Latest / Becker’s Payer Issues Podcast / Strengthening Payer Provider Collaboration to Improve Care and Efficiency with Dr. Daniel Elliott

Transcript

Strengthening Payer Provider Collaboration to Improve Care and Efficiency with Dr. Daniel Elliott · Becker’s Payer Issues Podcast

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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.