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 Becker's HealthCare podcast.
I'm Scott King. Thrilled today to be joined
by a very special guest, Dan Elliott, chief
medical officer,
provider experience over at the Centene Corporation. Dan,
how are you doing? Thanks so much for
joining us. I'm doing great, Scott. Thanks so
much for having me. Of course. No. We're
gonna lean on you for your expertise. A
lot of big topics in health care and
with with health plans. But before we do
that, I was wondering if you could please
share a little bit about your background and
your journey in health care.
Yeah. And I appreciate the opportunity.
So, yeah, I've I've been with Centene now
for three years.
I joined them as, the CMO in a
local market in my my home state of
Delaware.
Really enjoyed walking through that experience and really
learning the the nuts and bolts of managed
care, in a market that I understood deeply.
And then for last year, I served as
the CMO for provider experience at Centene. So
getting the opportunity to see the national environment,
to work across, all of our lines of
business, all of our different plans, and, really
exciting opportunity. And prior to that, you know,
I spent twenty one years with a health
system, here in Delaware.
Had a lot of different roles working with
accountable care organizations and sort of really applied
health services research and, just practical operational and
and clinical improvements, which, were wonderful in addition
to a long career as a primary care
clinician.
Well, thanks so much for sharing that background
info, Dan. You know, I've been asking a
lot of the,
speakers from you speaking at our spring pair
of shoes roundtable like yourself about that that
payer provider relationship.
And, yeah, I think with you, it's an
even more kind of with your role, it's
even more unique. So I I definitely wanna
hear what you think. And just regards to
that relationship and,
how is it changing as as both sides
face cost pressure and workforce shortages?
Yeah. There's there's real issues and real challenges
for sure. Well, you know, just a little
background. I I joined the payer side,
because I had deep experience on the provider
side, making the changes, doing the pop health
improvements and interventions. And I I really felt
like and wanted to understand more about what
are the levers that the payer side have.
And I I've always had this vision of
sort of a comprehensive ecosystem working well to
drive care for for members, for patients, whatever
your lens or focus is. Really just taking
care of the people who need our health
care services.
And so what was exciting about joining, the
managed care side and now having three years
of experience in the payer side, what I
I love to see is that we are
all fighting the same fight. You know, you
have different tools. You have some different sort
of things that you can lean on and
bring, into play.
But fundamentally, we're all working to provide a
health care ecosystem that delivers, you know, real
honestly, the best quality care we can for
most affordable outcomes.
And that is exciting to be part of.
And, frankly, our current environment
is challenging, and it's stressful with o b
three and coverage changes and financial and cost
structure changes. You know, we're all familiar with
those.
But, frankly, it takes, in my view, a
lot of the things that have been
underneath.
They've been challenges that we've been trying to
navigate through.
It puts a finer lens on them, and
it says, boy,
if we're gonna solve these things as a
country,
we're gonna have to solve them sort of
together. Right? And it starts to you have
to have that view that looks at all
of us sort of under that, sort of
broader need to make the the best health
care system we can. And so as we,
from a payer perspective, are working with our
providers, I think everyone's more acutely aware of
the fact that we have to do this
together. And there's lots of structures. There's lots
of ways to do that. But, fundamentally, I
think it's a movement or a moment for
us in health care to lean in and
say, how can we be good partners? How
can we things that maybe,
you know, are historically present, have been tolerated,
they're sort of built into the system.
How do we actually now start to find
ways to do those things more efficiently so
that we can make sure that the money
that's being spent in health care is is
going to what we want it to be,
which is, you know, helping people get the
care that they need.
Yeah. I think you're exactly right. I think
focusing on that on that big goal, you
know, definitely help both sides work together and
find solutions. So I think it's it's important
to keep that goal in mind like you
said.
The second thing I wanna ask you about,
Dan, is where do you see the biggest
gap today between
payer strategy and operational execution?
Yeah. You know, along the same vein, you
know, I I really think a lot and
have the opportunity in my role to just
constantly be evaluating how are we working as
the most effective partner we can, with our
provider partners out there. And so I think
the gap that I stare at sort of
face to face every day is saying, how
are we being the best partner? Are we
giving meaningful information? Are the insights that we're
providing, the information we're providing, the the support,
whether it's care support, care management, care coordination,
other aspects, whether it's just being a good
partner in terms of paying claims and sort
of moving things through the system in the
most efficient way. I'm constantly asking, are we
being that best partner? And I think we,
in fairness, have opportunities
to provide more meaningful information,
to put it in a way that's communicated
that that leads to clear actionable opportunities.
You know, it doesn't do anybody a a
a lot of service to just say, hey.
Here's a some generic score reports, and here's
some things that we've noticed. But, boy, how
do we dig in as partners and say,
in your practice, this is what we're seeing.
It may or may, you know, may or
may not be different than your peers or
other things we're seeing in your market, but
here's insights. And when I was on the
provider side, I really longed for that some
of that
broader payer view,
that sometimes when you're from a provider perspective
looking out, you don't you don't necessarily have
that that broader information. So I see this
gap in front of us that we're trying
to close of providing meaningful information
in a meaningful setting that drives action and
starts to solve the problems that members are
feeling, that our providers are feeling, and honestly,
that we as payers are feeling and experiencing
as well. So if we can have that
conversation meaningfully, if we can support it with
operational processes that start to solve those problems
and close those loops, I think it just
makes everything just go better from that point
forward.
