Latest / Becker’s Payer Issues Podcast / Karina Lupercio, VP of Market Integration & Data, and Ann Marie Gomez, Sr. Director of Marketing at Healthcare Highways

Transcript

Karina Lupercio, VP of Market Integration & Data, and Ann Marie Gomez, Sr. Director of Marketing at Healthcare Highways · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy, care, and
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  benefit solutions.
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  Barriers to care can lead to gaps in
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  care, which can drive up the total cost
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  of care. Our capabilities work seamlessly together to
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  create innovative pharmacy care and benefit solutions for
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  today and tomorrow.
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  Our connected health services make the treatment, prediction,
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  and prevention of health care's most complex conditions
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  easier and more accessible as we drive organizations
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  and people forward. Hello, and welcome to the
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  Becker's Payers Issues podcast recorded live at the
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  third annual spring Payers Issues roundtable here in
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  Chicago.
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  I'm joined today by Karina Lupercio and Ann
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  Marie Gomez.
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  Karina, can you start by taking a moment
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  to introduce yourself and your organization?
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  Absolutely. Good morning, and thank you for having
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  me. I'm excited to be here. My name
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  is Karina Lupercio, and I serve as vice
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  president of market integration and data quality management
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  at Healthcare Highways.
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  Our organization was founded in 02/2013,
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  and we initially operated in Oklahoma before expanding
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  into Texas
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  and forming our first joint venture in Louisiana.
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  We focus on building curated provider networks and
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  delivering the technology and the operational infrastructure
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  for clients who want to run their own
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  health plan.
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  In my role specifically, I lead joint venture
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  implementations
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  often between hospital systems and their provider sponsored
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  health plans.
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  My job is to ensure that the overall
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  structure is in place and fully operational by
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  the launch date.
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  That includes everything from project management, facilitating steering
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  committees, and work groups to coordinating across departments.
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  There are a lot of moving parts, and
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  every hospital system we partner with is different.
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  Some have robust internal teams, while others need
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  more hands on guidance.
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  That also means I spend time listening, understanding
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  the organization's
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  culture,
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  pain points, and where they need the most
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  support.
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  It's never a one size fits all. And
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  what what makes the work so meaningful,
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  is that we're building something truly custom for
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  each community.
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  But at the end of the day, my
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  role is to ensure that all of those
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  moving parts align so that the hospital system
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  is fully equipped to operate as a payer
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  on time and with confidence.
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  That's just one of the many ways that
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  I contribute.
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  Now, Ann Marie, would you mind introducing yourself?
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  Hi.
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  I'm Ann Marie Gomez, senior director of marketing
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  communications at Healthcare Highways.
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  My journey into marketing started with a passion
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  for advertising,
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  but what really hooked me was a strategy
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  behind it all. The idea that data could
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  steer decisions
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  and that delivering the right message at the
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  right time could truly hit home with people.
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  I quickly learned that data isn't just about
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  looking at past behavior.
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  It's an awesome way to predict what people
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  might need next and create communications that resonate.
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  I fell in love with using tech and
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  data tools like CRM and marketing automation and
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  predictive modeling to connect with the right audience.
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  I gained my expertise
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  working in fast paced agency settings where I
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  handle loyalty programs and managed omnichannel campaigns for
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  retail and tech brands.
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  Then I made the leap into health care,
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  and that's when it all clicked.
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  I realized marketing could do so much more
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  than just sell products or services.
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  It could actually help people navigate
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  tough choices
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  and feel supported during some of life's
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  key moments.
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  Now I'm leading marketing and communications at my
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  company, Health Care Highways,
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  and we're shaking things up in the employer
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  sponsored health plans.
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  It's pretty exciting.
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  We're challenging
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  the norm by offering employers
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  real alternatives
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  to the big national carriers.
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  We are doing this by proving that high
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  performance provider networks lead to more effective health
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  plans.
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  With the right design,
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  employers can offer access
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  to high quality care and get more value
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  out of every dollar spent.
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  It's a win for them and for their
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  employees.
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  Thus, I focus on creating engaging content that
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  sparks interest and drives growth.
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  But the real win comes when employers can
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  give their teams access to quality health care
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  without breaking the bank.
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  How is this done?
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  It's through implementing effective provider network design,
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  which can save cost and boost employee satisfaction
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  by ensuring they can receive the proper care
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  in the right place
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  at the right time, but most importantly, for
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  the right price.
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  At the end of the day, I'm all
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  about using marketing, not just to promote, but
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  to educate,
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  build trust,
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  and enhance the health care experience for everyone
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  involved.
