Latest / Becker’s Healthcare Podcast / Amanda Free on Affordability and Access in Georgia’s Commercial Market

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Amanda Free on Affordability and Access in Georgia’s Commercial Market · Becker’s Healthcare Podcast

• 0:02
  - GLP ones, Medicare Advantage Headwinds, a Medicaid landscape
• 0:06
  - that looks different
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  - every quarter.
• 0:09
  - Their leadership right now means making durable decisions
• 0:11
  - in an environment that keeps moving, and the
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  - organizations pulling ahead are the ones that stopped
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  - waiting for stability
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  - Becker's fifth annual fall payer issues roundtable convenes
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  - more than 500
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  - executive level attendees
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  - and 70 plus speakers November second and third
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  - at the Swiss Hotel Chicago.
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  - Two days of senior level dialogue on affordability,
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  - benefit design, value based care, and the strategies
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  - shaping how care gets financed
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  - and delivered, featuring a celebrity keynote from pro
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  - football hall of famer, Emmitt Smith. Agenda and
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  - registration at beckerspayer.com.
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  - Click events in the upper right.
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  - Hi, everyone. This is Elizabeth Cassello with the
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  - Becker's Payer Issues podcast.
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  - I'm thrilled today to be joined by Amanda
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  - Free, President of Commercial Business for Anthem Blue
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  - Cross and Blue Shield in Georgia.
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  - Amanda, thank you so much for joining us
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  - today. Thanks, Liz. I'm excited to talk to
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  - you today. Yeah, we're so happy to have
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  - you. So before we jump in, can you
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  - give us a little bit more background about
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  - your current role? You're relatively new to this
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  - specific role, but you have a much longer
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  - history in the commercial space and in this
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  - market. So we'd love to hear about your
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  - healthcare background.
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  - Right. I moved into this role about four
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  - months ago,
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  - but I actually started my career in the
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  - insurance and health care industry when I was
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  - in college.
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  - I was a risk management major at the
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  - University of Georgia and took an internship
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  - with a consulting
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  - company
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  - that focused on benefits. And I ended up
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  - working there for the full two years, the
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  - rest of the time that I was in
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  - school and then got a job with another
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  - consulting company
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  - after that in Augusta. So,
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  - started my career in that space. The agency
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  - that I worked for outside of Athens was
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  - pretty progressive in the stuff that they were
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  - doing, and so when I went to the
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  - consulting company in Augusta after school, some of
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  - the first things that I did were leasing
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  - a color copier,
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  - instituting a CRM,
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  - different things like that. But I had the
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  - opportunity to work with small employers,
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  - large employers,
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  - on retiree plans, and that offered a lot
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  - of experience. From there,
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  - I was offered a position with a payer
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  - who was expanding outside of Metro Atlanta for
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  - the first time, and so Augusta was the
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  - first market they were expanding to. And that
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  - role,
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  - because it was sort of a start up,
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  - gave me the opportunity to do a lot
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  - of things that I wouldn't have done if
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  - I had this similar role in Atlanta. So
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  - I was running around,
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  - the rural parts of the state with provider
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  - direct or paper provider contracts,
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  - in the back of my car, dropping them
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  - off when we identified gaps in our network
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  - or places that we needed
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  - to build a network in order to file
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  - to sell coverage in that county.
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  - I was working with, in that role, also
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  - small employers, large employers,
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  - labor unions,
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  - lots of lots of different variety.
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  - And so when I moved back into Atlanta,
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  - I was able to take a lot of
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  - what I had learned in that role and,
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  - translate it into all the roles that I've
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  - had in the twenty years since. And so
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  - that has led me to this role today,
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  - and I get to bring all of that
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  - together in helping Anthem Blue Cross Blue Shield
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  - grow,
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  - in Georgia.
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  - So given your background in Georgia and how
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  - you started there and you're still there, what
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  - is unique about the commercial market in the
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  - state that you're focusing on in this role?
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  - The challenges that we face in Georgia
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  - have unique ways
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  - of needing to be solved. They're not necessarily
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  - different than what you're hearing about nationally. Right?
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  - Health care needs to be more simpler.
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  - It needs to be easier to navigate, and
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  - it needs to be more affordable.
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  - When we think about each of those areas,
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  - there's opportunities
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  - in our state.
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  - And,
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  - we always say it's about getting people the
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  - right care at the right time
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  - in the right place and for a cost
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  - that they can afford.
