 --> 00:02:01,219 refer to us as a bit of an 55 00:02:01,219 --> 00:02:03,560 internal think tank in helping to bring, 56 00:02:04,260 --> 00:02:08,099 evidence, credible evidence to health policy conversations and 57 00:02:08,099 --> 00:02:11,000 to help shape the future of, healthcare policy. 58 00:02:11,635 --> 00:02:12,915 And the first thing I want to ask 59 00:02:12,915 --> 00:02:13,415 you 60 00:02:13,795 --> 00:02:16,215 is how do you describe the role within 61 00:02:16,275 --> 00:02:17,254 Medicare Advantage 62 00:02:17,555 --> 00:02:18,775 that it plays within 63 00:02:19,555 --> 00:02:21,335 your overall health plan strategy? 64 00:02:22,034 --> 00:02:24,115 Yeah. That's a great question, Scott. At Elevance 65 00:02:24,115 --> 00:02:26,780 Health, our affiliated health plans really serve people 66 00:02:26,780 --> 00:02:29,340 across every stage of life. So that includes 67 00:02:29,340 --> 00:02:32,620 Medicare Advantage, but it also includes Medicaid managed 68 00:02:32,620 --> 00:02:33,120 care, 69 00:02:33,500 --> 00:02:35,120 individual marketplace coverage, 70 00:02:35,500 --> 00:02:37,519 as well as employer sponsored plans. 71 00:02:37,844 --> 00:02:39,764 So you can think of Medicare Advantage as 72 00:02:39,764 --> 00:02:41,305 a critical part of that portfolio. 73 00:02:41,764 --> 00:02:43,844 It allows us to support older adults and 74 00:02:43,844 --> 00:02:44,905 people with disabilities 75 00:02:45,525 --> 00:02:48,405 with coordinated and affordable care. And so in 76 00:02:48,405 --> 00:02:51,144 that sense, Medicare Advantage plays a central role 77 00:02:51,290 --> 00:02:53,610 in how we think about lifelong health and 78 00:02:53,610 --> 00:02:54,670 whole person care. 79 00:02:55,770 --> 00:02:56,990 What do people outside 80 00:02:57,450 --> 00:02:59,150 the Medicare Advantage space 81 00:02:59,610 --> 00:03:02,030 most often misunderstand about the program? 82 00:03:02,650 --> 00:03:04,889 Yeah. I had, like, three core themes here 83 00:03:04,889 --> 00:03:06,830 with respect to Medicare Advantage. 84 00:03:07,604 --> 00:03:08,745 So one, value, 85 00:03:09,205 --> 00:03:10,664 two, access to care, 86 00:03:10,965 --> 00:03:12,585 and three, program efficiency. 87 00:03:13,125 --> 00:03:15,064 So first, with respect to value, 88 00:03:15,604 --> 00:03:17,705 today, more than half of Medicare beneficiaries 89 00:03:18,324 --> 00:03:20,664 now choose Medicare Advantage as their, 90 00:03:21,365 --> 00:03:23,560 coverage option. And I don't think that's an 91 00:03:23,560 --> 00:03:24,060 accident. 92 00:03:24,919 --> 00:03:27,979 So for sure, Medicare Advantage uses provider networks, 93 00:03:28,360 --> 00:03:30,680 but members also get an out of pocket 94 00:03:30,680 --> 00:03:31,180 maximum. 95 00:03:31,560 --> 00:03:34,199 They get integrated prescription drug coverage often at 96 00:03:34,199 --> 00:03:34,939 zero premium. 97 00:03:35,719 --> 00:03:38,514 Medicare Advantage has coordinated care, and it also 98 00:03:38,514 --> 00:03:40,935 includes extra benefits that aren't part of traditional 99 00:03:40,995 --> 00:03:41,495 Medicare. 100 00:03:41,794 --> 00:03:44,435 So through the Elevance Health Public Policy Institute, 101 00:03:44,435 --> 00:03:47,395 we've studied these supplemental benefits. So things like 102 00:03:47,395 --> 00:03:47,895 vision, 103 00:03:48,354 --> 00:03:49,495 dental, transportation 104 00:03:49,794 --> 00:03:50,294 assistance, 105 00:03:51,074 --> 00:03:52,694 healthy grocery benefits. 