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  So balancing affordability and quality is a constant
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  challenge for health plans. How is your organization
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  innovating to manage the cost of care while
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  maintaining or improving member outcomes?
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  That's a great question,
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  and it really gets to the heart of
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  what we do at HealthCare Highways.
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  We're focused on redefining how care is delivered
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  and paid for.
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  It starts with our curated high performance provider
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  networks.
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  What do we mean by curated?
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  When we say curated, we mean we just
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  don't include every hospital or doctor out there
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  like the big national carriers.
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  We carefully select providers who deliver great care,
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  have strong outcomes,
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  and are committed to keeping costs reasonable.
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  It's quality over quantity approach.
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  We don't believe in massive one size fits
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  all networks.
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  Instead, we partner with health care systems and
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  providers that meet rigorous quality standards
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  and are aligned around value based care.
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  These partnerships
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  help us ensure members are getting the right
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  care from the right providers at the right
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  time,
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  but that's just the beginning.
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  We're also committed to price transparency.
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  When employers and members know what costs upfront,
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  they're empowered
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  to make smarter, more informed decisions.
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  It's about removing the mystery from medical billing
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  and replacing it with clarity and confidence.
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  And beyond that, our model is built to
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  support advanced care management.
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  We leverage data and predictive analytics to coordinate
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  care more effectively,
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  especially for members with chronic or complex conditions.
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  This includes proactive wellness initiatives,
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  helping members navigate their benefits in a way
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  that feels human and is not transactional.
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  So all of this, curated networks,
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  transparent pricing,
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  proactive care coordination,
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  adds up to better outcomes and real cost
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  savings.
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  We're making health care work better for employers,
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  for members, and for the providers delivering the
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  care.
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  Now, Karina, I'm gonna turn this next one
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  over to you. Addressing health equity has become
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  a critical focus for many health plans. Can
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  you share a brief overview of a key
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  initiative here that you that you're involved in
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  or particularly excited about? And, what are you
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  hoping to achieve?
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  I'm excited about the panel on health literacy
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  happening tomorrow because to me, that's where the
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  work of health equity truly begins.
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  The idea of simplifying
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  complex health care information,
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  integrating mobile tools, and tailoring outreach to meet
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  people where they are, that's where the real
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  impact lies. It's also a topic that's deeply
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  personal to me because I come from an
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  immigrant family. And growing up, navigating The US
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  health care system was hard. We didn't always
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  know what was covered, how to access care,
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  or even who to turn to. Even today,
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  as I help my own parents transition into
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  Medicare, I realize it's still hard.
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  There are so many different types of plans
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  and coverage levels. It's overwhelming
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  even for those of of of us who
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  work in the industry.
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  And hidden in all of that complexity are
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  important details, like the fact that some plans
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  offer incentives
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  for completing
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  preventative screenings.
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  But that information is hard to find and
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  easy to miss. And that matters because these
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  missed opportunities
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  could impact patient outcomes.
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  So how do we communicate that better?
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  It's something I've had to explain to my
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  own parents, and every time I'm reminded how
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  confusing the system can be. That lived experience
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  has shaped how I see health equity, not
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  as an abstract com concept, but as something
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  deeply human.
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  For me, health literacy is the entry point
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  to equity.
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  You can have the best doctors, the best
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  hospitals, and the best benefits,
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  but if people don't understand them, they won't
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  use them. And I've seen how marginalized
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  communities, especially those where English isn't the first
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  language, face yet another layer of complexity
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  when trying to access care.
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  It's not just a language barrier, it's a
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  fluency barrier with the entire system.
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  That's why I'm so passionate about initiatives that
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  help people not just learn about their health,
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  but also how to navigate the system around
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  it. And this goes beyond brochures and websites.
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  It's about consistent,
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  culturally competent communication,
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  whether that's through a bilingual care navigator,
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  community health events, or partnerships with trusted organizations.
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  True health literacy isn't just about information.
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  It's about access, trust, and understanding.
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  And so I'm hopeful that health plans will
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  start seeing education as a core part of
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  member care, not just as an add on,
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  but as an essential service.
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  Because if we want better outcomes,
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  we have to build a better understanding first.
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  And I want families like mine to feel
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  empowered, not confused when it comes to managing
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  their health. Because when people understand their care,
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  they're more likely to trust it. And that's
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  how we start to close the gaps. That's
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  what I wish my family had, and it's
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  what drives me every day to help make
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  the system better.
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  Karina, I can really see why you're so
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  passionate about that. I really appreciate you sharing
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  that personal story.
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  Now, Anne Marie,
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  I wanna ask you. So member satisfaction is
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  essential to thrive in today's competitive market.