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  - And when you think about the right care
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  - in the right time, that's not necessarily
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  - unique. People,
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  - you know, we have to meet people where
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  - they are. So if they're healthy, we need
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  - to make sure they're getting their preventive care.
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  - We need to make sure they're following up
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  - on annual exams and tests and doing the
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  - things that they need to do to catch
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  - things early.
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  - If they're managing chronic conditions, we need to
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  - make sure that they're keeping compliant
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  - with their care plans there. They're taking their
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  - maintenance medications. They're following their provider's instructions.
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  - And if they have more significant issues, we
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  - need to make sure that we're removing barriers
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  - so that they can
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  - get access to those issues quickly and efficiently
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  - and get back to productive lives.
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  - An area that's a little bit unique is
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  - when we think about the right place, that's
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  - a little bit of a different conversation across
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  - Georgia.
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  - We spend a lot of time educating members
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  - on choosing the right site of care for
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  - the services that they're they're seeking.
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  - And in a metro
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  - area in Atlanta, that's that's an easy conversation.
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  - We can talk about
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  - urgent care clinics versus emergency room or ambulatory
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  - surgical centers or imaging, you know, freestanding imaging
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  - that's that's not connected to,
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  - a hospital.
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  - But in the rural areas,
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  - that's a very different conversation
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  - because a lot of those options
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  - don't exist.
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  - And I saw that firsthand
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  - in my role back when I first started,
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  - and I was doing open educate open enrollment
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  - meetings, member education,
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  - I would have to research before those meetings
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  - to see
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  - if options existed. Back then, convenience care clinics,
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  - like, attached to to a pharmacy were really
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  - expanding,
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  - and we were doing a lot of education
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  - on those. But in many of the rural
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  - communities, those didn't exist. And still today in
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  - many of the rural communities, an urgent care
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  - facility or a convenience care clinic doesn't exist.
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  - We have counties in Georgia where certain types
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  - of provider and certain types of care are
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  - not available in that county and not even
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  - in the county next door.
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  - So,
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  - you know, when you think about,
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  - the right place, the right setting,
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  - we have to think about the options that
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  - are available, and then we also have to
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  - continue to think about our role in expanding
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  - our partnerships with our providers to make sure
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  - that those options
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  - either continue to be available with some of
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  - our independent providers
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  - or that that that access is expanding.
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  - That takes us sort of a cost. So
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  - we think about our networks and and the
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  - provider
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  - contracts that we have. Our networks bring a
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  - lot of value to our members.
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  - But we have work to do to continue
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  - value based care and data connectivity with our
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  - providers.
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  - And then the member's role in the cost,
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  - making sure that
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  - the health care services that they're seeking are
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  - shoppable.
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  - For so long, they weren't shoppable, and there
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  - was no transparency
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  - to our member to be able to figure
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  - out how much the care was gonna cost
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  - that they were gonna receive. And we've made
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  - some progress there with member engagement tools and
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  - transparency,
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  - but there's still more to do there to
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  - make sure that the members are engaging on
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  - the cost side of the equation as well.
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  - Could you elaborate a bit more about the
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  - rural landscape and what y'all
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  - are doing with those providers and how those
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  - conversations are looking? You talked a little bit
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  - about value based care. I'm curious, like, what
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  - sorts of appetite for risk really exist in
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  - these rural communities?
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  - Yeah. So we're traveling around the state. I'm
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  - personally traveling around the state in my new
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  - role, meeting with the providers and health care,
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  - systems in the community and just really listening
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  - to their needs and thinking about how we
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  - can work together to to solve the issues
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  - that they're facing.
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  - We've partnered with independent practices in orthopedics and
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  - in gastroenterology
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  - recently,
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  - to expand their ability to open ambulatory surgical
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  - centers and things that create more access in
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  - those rural areas.
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  - And we've recently
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  - reengaged in a partnership
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  - with a community,
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  - physicians alliance that has providers in in rural
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  - areas to expand
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  - the networks that they participate in, which ultimately
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  - allows more of our members to seek care,
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  - with those physicians.
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  - So it's really a work of listening and
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  - partnering and thinking about how we can solve
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  - the needs in those communities. On the value
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  - based care side,
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  - a lot of it comes down to just
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  - being able to share data and have the
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  - connectivity.