106 00:03:53,180 --> 00:03:54,000 And our research shows 107 00:03:54,379 --> 00:03:56,639 that use of these benefits by our members 108 00:03:57,099 --> 00:03:58,879 correlates with better health outcomes 109 00:03:59,260 --> 00:04:01,439 as well as more appropriate health care utilization. 110 00:04:02,060 --> 00:04:04,300 And so this is also particularly true for 111 00:04:04,300 --> 00:04:05,520 people with chronic conditions 112 00:04:05,980 --> 00:04:06,719 like diabetes. 113 00:04:07,260 --> 00:04:09,645 So then second, access, I think is also 114 00:04:09,645 --> 00:04:10,465 often misunderstood. 115 00:04:11,085 --> 00:04:13,085 I think critics will point to networks as 116 00:04:13,085 --> 00:04:14,865 a limitation of Medicare Advantage, 117 00:04:15,245 --> 00:04:17,105 but some of our upcoming research 118 00:04:17,564 --> 00:04:20,145 finds that after controlling four key factors, 119 00:04:20,524 --> 00:04:23,819 Medicare Advantage members actually experienced shorter wait times 120 00:04:23,819 --> 00:04:24,719 to see neurologists 121 00:04:25,579 --> 00:04:27,599 compared to traditional Medicare beneficiaries 122 00:04:28,219 --> 00:04:29,680 that had Medigap coverage. 123 00:04:30,779 --> 00:04:31,279 Lastly, 124 00:04:31,979 --> 00:04:33,120 program wide efficiency. 125 00:04:33,979 --> 00:04:37,199 PPI research found that as Medicare Advantage penetration 126 00:04:37,259 --> 00:04:40,274 grows in a market, total Medicare spending growth 127 00:04:40,274 --> 00:04:40,774 slows. 128 00:04:41,154 --> 00:04:43,095 And this is due in part to spillover 129 00:04:43,154 --> 00:04:46,035 effects. So this means that, the incentives for 130 00:04:46,035 --> 00:04:48,454 delivering high value care in Medicare Advantage 131 00:04:48,754 --> 00:04:50,834 appear to influence how providers treat all of 132 00:04:50,834 --> 00:04:51,975 their Medicare patients. 133 00:04:52,560 --> 00:04:55,680 And, likewise, we've also sponsored independent analysis that 134 00:04:55,680 --> 00:04:57,860 shows Medicare Advantage is more effective 135 00:04:58,240 --> 00:05:00,560 at curbing fraud, waste, and abuse than fee 136 00:05:00,560 --> 00:05:01,620 for service Medicare. 137 00:05:02,479 --> 00:05:04,079 So it sounds like the program is a 138 00:05:04,079 --> 00:05:06,319 lot more accommodating than some people might think. 139 00:05:06,319 --> 00:05:08,154 Is that right? I think that's right. Yeah. 140 00:05:08,154 --> 00:05:10,095 And I think it brings more value to 141 00:05:10,235 --> 00:05:12,555 to members and to the Medicare program writ 142 00:05:12,555 --> 00:05:14,014 large than people might realize. 143 00:05:14,875 --> 00:05:16,394 The next thing I want to ask you, 144 00:05:16,394 --> 00:05:19,055 Jennifer, is how are priority shifting 145 00:05:19,579 --> 00:05:22,639 for health plans as the Medicare Advantage population 146 00:05:22,779 --> 00:05:24,000 continues to grow? 147 00:05:24,379 --> 00:05:26,240 Yeah. If any enrollment has grown, 148 00:05:26,540 --> 00:05:28,540 I think one of the most notable trends 149 00:05:28,540 --> 00:05:30,079 has been the increasing enrollment 150 00:05:30,379 --> 00:05:33,360 among individuals who are dually eligible for Medicare 151 00:05:33,745 --> 00:05:34,564 and Medicaid. 152 00:05:34,944 --> 00:05:37,985 And if you're not familiar, these individuals often 153 00:05:37,985 --> 00:05:40,865 have more complex healthcare needs. They tend to 154 00:05:40,865 --> 00:05:42,485 have higher rates of chronic conditions, 155 00:05:42,865 --> 00:05:44,544 and they also have to navigate these two 156 00:05:44,544 --> 00:05:47,444 separate benefit programs. And I think that complexity 157 00:05:47,584 --> 00:05:49,044 can create some real challenges. 