Latest / Becker’s Payer Issues Podcast / Karen Ignagni on Affordability, Medicaid and the Future of Health Insurance

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Karen Ignagni on Affordability, Medicaid and the Future of Health Insurance · Becker’s Payer Issues Podcast

0:02
- GLP ones, Medicare Advantage Headwinds, a Medicaid landscape
0:06
- that looks different
0:07
- every quarter.
0:09
- Their leadership right now means making durable decisions
0:11
- in an environment that keeps moving, and the
0:13
- organizations pulling ahead are the ones that stopped
0:16
- waiting for stability
0:18
- before acting.
0:19
- Becker's fifth annual fall payer issues roundtable convenes
0:22
- more than 500
0:24
- executive level attendees
0:25
- and 70 plus speakers November second and third
0:28
- at the Swiss Hotel Chicago.
0:30
- Two days of senior level dialogue on affordability,
0:33
- benefit design, value based care, and the strategies
0:36
- shaping how care gets financed
0:39
- and delivered, featuring a celebrity keynote from pro
0:43
- football hall of famer, Emmitt Smith. Agenda and
0:46
- registration at beckerspayer.com.
0:48
- Click events in the upper right.
0:51
- Hi, everyone. This is Elizabeth Cassello with the
0:53
- Becker's Payer Issues podcast.
0:56
- I'm thrilled today to be joined by Karen
0:57
- Ignani,
0:58
- CEO of EmblemHealth.
1:00
- Karen, thank you so much for chatting with
1:02
- us today. Thanks, Liz. Happy to do it.
1:05
- Thanks, Karen. So before we jump in, I
1:07
- would love to hear a little bit more
1:08
- about yourself,
1:09
- your health care career background,
1:11
- and also your current role at EmblemHealth, which
1:13
- there's been a very recent exciting update. So
1:16
- excited to hear what you have to say
1:17
- there. Thank you so much. I've,
1:20
- been asked by the board just a few
1:22
- days ago to
1:24
- reassume the CEO position here at EmblemHealth.
1:27
- Our CEO,
1:29
- has just retired,
1:31
- and, it was an honor to say yes.
1:34
- I love this company.
1:35
- We have,
1:36
- transformed this company, and we're growing now.
1:40
- So we have modernized every aspect of it.
1:44
- So it's a pleasure to come in at
1:46
- this stage now.
1:48
- I was executive chair after being CEO for
1:51
- eighteen months, so I never left, but now,
1:55
- it's wonderful to be working with the operating
1:57
- team again and getting back into all aspects
2:01
- of what we're doing.
2:03
- So just to kind of tease that out
2:04
- a little bit more with your reassumption of
2:07
- the CEO role, what is different now than
2:10
- prior?
2:11
- I would love to hear I know it's
2:12
- been a few days since it's been announced,
2:14
- but I'm just curious. I can answer that
2:16
- question,
2:17
- very quickly.
2:19
- When I came to EmblemHealth,
2:22
- it was a turnaround situation,
2:24
- and I'm so grateful. And many of the
2:26
- people are here who went through that with
2:29
- me.
2:30
- We are a very important,
2:33
- not for profit
2:34
- community
2:35
- mission plan in New York City. That's where
2:38
- we're domiciled.
2:40
- And bringing this plan back,
2:43
- which meant modernizing
2:45
- the technology,
2:46
- modernizing
2:48
- our customer service,
2:50
- making sure that we can compete with all
2:54
- of the large players.
2:56
- So we have technology now that's on par
2:58
- with all of them. We have,
3:01
- all of the bells and whistles that you
3:03
- would expect with respect to customer service,
3:06
- with respect to AI,
3:09
- with respect to every aspect
3:12
- of our care management
3:14
- and other
3:15
- medical enterprises.
3:17
- So we feel really excited about where we
3:20
- are. We feel excited about growth,
3:23
- and we feel equally excited about what we
3:26
- are doing in the community.
3:28
- We're the first plan in New York State
3:31
- to have NCQA
3:33
- accreditation
3:34
- health equity accreditation
3:36
- for all lines of business, and that's just
3:38
- been renewed. So we're very proud of that.
3:41
- It's a very important part of what we
3:42
- do.
3:44
- So you've previously led AHIP prior to your
3:46
- I did. Tenure at EmblemHealth. So I would
3:49
- love to hear what's the biggest thing you
3:50
- underestimated in that role that became more clear,
3:53
- especially in that turnaround phase of things,
3:56
- as you jumped into EmblemHealth.
