Latest / Becker’s Payer Issues Podcast / Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA,

Transcript

Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA, · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
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  payer and health plan executives and more than
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  100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George w
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
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  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone. Welcome to Becker's Healthcare Podcast. I'm
• 0:36
  Scott King. Thrilled today to be joined by
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  a very special guest, Sareya Sacaccio,
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  chief medical officer, Essence Healthcare. Sariya, how are
• 0:44
  you doing today?
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  I am doing well, Scott. Thanks so much
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  for the opportunity to join you today.
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  It's gonna be great. We have a lot
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  of big topics and and talking points to
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  to get to here, but we're really looking
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  forward to having you speak at our spring
• 0:58
  payer issues roundtable in April as well. Can't
• 1:01
  wait. So before we get to the questions
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  and topics, Sariya, I wanted to ask just
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  kind of about your background. If you could
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  please share, you know, a little bit about
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  your your journey into, health care with us.
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  You bet, Scott. I'm a family physician by
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  training, and I have worked across the gamut
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  of clinical care, whether it was in solo
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  practice, teaching residency programs, and academic institutions.
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  I've served as a chief medical officer in
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  several different health systems
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  and have been on the health plan side
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  of the industry for the last several years.
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  I so enjoy the work that we do,
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  serving our members and ensuring everybody gets the
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  right care, right place, right time, and has
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  the right experience
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  on their journey for health.
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  Thank you for sharing that. And you the
• 1:44
  the first topic I wanted to get to
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  with your perspective
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  is how are your relationships
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  with providers changing? You know, obviously,
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  both sides are facing regulatory pressures, but specifically
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  when you you look at cost pressure and
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  and work for for shortages.
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  Well, first of all, I am so
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  glad that we're starting with relationships.
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  This is the most critical part of the
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  work that we do. And at the end
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  of the day, we're in this together.
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  We are here to provide exceptional care to
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  patients and those who deserve
• 2:16
  that access to care.
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  And so while perhaps it hasn't changed, there
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  certainly is a palpable shift and that shift
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  would be a deepening
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  of collaboration.
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  I can't overemphasize
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  just how important that is and there are
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  a number of ways that we do that
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  in our business and with our partners.
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  First of all, it starts with real time
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  data.
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  Everybody needs this accurate data. This is what
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  I hear asked for the most and the
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  appreciation
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  that we have been able to deliver
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  down to the member level. The data that
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  impacts the care that our health systems and
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  providers deliver
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  in a way that is actionable
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  so that we can impact that health.
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  And transparency of strategy. We roll up our
• 2:59
  sleeves together
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  as partners to address the cost of care
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  of what we do, whether it's determining
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  the appropriate prior authorizations,
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  our pharmacy spend and the challenges there, as
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  we know, we've all struggled with that recently,
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  or expanding products within our health
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  plan. That is so important to us. And
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  finally, I'll say
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  this is the most important part of this
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  relationship.
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  It's listening first,
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  being curious about the current workflows and expectations
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  that exist
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  with our health system providers
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  so that we can align with the work
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  already being done. Because this is what we
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  know. Whether a health system has 17 different
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  contracts or 27 contracts,
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  we have got to be a part of
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  the solution
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  in developing efficiency
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  and reliability
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  so that care is delivered consistently regardless of
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  who the health payer is.
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  Yeah. You know, that's really interesting. I I've
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  heard from a lot of people on the
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  payer side that that relationship
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  has changed. Like you said, it's got more
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  collaborative.
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  I've heard some some people say it's because,
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  you know, they think that just both sides
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  are up against so many regulatory pressures that
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  both are just trying to figure out a
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  way to get things done. But your perspective
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  is interesting because you think it's coming from
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  a a data perspective, a need for both
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  sides to kinda share and utilize data. Is
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  that right? Well, sure. It's a huge part
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  of the equation here because without information,
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  you can't drive a strategy that delivers results.
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  That is critical in the work that we
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  do. And the more information available,
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  it's part of our responsibility to make sure
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  it's delivered in a way that we can
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  do something with it.
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  Sariya, where do you see the biggest gap
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  today between payer strategy and operational execution?
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  Goodness. There are so many gaps, and I'll
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  say it's so many solutions
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  that have developed. I will say what is
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  most heated
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  at the moment and the two challenges that
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  I'm seeing here is
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  member access
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  to resources that they need when they need
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  it. What I mean by that is more
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  ambulatory access. So Scott, it's rather interesting to
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  me, not surprising as we're all trying to
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  shore up margins these days after COVID,
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  but we saw
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  a significant
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  departure in ambulatory
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  services
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  and access to resources to health care.
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  So and I'll give my mother as an
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  example. She's Medicare Advantage age and has her
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  own plan she works with, and I say,
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  mom, the first thing you gotta do is
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  find out where you can receive these services
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  at an ambulatory
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  site. And here's why,
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  it hits the pocketbook of every member and
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  frankly at every health plan when services that
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  can be delivered in an ambulatory space
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  is turned around, the lights turned out, literally
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  lights turned out, and shifted back to a
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  hospital with a huge parking lot, an overwhelming
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  pathway just to get to the site of
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  service you need with a significant
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  price tag.
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  I do recognize having been on the health
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  system side
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  historically
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  that that's where margins are often shored up,
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  is in an inpatient facility
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  structure.
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  And we feel the pressure from an administration.
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  We know there's a change. We've got to
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  get to a point where regardless of the
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  site of care, that the service delivered that's
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  the same, cost the same. So that's one
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  piece. The other,
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  I'll talk a little bit specifically about pharmacy
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  gap, the cost of medications
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  and the member responsibility
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  and the health plan responsibility.