158 00:05:49,720 --> 00:05:52,779 And so as a result, both states and 159 00:05:52,839 --> 00:05:55,980 CMS, the Center for Medicare and Medicaid Services, 160 00:05:56,360 --> 00:05:57,980 as well as health plans themselves, 161 00:05:58,360 --> 00:06:01,500 are increasingly focused on better integrating these benefits 162 00:06:01,560 --> 00:06:03,579 for, dual eligible individuals. 163 00:06:04,225 --> 00:06:06,245 One key vehicle for that integration 164 00:06:06,625 --> 00:06:09,264 is known as Medicare Advantage Dual Eligible Special 165 00:06:09,264 --> 00:06:11,605 Needs Plans or more simply DSNPs. 166 00:06:12,064 --> 00:06:14,404 And DSNPs are plans that are designed 167 00:06:14,705 --> 00:06:17,345 specifically to meet the medical and social needs 168 00:06:17,345 --> 00:06:18,884 of people who are dually eligible. 169 00:06:19,330 --> 00:06:22,350 And so these plans emphasize coordinated care, 170 00:06:22,689 --> 00:06:23,910 they simplify navigation, 171 00:06:24,370 --> 00:06:26,210 and they take a whole person approach to 172 00:06:26,210 --> 00:06:29,090 care. And they can vary somewhat in their 173 00:06:29,090 --> 00:06:31,730 degree of integration. So the most fully integrated 174 00:06:31,730 --> 00:06:34,610 plans will also include long term services and 175 00:06:34,610 --> 00:06:35,024 supports. 176 00:06:35,584 --> 00:06:37,685 And upcoming research from the PPI 177 00:06:38,064 --> 00:06:40,165 focuses on really measuring and demonstrating 178 00:06:40,544 --> 00:06:43,285 the value of increasing integration of those benefits 179 00:06:43,584 --> 00:06:45,584 and for the members, of course, but also 180 00:06:45,584 --> 00:06:46,404 for the programs, 181 00:06:46,865 --> 00:06:47,524 writ large. 182 00:06:48,220 --> 00:06:49,419 I was just curious. What were some of 183 00:06:49,419 --> 00:06:52,639 the challenges you referred to in trying to 184 00:06:52,939 --> 00:06:54,879 then walk that line and keep the balance? 185 00:06:55,660 --> 00:06:57,819 Oh, yeah. I think, you know, for dual 186 00:06:57,819 --> 00:06:58,879 eligible members, 187 00:06:59,339 --> 00:07:01,419 I think what some of the challenges are 188 00:07:01,419 --> 00:07:04,245 that there's a set of benefits and a 189 00:07:04,245 --> 00:07:05,704 set of, providers 190 00:07:06,084 --> 00:07:08,324 that take Medicare coverage. And then there may 191 00:07:08,324 --> 00:07:10,084 be a whole separate set of rules with 192 00:07:10,084 --> 00:07:13,144 different benefits, different provider networks in the Medicaid 193 00:07:13,204 --> 00:07:15,079 program. And so absent, 194 00:07:15,860 --> 00:07:18,279 a plan or a care coordinator 195 00:07:19,060 --> 00:07:22,279 to help manage that those two separate programs, 196 00:07:22,419 --> 00:07:24,659 it can be challenging for an individual to 197 00:07:24,659 --> 00:07:27,240 navigate on their own, particularly if that individual 198 00:07:27,459 --> 00:07:29,564 also, you know, needs a lot of 199 00:07:30,285 --> 00:07:32,305 health care services or is, 200 00:07:32,685 --> 00:07:34,685 you know, has a chronic condition of some 201 00:07:34,685 --> 00:07:35,185 sort. 202 00:07:35,884 --> 00:07:37,084 Yeah. I could definitely say that it could 203 00:07:37,084 --> 00:07:39,404 be, difficult for someone to navigate on their 204 00:07:39,404 --> 00:07:39,904 own. 205 00:07:40,444 --> 00:07:42,285 Where do you see the biggest opportunities for 206 00:07:42,285 --> 00:07:43,024 health plans 207 00:07:43,529 --> 00:07:46,350 to better serve Medicare Advantage members? 