3:58
- It's actually a really good question
4:00
- and one I thought about quite a lot
4:03
- throughout my experience at AHIP.
4:05
- I think what coming into the role,
4:08
- we were and at that time, it was
4:10
- very similar to coming into, Emblem. We were
4:12
- building an organization,
4:14
- and I didn't quite understand
4:17
- the power of collaboration
4:19
- within an industry
4:21
- for positive change.
4:23
- And, indeed,
4:25
- we were quickly embedded
4:27
- in a range of challenges at AHIP
4:30
- and mobilizing
4:32
- the industry
4:33
- to work together
4:34
- to make people's lives better, to solve problems.
4:38
- I think I hadn't quite go going into
4:40
- that role,
4:43
- understood the power of that. I'll give you
4:45
- an example.
4:46
- During,
4:47
- 09/11,
4:49
- the leader
4:50
- that was then called Empire, which is the
4:52
- Blue Cross Blue Shield plan in New York
4:54
- City,
4:56
- they were in the tower.
4:58
- They lost, sadly, people,
5:01
- and they lost,
5:02
- their place of work. So we mobilized the
5:05
- industry
5:06
- to collaborate and help play claims
5:08
- and help, give
5:10
- the CEO there, Mike Stocker, doctor Stocker,
5:13
- support,
5:15
- in a variety of ways. And you wouldn't
5:17
- think about that from a health plan perspective,
5:19
- but everybody stood up and collaborated
5:22
- from small plan to large plan in this
5:25
- area.
5:26
- We also had a history of
5:28
- helping and partnering with the CDC, with NIH
5:33
- on some
5:34
- of the infectious disease and SARS issues that
5:38
- occurred,
5:38
- kind of a pre COVID sort of thing.
5:42
- And,
5:43
- that worked very, very well and very important.
5:46
- And then working together with president Bush on
5:49
- part d
5:50
- and being solution providers and then president Obama
5:54
- on the ACA
5:55
- And coming to the table with solutions,
5:58
- with thoughts, working with partners and other industries,
6:02
- just, well, a, learning how to do that
6:05
- and then executing it and really seeing the
6:08
- power of an industry working together to solve
6:11
- problems
6:13
- was something that I took away,
6:15
- from AHIP with me, and we've tried to
6:18
- do quite a lot of that here.
6:20
- We were we have been a leader
6:22
- in simplifying
6:24
- prior authorizations,
6:25
- for example.
6:26
- We've been a leader in value based payments
6:29
- and all shapes and sizes. We can do
6:32
- our technology
6:33
- allows us to customize
6:35
- and meet physicians and hospitals where they are.
6:38
- So wherever they are on the continuum, we
6:40
- can offer solutions to collaborate.
6:44
- And then we were early into
6:46
- the issue of social determinants of care because
6:49
- of our community mission.
6:52
- We have 15, what we call, neighborhood care
6:54
- centers,
6:55
- which anyone in our communities, you don't have
6:58
- to be a member of ours, can walk
6:59
- in,
7:00
- get help with food, with transportation, with housing,
7:03
- take a free class, ask a question,
7:06
- just generally
7:07
- get help and find people
7:10
- who are there to support the community.
7:13
- But that really gave us an understanding
7:16
- of the importance of addressing social determinants of
7:19
- care as we dealt with inequities
7:22
- and as we dealt with people who had
7:24
- been underserved.
7:26
- Our centers in are in some of the
7:28
- most underserved parts
7:30
- of New York,
7:32
- and so we're very proud to have contributed
7:35
- again,
7:36
- making people's lives better
7:38
- through those centers, through our team. And they
7:41
- they truly every time I go to one
7:43
- of these centers, I get goosebumps watching
7:46
- our team work
7:47
- and how they interact with the community and
7:49
- community based organizations.
7:51
- So I took those lessons with me from
7:54
- AHIP.
7:55
- Mhmm.
7:56
- I also wanna follow-up on some of the
7:59
- policy points and administration
8:01
- relationships you touched on earlier.
8:03
- I'm curious. You know, there are parts of
8:05
- the interoperability
8:06
- rule coming into play in 2027.
8:09
- So how are you feeling heading into 2027
8:12
- with some of those interfaces that are now
8:14
- going to be required?
8:15
- Well, if we hadn't modernized our technology, I
8:18
- wouldn't be sleeping a wink. But we have.
8:20
- So and our leader
8:22
- here,
8:24
- our chief operating officer, and his team have
8:26
- done just an outstanding job. So we are
8:29
- ready to share data.