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  - You know, I think the downside risk or
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  - upside risk is the ultimate goal. Right?
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  - But even just getting started with the data
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  - and the connectivity
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  - and our value based care programs,
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  - look at both
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  - big national world class health systems that we
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  - have in our state, but also the independent
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  - positions.
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  - So pivoting a little bit, I just saw
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  - some Commonwealth Fund survey results,
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  - saying that the cost of health insurance is
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  - the most pressing problem in healthcare right now,
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  - according to voters, which we're coming right up
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  - on the midterm, so it's relevant there.
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  - And then also we're seeing all these ACA
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  - rate filings and proposed increases of around 15%
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  - nationwide.
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  - And then on top of that, you know,
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  - employers are shifting cost burden onto employees,
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  - as they're navigating increases. So
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  - what are some of the biggest levers that
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  - y'all are pulling
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  - to mitigate
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  - rising costs,
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  - when it comes to premiums?
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  - I think the levers fall into those buckets
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  - that I was mentioning earlier.
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  - You know, the the member engagement tools, the
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  - making sure that they have
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  - access to information to make the right choices.
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  - In our Sydney app, which is, our member
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  - digital front door,
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  - We have cost estimates.
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  - We have
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  - physician ratings, so diamond provider ratings where we
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  - know that cost and quality are both being,
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  - considered when the members are going to those
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  - physicians.
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  - And then we also have our
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  - smart shopper tool. So the smart shopper tool
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  - provides actual cash incentives to members,
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  - for shopping for the care and then making
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  - good decisions on the front end. So there's
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  - there's that piece of it. I think there's
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  - also the network piece of it. We offer
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  - various networks,
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  - to our members in our state, and we
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  - have our high performance network. So if a
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  - member's living in an area where the high
• 9:56
  - performance network is available,
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  - that's gonna have, a more curated network. It's
• 10:01
  - not gonna be our huge broad open access
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  - network, but they are gonna see cost savings.
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  - So we we see upwards of 20% cost
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  - savings when members or employers are willing to
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  - consider that network. And then obviously product,
• 10:13
  - plan design that that drives smart decisions as
• 10:16
  - well.
• 10:17
  - Are there any sorts of big policy shifts
• 10:20
  - you're keeping your eyes on right now? Like,
• 10:22
  - whether it be something related to Medicare that
• 10:25
  - might set a precedent for commercial or something
• 10:28
  - that's ACA specific,
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  - anything that you're monitoring?
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  - I think our entire industry is monitoring what's
• 10:35
  - happening with independent dispute resolution right now.
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  - Obviously, we're seeing a lot more of those
• 10:40
  - requests come across than what was originally anticipated.
• 10:45
  - And the original estimates were that that was
• 10:47
  - going to reduce cost.
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  - And, you know, in fact, we've seen it
• 10:51
  - increase cost. So sometimes the payments that are
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  - going,
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  - to those providers
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  - for those sort of non shoppable
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  - services are five times
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  - even as upward as 25 times more than
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  - what we would have seen in the past.
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  - And that's really a big area that is
• 11:07
  - being discussed a lot in terms of policy,
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  - but is impacting cost as well.
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  - Well, Amanda, as we wrap up, is there
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  - anything else that you wanted to share with
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  - us? Any big takeaways from your role so
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  - far?
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  - Yeah. I think the thing that I'm seeing
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  - as I'm having conversations with policymakers,
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  - employers,
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  - providers, just people in our community
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  - is how,
• 11:28
  - connected we all are in in tackling the
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  - cost and the, you know, the affordability
• 11:33
  - and the simplicity of health care.
• 11:36
  - It really takes all of us to tackle
• 11:39
  - the problems and to find solutions for those
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  - things, and we have to build trust. If
• 11:44
  - we don't have the trust with each other,
• 11:46
  - we can't expect our members to have trust.
• 11:48
  - So I think that's the biggest goal overall
• 11:51
  - is to balance those competing priorities and create
• 11:54
  - a place where people can trust our system
• 11:57
  - and know how to engage with it.
• 11:59
  - Well, Amanda, thank you so much for taking
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  - the time today. I appreciate it. Thank you,
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  - Liz. Of course. And to our listeners, if
• 12:05
  - you'd like to hear more podcasts from Becker's
• 12:07
  - Healthcare, you can visit beckershospitalreview.com.
• 12:11
  - Thank you.