Latest / Becker’s Healthcare 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 Healthcare Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
• 0:10
  payer and health plan executives and more than
• 0:13
  100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George w
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone, and welcome to Becker's HealthCare podcast.
• 0:36
  I'm Scott King. Thrilled today to be joined
• 0:38
  by a very special guest, Dan Elliott, chief
• 0:41
  medical officer,
• 0:42
  provider experience over at the Centene Corporation. Dan,
• 0:45
  how are you doing? Thanks so much for
• 0:46
  joining us. I'm doing great, Scott. Thanks so
• 0:48
  much for having me. Of course. No. We're
• 0:50
  gonna lean on you for your expertise. A
• 0:52
  lot of big topics in health care and
• 0:54
  with with health plans. But before we do
• 0:55
  that, I was wondering if you could please
• 0:57
  share a little bit about your background and
• 0:58
  your journey in health care.
• 1:00
  Yeah. And I appreciate the opportunity.
• 1:02
  So, yeah, I've I've been with Centene now
• 1:04
  for three years.
• 1:05
  I joined them as, the CMO in a
• 1:08
  local market in my my home state of
• 1:09
  Delaware.
• 1:11
  Really enjoyed walking through that experience and really
• 1:14
  learning the the nuts and bolts of managed
• 1:16
  care, in a market that I understood deeply.
• 1:19
  And then for last year, I served as
• 1:20
  the CMO for provider experience at Centene. So
• 1:23
  getting the opportunity to see the national environment,
• 1:26
  to work across, all of our lines of
• 1:28
  business, all of our different plans, and, really
• 1:30
  exciting opportunity. And prior to that, you know,
• 1:32
  I spent twenty one years with a health
• 1:34
  system, here in Delaware.
• 1:36
  Had a lot of different roles working with
• 1:38
  accountable care organizations and sort of really applied
• 1:41
  health services research and, just practical operational and
• 1:44
  and clinical improvements, which, were wonderful in addition
• 1:47
  to a long career as a primary care
• 1:49
  clinician.
• 1:50
  Well, thanks so much for sharing that background
• 1:52
  info, Dan. You know, I've been asking a
• 1:54
  lot of the,
• 1:55
  speakers from you speaking at our spring pair
• 1:57
  of shoes roundtable like yourself about that that
• 1:59
  payer provider relationship.
• 2:01
  And, yeah, I think with you, it's an
• 2:03
  even more kind of with your role, it's
• 2:04
  even more unique. So I I definitely wanna
• 2:05
  hear what you think. And just regards to
• 2:07
  that relationship and,
• 2:10
  how is it changing as as both sides
• 2:12
  face cost pressure and workforce shortages?
• 2:15
  Yeah. There's there's real issues and real challenges
• 2:17
  for sure. Well, you know, just a little
• 2:19
  background. I I joined the payer side,
• 2:22
  because I had deep experience on the provider
• 2:24
  side, making the changes, doing the pop health
• 2:26
  improvements and interventions. And I I really felt
• 2:29
  like and wanted to understand more about what
• 2:31
  are the levers that the payer side have.
• 2:34
  And I I've always had this vision of
• 2:36
  sort of a comprehensive ecosystem working well to
• 2:39
  drive care for for members, for patients, whatever
• 2:42
  your lens or focus is. Really just taking
• 2:44
  care of the people who need our health
• 2:46
  care services.
• 2:47
  And so what was exciting about joining, the
• 2:49
  managed care side and now having three years
• 2:51
  of experience in the payer side, what I
• 2:53
  I love to see is that we are
• 2:55
  all fighting the same fight. You know, you
• 2:57
  have different tools. You have some different sort
• 3:00
  of things that you can lean on and
• 3:02
  bring, into play.
• 3:04
  But fundamentally, we're all working to provide a
• 3:06
  health care ecosystem that delivers, you know, real
• 3:09
  honestly, the best quality care we can for
• 3:10
  most affordable outcomes.
• 3:12
  And that is exciting to be part of.
• 3:14
  And, frankly, our current environment
• 3:16
  is challenging, and it's stressful with o b
• 3:18
  three and coverage changes and financial and cost
• 3:21
  structure changes. You know, we're all familiar with
• 3:24
  those.