8:31
- We are ready to do
8:33
- what is being required in the new regulations.
8:37
- And, again, we can seamlessly do this now.
8:40
- If you had asked this question and if
8:43
- those requirements had existed given
8:45
- you
8:46
- the
8:46
- confident
8:47
- answer that I just gave you.
8:50
- Mhmm.
8:51
- And another big policy
8:53
- item coming into play is going to be
8:55
- the Medicaid work requirements and more frequent
8:58
- eligibility checks for the expansion population. So you
9:01
- talked a little bit about the community centers,
9:03
- but I'm curious how is EmblemHealth preparing members
9:06
- for these changes?
9:08
- It's a full court press here because you
9:10
- have to look at it systematically.
9:12
- We have had lot and other health plans,
9:15
- of course, all the other health plans have
9:16
- had lots of experience with recertification.
9:20
- But this is entirely different because
9:23
- there is an entirely new structure now that's
9:25
- imposed,
9:27
- And it's very, very
9:29
- unclear
9:30
- as to,
9:32
- which individuals
9:33
- can get exemptions,
9:35
- for example, on work requirements. If you have
9:38
- cancer, you don't have an automatic exemption.
9:42
- That's a head scratcher to me, and there
9:44
- are many other examples of that sort. So
9:47
- we have to make sure we help our
9:49
- members understand
9:51
- what the requirements are,
9:53
- where there may be opportunities,
9:56
- quite importantly for them because they fall into
9:59
- various categories
10:00
- for exemptions,
10:02
- when they are going to be coming up
10:04
- for renewal,
10:05
- what kind of information they have to provide.
10:08
- So, again,
10:09
- it broadens out this role of a health
10:12
- plan.
10:14
- We are you know, it moves us into
10:17
- a social support
10:19
- mechanism
10:20
- and social support organization
10:22
- to provide this
10:24
- support, to provide this information,
10:27
- and provide a helping hand to our members.
10:30
- That means
10:31
- not only do you have to have the
10:32
- technology
10:33
- that helps
10:35
- give people warning,
10:37
- You have to have the information
10:39
- up to the minute
10:40
- of what are the regs say, what are
10:42
- the requirements, etcetera,
10:44
- and make sure that's always being refreshed. So
10:47
- you need spectacular government affairs people who are
10:50
- keeping in touch with that. And then you
10:52
- need communications
10:54
- people
10:55
- and customer service people to convey all this,
10:58
- and it's not one and done. It's a
11:00
- continuous process.
11:02
- So when I say it's a full court
11:04
- press,
11:05
- there are a number of,
11:08
- towers within our organization
11:11
- that not only are working on these issues,
11:14
- but working together because unless they work together,
11:17
- we will not be as effective as we
11:19
- need to be for our members.
11:22
- Do you have concerns about how state governments
11:25
- are prepared or how prepared they really are
11:27
- for these requirements
11:29
- coming in the new year? I have concerns
11:31
- about how everyone is prepared.
11:33
- I think that it is very, very difficult
11:36
- to sort through this.
11:39
- It hasn't been done.
11:40
- I think that
11:42
- the question is when folks
11:45
- see people falling through the cracks, which will
11:48
- definitely happen,
11:49
- it happens always with something that's new,
11:52
- will that be,
11:54
- a spark that causes people to really take
11:58
- another look, reevaluate,
12:01
- and really think about
12:03
- what are we asking for, for what purpose.
12:06
- Obviously, everyone supports
12:09
- this concept of fraud detection and preventing that.
12:13
- But if we are,
12:15
- imposing
12:16
- such requirements
12:17
- that you're discouraging
12:19
- people
12:20
- from participating
12:22
- because they're trying to take care of their
12:24
- families, they're trying to work,
12:26
- they're in school, etcetera, these are working families,
12:30
- then you wonder,
12:32
- you know, is
12:34
- is the goal being achieved because we want
12:37
- to make sure that people have the health
12:39
- care access that they need. So I'm very
12:42
- worried about people falling out of the system.
12:45
- I'm worried about bad debts, which I've been
12:47
- worried about in terms of the subsidies going
12:49
- away as well. And I think we're gonna
12:52
- see a number of people falling out, and
12:54
- I think that's gonna cause
12:57
- quite a lot of consternation,
12:59
- not only at the local level, but the
13:00
- state level, and it'll flow up to the
13:03
- national level as we head into a presidential
13:06
- election.
13:07
- So some of what you were just saying
13:09
- feeds into another thing I wanted to ask
13:11
- about.