208 00:07:47,050 --> 00:07:48,589 Yeah. So I frame the opportunities 209 00:07:49,129 --> 00:07:51,470 in Medicare Advantage around two themes, 210 00:07:51,850 --> 00:07:52,350 affordability 211 00:07:52,810 --> 00:07:53,949 and ease of navigation. 212 00:07:54,649 --> 00:07:56,350 So first, with respect to affordability, 213 00:07:57,210 --> 00:07:59,824 one example here is that health plans can 214 00:07:59,824 --> 00:08:02,384 help guide members to lower cost sites of 215 00:08:02,384 --> 00:08:05,425 care that have comparable quality when it's clinically 216 00:08:05,425 --> 00:08:08,004 appropriate for that member. So for example, 217 00:08:08,545 --> 00:08:12,129 recent research that we conducted found that non 218 00:08:12,129 --> 00:08:13,829 oncology infusion therapies 219 00:08:14,209 --> 00:08:16,149 that are delivered in physician offices, 220 00:08:16,849 --> 00:08:20,209 ambulatory infusion centers, or even at home were 221 00:08:20,209 --> 00:08:23,169 associated with lower costs, but similar or better 222 00:08:23,169 --> 00:08:25,990 outcomes when compared to hospital outpatient departments. 223 00:08:26,764 --> 00:08:29,105 And now this study focused on commercial members, 224 00:08:29,245 --> 00:08:31,084 but I think the lessons are still relevant 225 00:08:31,084 --> 00:08:32,304 for Medicare Advantage. 226 00:08:33,085 --> 00:08:34,705 And then second is navigation. 227 00:08:35,245 --> 00:08:36,764 We can do more to make the health 228 00:08:36,764 --> 00:08:39,804 care system easier to use, and there's lots 229 00:08:39,804 --> 00:08:42,279 of examples of this. We could, provide clear 230 00:08:42,279 --> 00:08:44,460 information on out of pocket costs and quality 231 00:08:44,759 --> 00:08:46,139 with digital tools. 232 00:08:46,519 --> 00:08:48,300 We can help members choose providers. 233 00:08:48,759 --> 00:08:50,460 We can support preventive care, 234 00:08:50,920 --> 00:08:53,320 with simple reminders, such as about flu shots 235 00:08:53,320 --> 00:08:54,379 or cancer screenings. 236 00:08:54,834 --> 00:08:56,375 And then to bring it back to supplemental 237 00:08:56,434 --> 00:08:58,514 benefits, I think they're an opportunity here as 238 00:08:58,514 --> 00:09:00,934 well. So benefits like dental coverage, 239 00:09:01,315 --> 00:09:02,615 healthy grocery allowances, 240 00:09:03,235 --> 00:09:06,455 and things like transportation assistance all help address 241 00:09:06,514 --> 00:09:09,075 the full range of factors that influence access 242 00:09:09,075 --> 00:09:11,259 to care along with health and well-being. 243 00:09:12,679 --> 00:09:15,399 And what does success in Medicare Advantage look 244 00:09:15,399 --> 00:09:15,899 like 245 00:09:16,519 --> 00:09:19,799 from, a leadership perspective? Obviously, this you know, 246 00:09:19,799 --> 00:09:22,439 to to structure these programs the right way 247 00:09:22,439 --> 00:09:24,475 and and for them to be as accommodating 248 00:09:24,475 --> 00:09:26,714 as they are takes a a big amount 249 00:09:26,714 --> 00:09:28,654 of of the right kind of leadership. Right? 250 00:09:29,034 --> 00:09:29,534 Absolutely. 251 00:09:30,074 --> 00:09:32,394 And from my perspective and, you know, from 252 00:09:32,394 --> 00:09:35,194 my role at Elevance Health, success in Medicare 253 00:09:35,194 --> 00:09:37,834 Advantage really means leading with that credible data 254 00:09:37,834 --> 00:09:40,669 driven evidence that will ultimately support our members 255 00:09:40,669 --> 00:09:42,049 and living healthier lives. 