• 3:24
  But, frankly, it takes, in my view, a
• 3:27
  lot of the things that have been
• 3:29
  underneath.
• 3:30
  They've been challenges that we've been trying to
• 3:32
  navigate through.
• 3:34
  It puts a finer lens on them, and
• 3:35
  it says, boy,
• 3:37
  if we're gonna solve these things as a
• 3:38
  country,
• 3:39
  we're gonna have to solve them sort of
• 3:41
  together. Right? And it starts to you have
• 3:44
  to have that view that looks at all
• 3:45
  of us sort of under that, sort of
• 3:47
  broader need to make the the best health
• 3:49
  care system we can. And so as we,
• 3:52
  from a payer perspective, are working with our
• 3:53
  providers, I think everyone's more acutely aware of
• 3:56
  the fact that we have to do this
• 3:57
  together. And there's lots of structures. There's lots
• 4:00
  of ways to do that. But, fundamentally, I
• 4:02
  think it's a movement or a moment for
• 4:04
  us in health care to lean in and
• 4:07
  say, how can we be good partners? How
• 4:09
  can we things that maybe,
• 4:11
  you know, are historically present, have been tolerated,
• 4:14
  they're sort of built into the system.
• 4:16
  How do we actually now start to find
• 4:18
  ways to do those things more efficiently so
• 4:20
  that we can make sure that the money
• 4:22
  that's being spent in health care is is
• 4:24
  going to what we want it to be,
• 4:25
  which is, you know, helping people get the
• 4:27
  care that they need.
• 4:29
  Yeah. I think you're exactly right. I think
• 4:30
  focusing on that on that big goal, you
• 4:32
  know, definitely help both sides work together and
• 4:35
  find solutions. So I think it's it's important
• 4:36
  to keep that goal in mind like you
• 4:37
  said.
• 4:38
  The second thing I wanna ask you about,
• 4:40
  Dan, is where do you see the biggest
• 4:42
  gap today between
• 4:44
  payer strategy and operational execution?
• 4:47
  Yeah. You know, along the same vein, you
• 4:49
  know, I I really think a lot and
• 4:52
  have the opportunity in my role to just
• 4:54
  constantly be evaluating how are we working as
• 4:57
  the most effective partner we can, with our
• 4:59
  provider partners out there. And so I think
• 5:01
  the gap that I stare at sort of
• 5:04
  face to face every day is saying, how
• 5:06
  are we being the best partner? Are we
• 5:08
  giving meaningful information? Are the insights that we're
• 5:11
  providing, the information we're providing, the the support,
• 5:14
  whether it's care support, care management, care coordination,
• 5:17
  other aspects, whether it's just being a good
• 5:19
  partner in terms of paying claims and sort
• 5:21
  of moving things through the system in the
• 5:23
  most efficient way. I'm constantly asking, are we
• 5:26
  being that best partner? And I think we,
• 5:28
  in fairness, have opportunities
• 5:30
  to provide more meaningful information,
• 5:33
  to put it in a way that's communicated
• 5:35
  that that leads to clear actionable opportunities.
• 5:38
  You know, it doesn't do anybody a a
• 5:40
  a lot of service to just say, hey.
• 5:42
  Here's a some generic score reports, and here's
• 5:45
  some things that we've noticed. But, boy, how
• 5:47
  do we dig in as partners and say,
• 5:49
  in your practice, this is what we're seeing.
• 5:52
  It may or may, you know, may or
• 5:53
  may not be different than your peers or
• 5:55
  other things we're seeing in your market, but
• 5:57
  here's insights. And when I was on the
• 5:58
  provider side, I really longed for that some
• 6:01
  of that
• 6:02
  broader payer view,
• 6:03
  that sometimes when you're from a provider perspective
• 6:06
  looking out, you don't you don't necessarily have
• 6:08
  that that broader information. So I see this
• 6:11
  gap in front of us that we're trying
• 6:12
  to close of providing meaningful information
• 6:15
  in a meaningful setting that drives action and
• 6:17
  starts to solve the problems that members are
• 6:20
  feeling, that our providers are feeling, and honestly,
• 6:22
  that we as payers are feeling and experiencing
• 6:24
  as well. So if we can have that
• 6:26
  conversation meaningfully, if we can support it with
• 6:29
  operational processes that start to solve those problems
• 6:31
  and close those loops, I think it just
• 6:33
  makes everything just go better from that point
• 6:36
  forward.