13:12
- You know, we are approaching one year since
13:14
- ACA enhanced subsidies
13:16
- expired, and the Trump administration
13:18
- recently announced it would send $500 checks to
13:21
- nearly 1,000,000 Americans in states using the federal
13:23
- exchange. So while that does exclude New York,
13:27
- you know, I am curious because I think
13:28
- have a state exempt. Exactly. Just so everybody
13:30
- knows. Yeah. We have a state exchange. Right.
13:33
- But I am curious with your AHIP background,
13:36
- what is your reaction to that given the
13:38
- subsidy expiration?
13:39
- I think that the fact that,
13:42
- the administration
13:43
- is recognizing that people need help
13:46
- is important. Now the question is
13:49
- whether that is adequate,
13:52
- whether,
13:54
- it will allow people
13:56
- to
13:57
- continue the coverage that they need,
14:00
- and,
14:01
- whether or not given the high price of
14:04
- food, the high price of gas,
14:06
- the high price of health care, that it
14:08
- will actually go to help them with their
14:11
- health care expenditures.
14:13
- I don't know the answer to that right
14:15
- now. This is it'll be the kitchen table
14:18
- test for many families,
14:21
- and we know people need coverage.
14:23
- We know affordability is
14:26
- number one on their minds.
14:28
- And but we also know that going to
14:30
- the grocery store is far more expensive today
14:34
- and continuing to be more expensive. We know
14:36
- gas is more expensive as, you know, seems
14:39
- by the hour.
14:40
- So I'm very worried about
14:43
- how people
14:44
- will afford to stay in the system, and
14:47
- that have has significant
14:50
- repercussions if they can't. That means prevention goes
14:53
- away. That means if I have asthma, if
14:56
- I have chronic
14:57
- heart disease, if I have,
15:00
- name your disease,
15:02
- that I don't get the care management. I
15:05
- don't get the drugs. I don't get the
15:07
- support I need to manage that. So the
15:10
- only alternative,
15:11
- if I'm uncovered,
15:13
- is to ignore things because I can't afford
15:16
- it
15:17
- and wait till things get to a critical
15:19
- stage
15:20
- and enter the doors of the health care
15:22
- system through the hospital emergency room. That creates
15:26
- more bad debts. That makes things more expensive
15:29
- for everyone. It's a burden on our hospitals,
15:31
- on our hospital workers,
15:33
- and it makes no sense because it turns
15:36
- upside down everything we know about the value
15:39
- of early intervention.
15:42
- I was just reading another article about how
15:44
- even some health care workers are opting out
15:46
- of coverage because they're so late can't afford
15:49
- it. Well, that is the subsidy story.
15:52
- The subsidies
15:53
- were,
15:54
- and I'm not so sure it seemed to
15:56
- happen so quickly
15:58
- for people to really document this.
16:01
- But for those of us in the health
16:02
- plan community, we know the subsidies were going
16:06
- to working families.
16:07
- Many of them are health care workers. They
16:10
- work in the nurse in nursing homes. They
16:13
- work in home health. They work in FQHCs.
16:16
- They work, you know, in, you know,
16:19
- certain hospitals
16:21
- around the country.
16:23
- For those workers
16:24
- to lose health care coverage,
16:27
- we are talking about working families.
16:29
- We're also having a conversation
16:32
- macroly in our country
16:34
- about how we encourage growth.
16:36
- Working families are the key to productivity
16:39
- and growth
16:40
- throughout our economy. So to yank health insurance
16:44
- from those individuals,
16:47
- I think
16:48
- is penny wise and pound foolish from an
16:50
- economic
16:52
- perspective,
16:53
- and it's awful from a health care perspective
16:55
- because those are the very workers you need
16:58
- to stay healthy
16:59
- so they can do their jobs. They are
17:01
- helping the rest of us.
17:03
- On the topic of affordability,
17:05
- you can think about EmblemHealth, but you could
17:07
- also think big picture. What is the best
17:09
- insurer strategy you've seen to address those concerns
17:12
- right now? Well, first of all, let me
17:13
- tell you what's not being done on affordability.
17:17
- People who are leaders in congress, in state
17:20
- government
17:21
- are allergic to
17:23
- the issue of affordability
17:25
- because they don't wanna confront the politics.
17:28
- And I'm gonna give you one
17:32
- example of something,
17:34
- a very compelling study that I saw just
17:36
- a few days ago from Yale.
17:38
- It was in JAMA
17:39
- about what's really driving costs.
17:42
- And they actually said what we know in
17:45
- the health care community and the health plan
17:47
- community,
17:47
- our admin is coming down.
