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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 Becker's HealthCare podcast.

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I'm Scott King. Thrilled today to be joined

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by a very special guest, Dan Elliott, chief

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medical officer,

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provider experience over at the Centene Corporation. Dan,

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how are you doing? Thanks so much for

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joining us. I'm doing great, Scott. Thanks so

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much for having me. Of course. No. We're

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gonna lean on you for your expertise. A

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lot of big topics in health care and

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with with health plans. But before we do

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that, I was wondering if you could please

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share a little bit about your background and

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your journey in health care.

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Yeah. And I appreciate the opportunity.

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So, yeah, I've I've been with Centene now

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for three years.

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I joined them as, the CMO in a

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local market in my my home state of

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Delaware.

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Really enjoyed walking through that experience and really

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learning the the nuts and bolts of managed

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care, in a market that I understood deeply.

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And then for last year, I served as

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the CMO for provider experience at Centene. So

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getting the opportunity to see the national environment,

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to work across, all of our lines of

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business, all of our different plans, and, really

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exciting opportunity. And prior to that, you know,

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I spent twenty one years with a health

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system, here in Delaware.

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Had a lot of different roles working with

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accountable care organizations and sort of really applied

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health services research and, just practical operational and

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and clinical improvements, which, were wonderful in addition

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to a long career as a primary care

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clinician.

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Well, thanks so much for sharing that background

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info, Dan. You know, I've been asking a

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lot of the,

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speakers from you speaking at our spring pair

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of shoes roundtable like yourself about that that

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payer provider relationship.

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And, yeah, I think with you, it's an

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even more kind of with your role, it's

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even more unique. So I I definitely wanna

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hear what you think. And just regards to

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that relationship and,

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how is it changing as as both sides

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face cost pressure and workforce shortages?

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Yeah. There's there's real issues and real challenges

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for sure. Well, you know, just a little

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background. I I joined the payer side,

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because I had deep experience on the provider

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side, making the changes, doing the pop health

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improvements and interventions. And I I really felt

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like and wanted to understand more about what

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are the levers that the payer side have.

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And I I've always had this vision of

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sort of a comprehensive ecosystem working well to

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drive care for for members, for patients, whatever

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your lens or focus is. Really just taking

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care of the people who need our health

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care services.

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And so what was exciting about joining, the

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managed care side and now having three years

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of experience in the payer side, what I

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I love to see is that we are

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all fighting the same fight. You know, you

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have different tools. You have some different sort

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of things that you can lean on and

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bring, into play.

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But fundamentally, we're all working to provide a

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health care ecosystem that delivers, you know, real

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honestly, the best quality care we can for

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most affordable outcomes.

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And that is exciting to be part of.

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And, frankly, our current environment

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is challenging, and it's stressful with o b

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three and coverage changes and financial and cost

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structure changes. You know, we're all familiar with

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those.

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But, frankly, it takes, in my view, a

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lot of the things that have been

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underneath.

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They've been challenges that we've been trying to

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navigate through.

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It puts a finer lens on them, and

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it says, boy,

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if we're gonna solve these things as a

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country,

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we're gonna have to solve them sort of

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together. Right? And it starts to you have

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to have that view that looks at all

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of us sort of under that, sort of

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broader need to make the the best health

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care system we can. And so as we,

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from a payer perspective, are working with our

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providers, I think everyone's more acutely aware of

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the fact that we have to do this

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together. And there's lots of structures. There's lots

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of ways to do that. But, fundamentally, I

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think it's a movement or a moment for

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us in health care to lean in and

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say, how can we be good partners? How

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can we things that maybe,

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you know, are historically present, have been tolerated,

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they're sort of built into the system.

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How do we actually now start to find

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ways to do those things more efficiently so

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that we can make sure that the money

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that's being spent in health care is is

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going to what we want it to be,

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which is, you know, helping people get the

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care that they need.

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Yeah. I think you're exactly right. I think

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focusing on that on that big goal, you

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know, definitely help both sides work together and

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find solutions. So I think it's it's important

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to keep that goal in mind like you

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said.

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The second thing I wanna ask you about,

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Dan, is where do you see the biggest

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gap today between

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payer strategy and operational execution?

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Yeah. You know, along the same vein, you

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know, I I really think a lot and

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have the opportunity in my role to just

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constantly be evaluating how are we working as

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the most effective partner we can, with our

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provider partners out there. And so I think

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the gap that I stare at sort of

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face to face every day is saying, how

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are we being the best partner? Are we

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giving meaningful information? Are the insights that we're

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providing, the information we're providing, the the support,

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whether it's care support, care management, care coordination,

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other aspects, whether it's just being a good

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partner in terms of paying claims and sort

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of moving things through the system in the

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most efficient way. I'm constantly asking, are we

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being that best partner? And I think we,

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in fairness, have opportunities

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to provide more meaningful information,

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to put it in a way that's communicated

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that that leads to clear actionable opportunities.

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You know, it doesn't do anybody a a

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a lot of service to just say, hey.

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Here's a some generic score reports, and here's

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some things that we've noticed. But, boy, how

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do we dig in as partners and say,

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in your practice, this is what we're seeing.

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It may or may, you know, may or

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may not be different than your peers or

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other things we're seeing in your market, but

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here's insights. And when I was on the

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provider side, I really longed for that some

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of that

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broader payer view,

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that sometimes when you're from a provider perspective

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looking out, you don't you don't necessarily have

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that that broader information. So I see this

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gap in front of us that we're trying

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to close of providing meaningful information

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in a meaningful setting that drives action and

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starts to solve the problems that members are

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feeling, that our providers are feeling, and honestly,

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that we as payers are feeling and experiencing

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as well. So if we can have that

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conversation meaningfully, if we can support it with

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operational processes that start to solve those problems

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and close those loops, I think it just

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makes everything just go better from that point

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forward.

