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
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upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone, and welcome to Becker's HealthCare podcast.
I'm Scott King. Thrilled today to be joined
by a very special guest, Jennifer Kowalski, vice
president, Public Policy Institute over at Eleventh Health.
Jennifer, thanks so much for joining us. How
are you doing today? Good. Thanks for having
me, Scott. Of course. You know, we have
a lot of of big topics to to
get to, and we're definitely very excited for
you to be speaking with us at our
spring payer issues roundtable in April. But, before
we get to some of those topics I
wanted to ask you about now, I was
wondering if you could please tell us a
little about your background, your career in health
care.
Sure. Well, as you mentioned, I'm currently the
vice president of the Elevant Health Public Policy
Institute, or PPI,
where I've led a team of policy experts
and researchers for over eleven years.
And PPI's role is to conduct and publish
policy relevant and data driven research that helps
to inform health policy
discussions.
And prior to my career at Elevance Health,
I spent about a dozen years in health
care policy consulting,
advising a range of,
companies, health plans, pharmaceutical manufacturers, and so forth
on health care policy and strategy.
So
to follow-up your your background there, Jennifer, you
know, we always hear about how much how
important data is to health plans. But with
your role with all events, it it sounds
like it's it's extra important. Is that fair
to say? Yeah. I think that's exactly fair
to say. You know, that that is part
of, what my team brings to the company.
I sometimes
refer to us as a bit of an
internal think tank in helping to bring,
evidence, credible evidence to health policy conversations and
to help shape the future of, healthcare policy.
And the first thing I want to ask
you
is how do you describe the role within
Medicare Advantage
that it plays within
your overall health plan strategy?
Yeah. That's a great question, Scott. At Elevance
Health, our affiliated health plans really serve people
across every stage of life. So that includes
Medicare Advantage, but it also includes Medicaid managed
care,
individual marketplace coverage,
as well as employer sponsored plans.
So you can think of Medicare Advantage as
a critical part of that portfolio.
It allows us to support older adults and
people with disabilities
with coordinated and affordable care. And so in
that sense, Medicare Advantage plays a central role
in how we think about lifelong health and
whole person care.
What do people outside
the Medicare Advantage space
most often misunderstand about the program?
Yeah. I had, like, three core themes here
with respect to Medicare Advantage.
So one, value,
two, access to care,
and three, program efficiency.
So first, with respect to value,
today, more than half of Medicare beneficiaries
now choose Medicare Advantage as their,
coverage option. And I don't think that's an
accident.
So for sure, Medicare Advantage uses provider networks,
but members also get an out of pocket
maximum.
They get integrated prescription drug coverage often at
zero premium.
Medicare Advantage has coordinated care, and it also
includes extra benefits that aren't part of traditional
Medicare.
So through the Elevance Health Public Policy Institute,
we've studied these supplemental benefits. So things like
vision,
dental, transportation
assistance,
healthy grocery benefits.
And our research shows
that use of these benefits by our members
correlates with better health outcomes
as well as more appropriate health care utilization.
And so this is also particularly true for
people with chronic conditions
like diabetes.
So then second, access, I think is also
often misunderstood.
I think critics will point to networks as
a limitation of Medicare Advantage,
but some of our upcoming research
finds that after controlling four key factors,
Medicare Advantage members actually experienced shorter wait times
to see neurologists
compared to traditional Medicare beneficiaries
that had Medigap coverage.
Lastly,
program wide efficiency.
PPI research found that as Medicare Advantage penetration
grows in a market, total Medicare spending growth
slows.
And this is due in part to spillover
effects. So this means that, the incentives for
delivering high value care in Medicare Advantage
appear to influence how providers treat all of
their Medicare patients.
And, likewise, we've also sponsored independent analysis that
shows Medicare Advantage is more effective
at curbing fraud, waste, and abuse than fee
for service Medicare.
So it sounds like the program is a
lot more accommodating than some people might think.
Is that right? I think that's right. Yeah.
And I think it brings more value to
to members and to the Medicare program writ
large than people might realize.
The next thing I want to ask you,
Jennifer, is how are priority shifting
for health plans as the Medicare Advantage population
continues to grow?
Yeah. If any enrollment has grown,
I think one of the most notable trends
has been the increasing enrollment
among individuals who are dually eligible for Medicare
and Medicaid.
And if you're not familiar, these individuals often
have more complex healthcare needs. They tend to
have higher rates of chronic conditions,
and they also have to navigate these two
separate benefit programs. And I think that complexity
can create some real challenges.