• 6:37
  Absolutely.
• 6:38
  What's one investment or initiative you believe will
• 6:41
  most reshape how health plans operate over the
• 6:43
  next two to three years?
• 6:45
  You know, honestly, I think
• 6:47
  there's a lot of hype out there about
• 6:49
  AI and technology.
• 6:51
  But I I really do believe that it
• 6:53
  it's gonna be a game changer for us.
• 6:55
  And, you know, it's funny. I think often,
• 6:57
  back to sort of the early days of
• 6:59
  population health and accountable care organizations, and everyone
• 7:02
  was just hungry for data. And we were
• 7:04
  doing everything we could do to get data
• 7:06
  in any which way.
• 7:08
  And
• 7:09
  it was it was kinda funny times because
• 7:11
  a couple years into that process, we were
• 7:13
  sitting around a table with a a number
• 7:14
  of of of folks who were in that
• 7:16
  space, and we're like, woah. What are we
• 7:17
  gonna do with all this data now? Right?
• 7:19
  And we almost saturate or supersaturated
• 7:21
  our ability to sort of engage and and
• 7:23
  interact with that information. And so now as
• 7:26
  we think about technology,
• 7:27
  we think about AI sort of overlaying on
• 7:30
  some of these these assets that have been
• 7:32
  accumulated from a data perspective.
• 7:34
  I'm encouraged by what's possible. I think I
• 7:36
  tend to think basic blocking and tackling first
• 7:40
  with these things. So,
• 7:41
  you know, how can we improve efficiency of
• 7:43
  basic services? How can we improve the efficiency
• 7:46
  of our own workflows internally, whether you're on
• 7:48
  the payer or the provider side? We need
• 7:50
  to get more efficient, and AI starts to
• 7:52
  provide opportunities to do that by surfacing,
• 7:56
  observations and and things that maybe we wouldn't
• 7:58
  see. And then, certainly,
• 7:59
  you know, collating information from different sources. You
• 8:02
  can think about all the applications within the
• 8:04
  payer provider intersection
• 8:06
  where that's needed. Right? We spend so much
• 8:08
  time exchanging information and trying to, you know,
• 8:11
  make sure things are in the right format,
• 8:13
  golly, to have a technology sit solution
• 8:16
  that can help us there. I think,
• 8:18
  it honestly, it's pretty encouraging to think about
• 8:20
  what's possible. I do,
• 8:22
  though,
• 8:23
  want us to really be thoughtful.
• 8:25
  And I tend to think about, what are
• 8:27
  those basic blocking and tackling things that we
• 8:29
  can do first and get momentum.
• 8:31
  And I think that's the space where we'll
• 8:33
  see the greatest incremental gains.
• 8:35
  Yeah. I appreciate what you said about the
• 8:36
  the blocking and tackling it with with AI
• 8:39
  because you it's I I think and kinda
• 8:42
  what you're saying, it's best as, like, thing
• 8:43
  that is maybe a long game. Like, everyone
• 8:45
  who was
• 8:46
  very onboard and gung ho with AI right
• 8:48
  away,
• 8:49
  they kinda panic when you notice mistakes early
• 8:52
  on. They go, it forgot x y z
• 8:53
  or it didn't do what I thought it
• 8:54
  did. So I I think as long as
• 8:56
  you know there's gonna be some tweaks, it's
• 8:57
  gonna improve. It'll end up helping, you know,
• 9:00
  everyone a lot tremendously. Is that kinda what
• 9:02
  you're saying, Dan? Oh, a 100%. You know,
• 9:04
  it's like with any kind of change management
• 9:06
  piece. Right? There there's always gonna be speed
• 9:08
  bumps along the way. And if sometimes, if
• 9:11
  you take too big a bite and you
• 9:12
  try to overhaul something completely,
• 9:14
  then that first taste that people get of
• 9:16
  it, it it's got too many too many
• 9:18
  speed bumps. Right? It's a little too risky,
• 9:20
  and then people back off quickly. So we're
• 9:22
  honestly spending a lot of our time looking
• 9:24
  at what are those, you know, incremental gains
• 9:26
  and efficiency,
• 9:28
  that we can really see, that people can
• 9:30
  feel.