17:50
- Meanwhile,
17:51
- costs, unit costs are going up.
17:54
- Unit costs, according to the study in JAMA,
17:57
- just published,
18:00
- fuels 90% has fueled 90% of the growth
18:03
- in expenditures
18:04
- from,
18:05
- 2011
18:06
- to '24.
18:08
- Members of congress
18:09
- and in states
18:10
- don't wanna confront the policy the the policy
18:13
- issues surrounding
18:15
- higher and higher hospital costs.
18:18
- We have hospitals that are over 400%
18:20
- of Medicare.
18:22
- We have hospitals
18:23
- that
18:24
- have been highly consolidated
18:27
- and have anticompetitive
18:28
- contract provisions, which is causing
18:31
- a growth in premiums.
18:33
- There is a reluctance to confront that because
18:35
- of the politics.
18:37
- Now we get to the pharmaceutical
18:38
- companies.
18:39
- They basically say, oh, it's the health plan's
18:42
- fault. Well, the data show
18:44
- that they're making profits in the 20 to
18:46
- 25%
18:47
- range.
18:48
- They're not allocating
18:50
- these resources
18:51
- to development
18:52
- of drugs.
18:54
- And so one of the things, Liz, I
18:55
- think
18:56
- a simple thing.
18:57
- We have an MLR in our industry.
19:00
- If we had an MLR for hospitals and
19:03
- pharmaceutical
19:04
- companies,
19:04
- the public could clearly see
19:07
- what the administrative costs are, number one, what
19:10
- are profits,
19:11
- and have a conversation about what's really driving
19:14
- costs because we are not having that conversation
19:18
- today
19:19
- at all.
19:20
- So when you ask me what are the
19:22
- productive
19:23
- strategies
19:24
- from a health plan perspective,
19:26
- we will continue
19:28
- to do a number of things to try
19:32
- to bend the curve with care management, value
19:35
- based payments.
19:36
- We will continue to move upstream
19:40
- on preventive care and wellness
19:43
- and making sure that people who have chronic
19:46
- conditions
19:47
- are being managed so that we keep their
19:50
- costs from their perspective down, but we keep
19:54
- them out of the hospital and we keep
19:56
- them as healthy as we can. That's our
19:58
- role, and we're doing a number of things
20:01
- as are a number of health plans to
20:03
- do that. And we're using AI in very
20:06
- interesting areas
20:07
- to really help
20:09
- support an individual
20:11
- who has congestive heart disease or who has
20:15
- another type of chronic condition
20:17
- because everybody wants to be treated as an
20:19
- n of one.
20:21
- You know, we've had this this language in
20:23
- the health care community, population health.
20:26
- People don't wanna be a population. They wanna
20:29
- be an n of one. And now we
20:31
- have the tools to go upstream
20:34
- to do the predictive modeling that's necessary to
20:36
- say,
20:37
- I may be at risk of a certain
20:40
- chronic disease
20:41
- to reach out, to help, to support,
20:44
- and to help manage,
20:47
- me and anybody else in that category.
20:50
- So those are the really exciting things that
20:52
- are going on in the health plan community
20:54
- because we touch people
20:56
- in every encounter in the health care system.
20:59
- No other industry is in that position.
21:02
- So we are u now we have the
21:05
- tools that allow us to customize
21:08
- treatment, to target treatment,
21:10
- and to really support people the way they
21:13
- want to be supported.
21:14
- We have the tools to make people's lives
21:17
- better, which is really exciting.
21:20
- Do you have any final thoughts for industry
21:22
- leaders as we wrap up?
21:25
- I think that we
21:27
- have a lot,
21:28
- that we need to do if we're going
21:30
- to be in
21:32
- the congressional,
21:34
- arena, the state arena, and talk about
21:37
- affordability
21:38
- and what others should do, then we have
21:40
- an obligation to make sure our own houses
21:43
- are in order, that we're doing things to
21:46
- take down abrasion
21:47
- for individuals.
21:49
- We're cleaning up practices, and we're doing
21:52
- as much as we can to simplify
21:54
- processes.
21:55
- And there's a whole list of things that
21:58
- could be done. Maybe that's our next podcast.
22:01
- Well, thank you so much, Karen, for taking
22:03
- the time today. I appreciate it.
22:05
- And to our listeners, if you'd like to
22:07
- hear more podcasts from Becker's Healthcare, you can
22:09
- visit beckershospitalreview.com.
22:11
- Thanks again, Karen. Thank you.