Absolutely.
What's one investment or initiative you believe will
most reshape how health plans operate over the
next two to three years?
You know, honestly, I think
there's a lot of hype out there about
AI and technology.
But I I really do believe that it
it's gonna be a game changer for us.
And, you know, it's funny. I think often,
back to sort of the early days of
population health and accountable care organizations, and everyone
was just hungry for data. And we were
doing everything we could do to get data
in any which way.
And
it was it was kinda funny times because
a couple years into that process, we were
sitting around a table with a a number
of of of folks who were in that
space, and we're like, woah. What are we
gonna do with all this data now? Right?
And we almost saturate or supersaturated
our ability to sort of engage and and
interact with that information. And so now as
we think about technology,
we think about AI sort of overlaying on
some of these these assets that have been
accumulated from a data perspective.
I'm encouraged by what's possible. I think I
tend to think basic blocking and tackling first
with these things. So,
you know, how can we improve efficiency of
basic services? How can we improve the efficiency
of our own workflows internally, whether you're on
the payer or the provider side? We need
to get more efficient, and AI starts to
provide opportunities to do that by surfacing,
observations and and things that maybe we wouldn't
see. And then, certainly,
you know, collating information from different sources. You
can think about all the applications within the
payer provider intersection
where that's needed. Right? We spend so much
time exchanging information and trying to, you know,
make sure things are in the right format,
golly, to have a technology sit solution
that can help us there. I think,
it honestly, it's pretty encouraging to think about
what's possible. I do,
though,
want us to really be thoughtful.
And I tend to think about, what are
those basic blocking and tackling things that we
can do first and get momentum.
And I think that's the space where we'll
see the greatest incremental gains.
Yeah. I appreciate what you said about the
the blocking and tackling it with with AI
because you it's I I think and kinda
what you're saying, it's best as, like, thing
that is maybe a long game. Like, everyone
who was
very onboard and gung ho with AI right
away,
they kinda panic when you notice mistakes early
on. They go, it forgot x y z
or it didn't do what I thought it
did. So I I think as long as
you know there's gonna be some tweaks, it's
gonna improve. It'll end up helping, you know,
everyone a lot tremendously. Is that kinda what
you're saying, Dan? Oh, a 100%. You know,
it's like with any kind of change management
piece. Right? There there's always gonna be speed
bumps along the way. And if sometimes, if
you take too big a bite and you
try to overhaul something completely,
then that first taste that people get of
it, it it's got too many too many
speed bumps. Right? It's a little too risky,
and then people back off quickly. So we're
honestly spending a lot of our time looking
at what are those, you know, incremental gains
and efficiency,
that we can really see, that people can
feel.
And that again, a lot of that is
internal at this process, but, we certainly look
forward to it and having sort of broader
implications for our work with providers as well.
100%.
If you could change one regulatory or industry
practice tomorrow
to improve affordability and access, what would it
be and why?
It's it's hard to talk about the the
provider payer space and and not
think, about the prior authorization process and sort
of how is done. And,
again, this is a place
where, you know, we have a lot of
commitments, the AHIP commitments and others about processes
and technologies to support these things.
But I I do think
it feels like just the right opportunity in
front of us
to look at how we have these conversations,
how we exchange information, how,
our skilled teams talk with other skilled teams.
How can we make sure that we're applying
those resources in the place that makes the
most sense,
that everyone gets the the sort of most
benefit out of a conversation like that? What
can we move through in,
an automated or a semi automated way? Of
course, with all of the right sort of
precautions and other things that could go with
it. But I think that's the area where,
you know, from decreasing friction and abrasion, from
really helping us be,
experience each other as partners in this space.
Again, we're we're all about the same thing,
and that's a place where there's sometimes unnecessary
friction. And and I'm honestly super excited about
what it might look like,
as, again, technology
as, under the current,
you know, cost structures and challenges that we're
thinking about, we put a real laser focus
on this area. I think we can make
progress and make sure that we're spending our
time, spending our resources in the places where
everyone's comfortable that we're getting something out of
that investment. And, I think that'll be good.
And the last thing I wanna ask you,
Dan, what issue is putting the most pressure
on health plan margins right now, and and
how are you responding differently this year in
2026?
Yeah.
Medex,
medical expense, the way things are moving, I
think that's always top of mind. You're watching.
You're seeing where are things popping,
what's new this year, what's, you know, where
are areas that are sort of starting to
to gain traction. It's just something to monitor.
And, again,
we we want people to get the health
care they need. So,
understanding,
is it appropriate? Is it the right care
for the right people? Those are all the
questions in the lens through which you look.
I I think,
you know, when we look to sort of
the next steps,
in this process,
it's trying to understand how do we now
turn that and focus on working with a
partner, a provider, a system, a region, and
start to take those margins in place or
start to take those med x trends and
start to make them real in terms of
the members, in terms of the providers where
that care is delivered. And I think,
you know, that's a it's a real opportunity.
And, again, one where we're applying technology,
AI, and other things to start to be
more sophisticated and even more nuanced in where
and how we see,
those trends,
playing out.
Well, Dan, thanks for joining us on the
podcast and for a great conversation. Looking forward
to working with you in April. Awesome. Thanks,
Scott. Appreciate the time.