• 9:31
  And that again, a lot of that is
• 9:33
  internal at this process, but, we certainly look
• 9:35
  forward to it and having sort of broader
• 9:37
  implications for our work with providers as well.
• 9:40
  100%.
• 9:41
  If you could change one regulatory or industry
• 9:43
  practice tomorrow
• 9:45
  to improve affordability and access, what would it
• 9:47
  be and why?
• 9:49
  It's it's hard to talk about the the
• 9:52
  provider payer space and and not
• 9:54
  think, about the prior authorization process and sort
• 9:57
  of how is done. And,
• 10:00
  again, this is a place
• 10:01
  where, you know, we have a lot of
• 10:03
  commitments, the AHIP commitments and others about processes
• 10:06
  and technologies to support these things.
• 10:08
  But I I do think
• 10:10
  it feels like just the right opportunity in
• 10:12
  front of us
• 10:13
  to look at how we have these conversations,
• 10:15
  how we exchange information, how,
• 10:18
  our skilled teams talk with other skilled teams.
• 10:21
  How can we make sure that we're applying
• 10:23
  those resources in the place that makes the
• 10:25
  most sense,
• 10:26
  that everyone gets the the sort of most
• 10:28
  benefit out of a conversation like that? What
• 10:30
  can we move through in,
• 10:32
  an automated or a semi automated way? Of
• 10:34
  course, with all of the right sort of
• 10:36
  precautions and other things that could go with
• 10:38
  it. But I think that's the area where,
• 10:40
  you know, from decreasing friction and abrasion, from
• 10:43
  really helping us be,
• 10:45
  experience each other as partners in this space.
• 10:47
  Again, we're we're all about the same thing,
• 10:51
  and that's a place where there's sometimes unnecessary
• 10:53
  friction. And and I'm honestly super excited about
• 10:56
  what it might look like,
• 10:58
  as, again, technology
• 11:00
  as, under the current,
• 11:02
  you know, cost structures and challenges that we're
• 11:03
  thinking about, we put a real laser focus
• 11:06
  on this area. I think we can make
• 11:08
  progress and make sure that we're spending our
• 11:09
  time, spending our resources in the places where
• 11:11
  everyone's comfortable that we're getting something out of
• 11:14
  that investment. And, I think that'll be good.
• 11:17
  And the last thing I wanna ask you,
• 11:18
  Dan, what issue is putting the most pressure
• 11:21
  on health plan margins right now, and and
• 11:23
  how are you responding differently this year in
• 11:25
  2026?
• 11:27
  Yeah.
• 11:28
  Medex,
• 11:29
  medical expense, the way things are moving, I
• 11:31
  think that's always top of mind. You're watching.
• 11:33
  You're seeing where are things popping,
• 11:36
  what's new this year, what's, you know, where
• 11:38
  are areas that are sort of starting to
• 11:40
  to gain traction. It's just something to monitor.
• 11:43
  And, again,
• 11:44
  we we want people to get the health
• 11:45
  care they need. So,
• 11:47
  understanding,
• 11:48
  is it appropriate? Is it the right care
• 11:50
  for the right people? Those are all the
• 11:51
  questions in the lens through which you look.
• 11:53
  I I think,
• 11:55
  you know, when we look to sort of
• 11:57
  the next steps,
• 11:58
  in this process,
• 12:00
  it's trying to understand how do we now
• 12:02
  turn that and focus on working with a
• 12:04
  partner, a provider, a system, a region, and
• 12:08
  start to take those margins in place or
• 12:10
  start to take those med x trends and
• 12:12
  start to make them real in terms of
• 12:13
  the members, in terms of the providers where
• 12:15
  that care is delivered. And I think,
• 12:18
  you know, that's a it's a real opportunity.
• 12:19
  And, again, one where we're applying technology,
• 12:21
  AI, and other things to start to be
• 12:23
  more sophisticated and even more nuanced in where
• 12:26
  and how we see,
• 12:28
  those trends,
• 12:29
  playing out.
• 12:31
  Well, Dan, thanks for joining us on the
• 12:32
  podcast and for a great conversation. Looking forward
• 12:34
  to working with you in April. Awesome. Thanks,
• 12:37
  Scott. Appreciate the time.