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Absolutely.

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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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You know, honestly, I think

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there's a lot of hype out there about

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AI and technology.

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But I I really do believe that it

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it's gonna be a game changer for us.

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And, you know, it's funny. I think often,

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back to sort of the early days of

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population health and accountable care organizations, and everyone

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was just hungry for data. And we were

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doing everything we could do to get data

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in any which way.

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And

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it was it was kinda funny times because

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a couple years into that process, we were

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sitting around a table with a a number

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of of of folks who were in that

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space, and we're like, woah. What are we

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gonna do with all this data now? Right?

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And we almost saturate or supersaturated

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our ability to sort of engage and and

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interact with that information. And so now as

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we think about technology,

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we think about AI sort of overlaying on

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some of these these assets that have been

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accumulated from a data perspective.

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I'm encouraged by what's possible. I think I

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tend to think basic blocking and tackling first

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with these things. So,

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you know, how can we improve efficiency of

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basic services? How can we improve the efficiency

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of our own workflows internally, whether you're on

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the payer or the provider side? We need

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to get more efficient, and AI starts to

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provide opportunities to do that by surfacing,

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observations and and things that maybe we wouldn't

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see. And then, certainly,

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you know, collating information from different sources. You

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can think about all the applications within the

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payer provider intersection

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where that's needed. Right? We spend so much

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time exchanging information and trying to, you know,

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make sure things are in the right format,

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golly, to have a technology sit solution

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that can help us there. I think,

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it honestly, it's pretty encouraging to think about

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what's possible. I do,

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though,

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want us to really be thoughtful.

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And I tend to think about, what are

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those basic blocking and tackling things that we

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can do first and get momentum.

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And I think that's the space where we'll

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see the greatest incremental gains.

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Yeah. I appreciate what you said about the

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the blocking and tackling it with with AI

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because you it's I I think and kinda

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what you're saying, it's best as, like, thing

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that is maybe a long game. Like, everyone

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who was

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very onboard and gung ho with AI right

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away,

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they kinda panic when you notice mistakes early

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on. They go, it forgot x y z

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or it didn't do what I thought it

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did. So I I think as long as

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you know there's gonna be some tweaks, it's

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gonna improve. It'll end up helping, you know,

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everyone a lot tremendously. Is that kinda what

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you're saying, Dan? Oh, a 100%. You know,

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it's like with any kind of change management

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piece. Right? There there's always gonna be speed

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bumps along the way. And if sometimes, if

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you take too big a bite and you

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try to overhaul something completely,

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then that first taste that people get of

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it, it it's got too many too many

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speed bumps. Right? It's a little too risky,

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and then people back off quickly. So we're

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honestly spending a lot of our time looking

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at what are those, you know, incremental gains

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and efficiency,

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that we can really see, that people can

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feel.

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And that again, a lot of that is

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internal at this process, but, we certainly look

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forward to it and having sort of broader

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implications for our work with providers as well.

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100%.

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If you could change one regulatory or industry

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practice tomorrow

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to improve affordability and access, what would it

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be and why?

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It's it's hard to talk about the the

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provider payer space and and not

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think, about the prior authorization process and sort

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of how is done. And,

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again, this is a place

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where, you know, we have a lot of

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commitments, the AHIP commitments and others about processes

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and technologies to support these things.

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But I I do think

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it feels like just the right opportunity in

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front of us

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to look at how we have these conversations,

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how we exchange information, how,

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our skilled teams talk with other skilled teams.

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How can we make sure that we're applying

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those resources in the place that makes the

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most sense,

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that everyone gets the the sort of most

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benefit out of a conversation like that? What

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can we move through in,

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an automated or a semi automated way? Of

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course, with all of the right sort of

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precautions and other things that could go with

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it. But I think that's the area where,

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you know, from decreasing friction and abrasion, from

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really helping us be,

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experience each other as partners in this space.

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Again, we're we're all about the same thing,

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and that's a place where there's sometimes unnecessary

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friction. And and I'm honestly super excited about

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what it might look like,

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as, again, technology

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as, under the current,

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you know, cost structures and challenges that we're

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thinking about, we put a real laser focus

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on this area. I think we can make

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progress and make sure that we're spending our

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time, spending our resources in the places where

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everyone's comfortable that we're getting something out of

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that investment. And, I think that'll be good.

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And the last thing I wanna ask you,

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Dan, what issue is putting the most pressure

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on health plan margins right now, and and

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how are you responding differently this year in

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2026?

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Yeah.

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Medex,

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medical expense, the way things are moving, I

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think that's always top of mind. You're watching.

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You're seeing where are things popping,

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what's new this year, what's, you know, where

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are areas that are sort of starting to

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to gain traction. It's just something to monitor.

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And, again,

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we we want people to get the health

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care they need. So,

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understanding,

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is it appropriate? Is it the right care

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for the right people? Those are all the

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questions in the lens through which you look.

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I I think,

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you know, when we look to sort of

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the next steps,

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in this process,

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it's trying to understand how do we now

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turn that and focus on working with a

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partner, a provider, a system, a region, and

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start to take those margins in place or

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start to take those med x trends and

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start to make them real in terms of

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the members, in terms of the providers where

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that care is delivered. And I think,

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you know, that's a it's a real opportunity.

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And, again, one where we're applying technology,

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AI, and other things to start to be

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more sophisticated and even more nuanced in where

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and how we see,

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those trends,

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playing out.

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Well, Dan, thanks for joining us on the

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podcast and for a great conversation. Looking forward

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to working with you in April. Awesome. Thanks,

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Scott. Appreciate the time.