256 00:09:42,509 --> 00:09:45,230 And so that can include producing rigorous research 257 00:09:45,230 --> 00:09:48,289 that informs our engagement with policymakers and regulators 258 00:09:48,669 --> 00:09:49,649 and other stakeholders 259 00:09:50,190 --> 00:09:52,429 as they're shaping the future of the MA 260 00:09:52,429 --> 00:09:52,929 program. 261 00:09:53,355 --> 00:09:55,195 It also means using the evidence that we 262 00:09:55,195 --> 00:09:56,095 produce internally. 263 00:09:56,554 --> 00:09:59,115 So whether that's to inform strategy, or to 264 00:09:59,115 --> 00:10:00,575 help identify opportunities 265 00:10:00,955 --> 00:10:02,735 to improve care for our members. 266 00:10:03,434 --> 00:10:06,475 But ultimately, we really wanna use PPI's research 267 00:10:06,475 --> 00:10:08,254 to shape thoughtful public policy 268 00:10:08,649 --> 00:10:11,850 that supports innovation in Medicare Advantage, that promotes 269 00:10:11,850 --> 00:10:14,809 sustainability for the program, and that creates value 270 00:10:14,809 --> 00:10:17,209 for the Medicare Advantage members that we serve, 271 00:10:17,209 --> 00:10:19,209 and, of course, for the Medicare program over 272 00:10:19,209 --> 00:10:20,110 the long term. 273 00:10:21,075 --> 00:10:22,514 And, Jennifer, when you look back at your 274 00:10:22,514 --> 00:10:24,754 career and, you know, specifically with the things 275 00:10:24,754 --> 00:10:26,035 you're you're working on now, how do you 276 00:10:26,035 --> 00:10:27,575 think you've evolved as a leader? 277 00:10:28,355 --> 00:10:30,355 You know, I think over the last, you 278 00:10:30,355 --> 00:10:32,035 know, twenty five years or so of my 279 00:10:32,035 --> 00:10:34,995 career, I've certainly gone from being in the 280 00:10:34,995 --> 00:10:37,470 weeds and really knowing all of the details 281 00:10:38,090 --> 00:10:39,870 of policies and programs 282 00:10:40,250 --> 00:10:42,090 to taking a much, you know, kind of 283 00:10:42,090 --> 00:10:44,410 higher level strategic look at how it all 284 00:10:44,410 --> 00:10:47,210 fits together and how I can support the 285 00:10:47,210 --> 00:10:48,590 members of my team 286 00:10:49,684 --> 00:10:52,085 in really, you know, shining and being experts 287 00:10:52,085 --> 00:10:54,165 in their own right and, you know, having 288 00:10:54,165 --> 00:10:56,184 the opportunity to grow and learn as well. 289 00:10:56,884 --> 00:10:58,884 Yeah. So there's there's a lot of strategy 290 00:10:58,884 --> 00:10:59,705 in involved 291 00:11:00,085 --> 00:11:02,610 in this this program, obviously. Right? 292 00:11:03,009 --> 00:11:03,509 Exactly. 293 00:11:04,049 --> 00:11:05,990 Exactly. And from an MA perspective, 294 00:11:07,169 --> 00:11:09,909 I sort of started my career in consulting 295 00:11:09,970 --> 00:11:12,610 around the time that the Medicare modernization act 296 00:11:12,690 --> 00:11:16,149 created Medicare Advantage as we know it today. 297 00:11:16,404 --> 00:11:18,164 And so I I feel like the the 298 00:11:18,164 --> 00:11:21,065 program has grown alongside my career and evolved 299 00:11:21,205 --> 00:11:22,964 alongside my career, which has been kind of 300 00:11:22,964 --> 00:11:25,605 fun. Yeah. Definitely some some big parallels there. 301 00:11:25,605 --> 00:11:27,445 And, Jennifer, thanks so much for for joining 302 00:11:27,445 --> 00:11:29,284 the podcast for a great conversation. Like I 303 00:11:29,284 --> 00:11:30,960 said, really looking forward to speaking with us 304 00:11:30,960 --> 00:11:32,399 in April and and looking forward to work 305 00:11:32,399 --> 00:11:34,399 with you again soon. Thanks, Scott. I'm looking 306 00:11:34,399 --> 00:11:36,160 forward to it as well. I appreciate the 307 00:11:36,160 --> 00:11:37,220 conversation today.