And so as a result, both states and
CMS, the Center for Medicare and Medicaid Services,
as well as health plans themselves,
are increasingly focused on better integrating these benefits
for, dual eligible individuals.
One key vehicle for that integration
is known as Medicare Advantage Dual Eligible Special
Needs Plans or more simply DSNPs.
And DSNPs are plans that are designed
specifically to meet the medical and social needs
of people who are dually eligible.
And so these plans emphasize coordinated care,
they simplify navigation,
and they take a whole person approach to
care. And they can vary somewhat in their
degree of integration. So the most fully integrated
plans will also include long term services and
supports.
And upcoming research from the PPI
focuses on really measuring and demonstrating
the value of increasing integration of those benefits
and for the members, of course, but also
for the programs,
writ large.
I was just curious. What were some of
the challenges you referred to in trying to
then walk that line and keep the balance?
Oh, yeah. I think, you know, for dual
eligible members,
I think what some of the challenges are
that there's a set of benefits and a
set of, providers
that take Medicare coverage. And then there may
be a whole separate set of rules with
different benefits, different provider networks in the Medicaid
program. And so absent,
a plan or a care coordinator
to help manage that those two separate programs,
it can be challenging for an individual to
navigate on their own, particularly if that individual
also, you know, needs a lot of
health care services or is,
you know, has a chronic condition of some
sort.
Yeah. I could definitely say that it could
be, difficult for someone to navigate on their
own.
Where do you see the biggest opportunities for
health plans
to better serve Medicare Advantage members?
Yeah. So I frame the opportunities
in Medicare Advantage around two themes,
affordability
and ease of navigation.
So first, with respect to affordability,
one example here is that health plans can
help guide members to lower cost sites of
care that have comparable quality when it's clinically
appropriate for that member. So for example,
recent research that we conducted found that non
oncology infusion therapies
that are delivered in physician offices,
ambulatory infusion centers, or even at home were
associated with lower costs, but similar or better
outcomes when compared to hospital outpatient departments.
And now this study focused on commercial members,
but I think the lessons are still relevant
for Medicare Advantage.
And then second is navigation.
We can do more to make the health
care system easier to use, and there's lots
of examples of this. We could, provide clear
information on out of pocket costs and quality
with digital tools.
We can help members choose providers.
We can support preventive care,
with simple reminders, such as about flu shots
or cancer screenings.
And then to bring it back to supplemental
benefits, I think they're an opportunity here as
well. So benefits like dental coverage,
healthy grocery allowances,
and things like transportation assistance all help address
the full range of factors that influence access
to care along with health and well-being.
And what does success in Medicare Advantage look
like
from, a leadership perspective? Obviously, this you know,
to to structure these programs the right way
and and for them to be as accommodating
as they are takes a a big amount
of of the right kind of leadership. Right?
Absolutely.
And from my perspective and, you know, from
my role at Elevance Health, success in Medicare
Advantage really means leading with that credible data
driven evidence that will ultimately support our members
and living healthier lives.
And so that can include producing rigorous research
that informs our engagement with policymakers and regulators
and other stakeholders
as they're shaping the future of the MA
program.
It also means using the evidence that we
produce internally.
So whether that's to inform strategy, or to
help identify opportunities
to improve care for our members.
But ultimately, we really wanna use PPI's research
to shape thoughtful public policy
that supports innovation in Medicare Advantage, that promotes
sustainability for the program, and that creates value
for the Medicare Advantage members that we serve,
and, of course, for the Medicare program over
the long term.
And, Jennifer, when you look back at your
career and, you know, specifically with the things
you're you're working on now, how do you
think you've evolved as a leader?
You know, I think over the last, you
know, twenty five years or so of my
career, I've certainly gone from being in the
weeds and really knowing all of the details
of policies and programs
to taking a much, you know, kind of
higher level strategic look at how it all
fits together and how I can support the
members of my team
in really, you know, shining and being experts
in their own right and, you know, having
the opportunity to grow and learn as well.
Yeah. So there's there's a lot of strategy
in involved
in this this program, obviously. Right?
Exactly.
Exactly. And from an MA perspective,
I sort of started my career in consulting
around the time that the Medicare modernization act
created Medicare Advantage as we know it today.
And so I I feel like the the
program has grown alongside my career and evolved
alongside my career, which has been kind of
fun. Yeah. Definitely some some big parallels there.
And, Jennifer, thanks so much for for joining
the podcast for a great conversation. Like I
said, really looking forward to speaking with us
in April and and looking forward to work
with you again soon. Thanks, Scott. I'm looking
forward to it as well. I appreciate the
conversation today.