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  What experience or engagement strategies have proven effective
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  for your organization,
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  and, you know, what are your KPIs? How
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  are you managing success?
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  Absolutely. And it's a good segue off of
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  what Karina had mentioned about health equity and
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  education for the members.
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  Member satisfaction is everything
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  in today's health care environment.
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  People are no longer just patients.
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  They're consumers, and they expect healthcare to feel
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  more personal,
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  more transparent, and easier to navigate.
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  One of the most effective strategies I have
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  found is showing up for members in real
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  tangible ways.
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  And this is through personalized outreach,
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  providing bilingual resources,
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  and easy to understand materials that help take
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  the guesswork out of their benefits.
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  We also work closely with our partners and
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  our internal team to provide on-site support.
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  This is through
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  real people who are available to answer questions,
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  help with benefit navigation, and be a friendly
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  face when members need it most.
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  Whether it's
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  during open enrollment,
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  onboarding, or just day to day life.
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  That kind of presence makes a huge impact.
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  It turns the health care experience from confusing
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  and frustrating into one that's approachable and human.
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  And it's not just about being went there
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  when something goes wrong.
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  We partner with care coordination services,
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  chronic condition support programs,
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  and primary care providers
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  to proactively help members stay healthier.
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  The more engaged people are with their care
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  early on, the better the outcomes and the
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  more trust we build.
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  We measure success through a mix of data,
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  engagement metrics, satisfaction surveys,
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  net promoter scores, and the stories we hear.
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  Because when members tell us that her person
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  helped me when I didn't know where to
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  turn,
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  that's when we know we're doing something right.
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  Because at the end of the day, satisfaction
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  isn't just a number. It's how someone feels
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  when they know they're not alone,
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  especially when they need medical help.
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  And, Maria, I really love that answer, especially
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  when, you know, you're saying it lets people
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  know they're not alone. Karina,
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  final question. Looking ahead, what do you see
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  as the biggest opportunity for payers to lead
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  the charge in transforming health care delivery and
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  driving better outcomes for all stakeholders?
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  How can leaders take a step in this
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  direction right now?
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  Everything that Anne Marie said reinforces the point
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  that today's members expect more, and they should.
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  And as we look ahead, this is one
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  of the most exciting moments I've seen in
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  health care. The opportunity for payers isn't just
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  to optimize what we already do. It's to
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  reimagine how we show up for members, providers,
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  and our communities.
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  Artificial intelligence or AI gives us the tools
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  to rethink, not just automate how we work.
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  It helps streamline operations, speed up decision making,
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  and proactively
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  identify care needs, often before a member even
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  knows to ask for help.
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  But I think the biggest shift is this.
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  AI allows us to be proactive
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  and not reactive.
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  We can use data not just to analyze
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  what went wrong, but to anticipate what could
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  go right. For the first time, we have
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  the tools to act on that insight at
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  scale.
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  It's an opportunity
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  we haven't had before, and now is the
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  time to take full advantage of it. It
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  unlocks earlier outreach, smarter navigation, and more personalized
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  care journeys.
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  And it's not about replacing people. It's about
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  empowering people, especially those on the front line
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  to do more of what matters.
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  Imagine
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  freeing up time for a care manager to
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  focus on a high risk member because AI
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  is handling the repeatable admin task in the
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  background.
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  One of the biggest opportunities
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  I see
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  transforming the front door of health care is
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  making the member experience intuitive,
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  digital first, and built around trust.
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  But all of that depends on one thing,
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  readiness.
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  Readiness in your data,
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  readiness in your people, readiness in your mindset.
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  So how can leaders take that step now?
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  For leaders,
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  I believe it means committing to continuous learning.
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  The leaders who stay curious, who evolve
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  alongside the technology
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  are the ones who will create lasting change.
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  The pace of change is, like, unlike anything
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  we've seen, and AI has only accelerated that
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  curve. To lead in this moment, we don't
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  have to know everything,
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  but we do have to be willing to
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  keep learning because staying open and adaptable
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  alongside the technology
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  is what will allow us to lead through
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  the change, not just react to it. And
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  that's what excites me. We're not just building
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  tools. We're building entirely new ways to think
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  about care delivery.
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  The organizations
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  that embrace this mindset are going to reshape
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  what it means to be a payer, a
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  partner, and a leader in this industry.
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  These are exciting times. And the real question
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  now isn't whether we can transform care. It's
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  whether we're bold enough to lead it.
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  Well, Karina and Marie, I really appreciate you
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  both joining us today on the Becker's Healthcare
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  podcast. It's been an absolute pleasure. Thank you
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  so much.
• 15:30
  Thank you. It was a pleasure. You both
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  have a lovely rest of your day.