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  We have these pressures for the right reasons.
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  I say that because
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  we know this. Medications are too expensive today
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  and they're too expensive for everyone. So those
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  are two gaps that we have got to
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  find solutions for and find them quickly.
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  In terms of finding solutions, what's one investment
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  or initiative you believe
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  will will most reshape how health plans operate
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  over the next two to three years?
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  Well, I'm gonna shift gears and think more
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  global
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  when it comes to an overall investment. And
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  as a family physician, I'm gonna think population
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  health first. And, Scott, this is what we
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  know. More people die of heart disease
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  than any other condition,
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  both men and women. We know this. And
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  in the spirit
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  of February is heart month and we are
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  in February,
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  cardiometabolic
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  investment is critical
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  to the future in the quality of life
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  for all Americans.
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  So it's not just the medications. That's a
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  piece of it. We know a driver of
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  cardiometabolic
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  impact is obesity. It often starts there. In
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  fact, it's starting in the pediatric
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  space and where it used to be in
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  adulthood that we had to be concerned. So
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  across that age span, we have got to
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  be thinking about the investment of lifestyle benefits.
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  Do people have safe places to walk? Is
• 7:54
  it part of the workplace,
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  the employer space?
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  How are we involving behavioral health? We know
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  when people are less active, when they have
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  chronic conditions such as
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  diabetes,
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  heart disease,
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  heart failure,
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  they are more likely
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  to suffer from depression, anxiety,
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  and other mental health challenges that make it
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  even harder for their over health to overall
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  health to improve.
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  And then finally, those medication barriers.
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  First one that usually comes to mind for
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  folks are those GLP one agonists,
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  and that is because they help reduce,
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  the weight,
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  but they also increase the cost of care.
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  Addressing the barriers in all of these spaces,
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  investing in a comprehensive approach is something that
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  we have to do in partnership
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  across the entire industry.
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  If you could change
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  one regulatory
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  or industry practice tomorrow to improve a 4,000,000,000
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  access,
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  what would it be and why?
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  Well, I hinted at this just a moment
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  ago. In fact, it was probably more than
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  a hint. It was an obvious nudge. Site
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  neutrality
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  is what's frankly best for our patients
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  and for overall Americans.
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  Receiving
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  the same care at the same price regardless
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  of the address
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  really matters to people and really matters to
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  the increasing cost of care that we see
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  today. The other is pharmacy,
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  flattening the cost. How do we identify those
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  biosimilars
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  for these fantastic
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  new life saving and life changing drugs
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  for these diseases where people have struggled for
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  so many years? We've got to be quicker
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  to
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  provide those biosimilars
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  for generics to be available and for specialty
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  cost drugs out of the gate. We have
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  some therapies now that cost a million dollars
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  a year.
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  Now, as we know, fewer and fewer people
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  will have access to health care
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  and more people will be uninsured in 2026
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  and onward.
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  There will be more people who cannot afford
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  that million dollar therapy. Again, that can be
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  life saving, life changing. So those are the
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  two things, site neutrality and pharmacy flattening of
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  costs, and we would see a healthier America.
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  A 100%. And there's certainly a lot more
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  work to do with with pharmacy costs as
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  you're alluding alluding to. Another thing is gonna
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  be a big topic at our Spring Payer
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  Issues Roundtable.
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  The last thing I wanted to ask you,
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  what issue
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  do you think is putting the most pressure
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  on health plan margins right now,
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  and how are you responding differently, for 2026?
• 10:27
  Well, for us at Essence and for me
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  as a clinician,
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  it always ends with
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  quality. Quality of care, so I think of
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  star performance.
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  There's a tremendous amount of pressure to maintain
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  where we are. We're a four and a
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  half star HMO plan. In fact, in all
• 10:44
  of our markets, we're the highest rated plan,
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  very proud of that because that is the
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  care that our members are receiving and can
• 10:51
  rely upon that they will receive by our
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  providers. It's because that strong relationship and collaboration
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  we have with our partners. Now that being
• 10:59
  said, the bar will continue to rise
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  in a good way. I remind folks of
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  this all the time.
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  We should not be practicing medicine the way
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  we did five years, ten years ago. We
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  should get better year after year after year.
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  What will continue to challenge us
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  are the social conditions that people are experiencing,
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  less money in their pocket,
• 11:21
  less,
• 11:22
  food on the table that's healthy for them
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  in a way that people can afford these
• 11:27
  medications
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  and their
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  nourishment.
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  That's really important. And the investment in services
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  that close-up all of those gaps in care.
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  So so many folks forget that
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  STAR includes
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  the gaps in care, the operations of the
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  business, the improvement year over year, and that
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  finally the experience.
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  I mentioned my mother a moment ago, and
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  I always consider what would Mimi do, how
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  would Mimi feel if she was in a
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  situation
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  needed help to health care? And did she
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  have someone to hold her hand
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  through the process? And that's what we're here
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  to do. That's what we should all be
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  doing is holding the hands of our patients
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  and ensuring they have an exceptional experience,
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  know that they're taken care of and can
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  receive the highest level of care, again, regardless
• 12:14
  of location, because at the end of the
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  day, this is what we do and we
• 12:18
  do it together
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  in health care.
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  Saree, thank you so much for joining us
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  on the podcast and for a great conversation.
• 12:25
  And, again, we're really looking forward to you
• 12:27
  speaking with us in April. Thank you, Scott.
• 12:29
  This is important work, and I am grateful
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  to do it every day.