Latest / Becker’s Payer Issues Podcast / Jeff Bak, President and Chief Executive Officer of Imagine360

Transcript

Jeff Bak, President and Chief Executive Officer of Imagine360 · Becker’s Payer Issues Podcast

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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, Jeff Beck, president
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  and chief executive officer of Imagine three sixty.
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  Jeff, thanks so much for finding the time
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  to join us on the podcast. How are
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  things going? Good. Good, Scott. And, delighted to
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  be here and and looking forward to today.
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  Absolutely. And, you know, we're really looking forward
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  to featuring you as a speaker just next
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  week now when we record this. It's, it's
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  it's it's April, and we're ready to go
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  to our spring payer, issues roundtable. So thanks
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  so much for speaking with us there as
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  well. Yeah. No. We, we we've really enjoyed,
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  the opportunities to do this in the past,
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  and,
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  the content's really good. And so I would
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  encourage your audience to take advantage of it.
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  It's really it's really good, rich content.
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  Yeah. Greatly appreciate that. Thanks so much, Jeff.
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  And, yeah, we're really looking forward to getting
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  that going. But, you know, first here, just
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  kind of some topics at hand, but I
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  would love for you to weigh in on
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  the first being,
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  you know, health literacy is is one of
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  those
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  biggest barriers to members getting value from their
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  coverage.
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  What does your plan do to to close
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  that gap?
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  Yeah. You know, I I I think when
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  you think about Imagine three sixty
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  and the core tenant of what they offer,
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  it's
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  either
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  a very select
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  high performing
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  contract
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  with a with a provider health care system,
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  hospital system that has
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  really gotten aggressive and has the type of
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  quality you and I would feel proud for
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  our families to go utilize,
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  in a price point that's gonna be, you
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  know, pretty competitive. And if we don't have
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  that, we're typically using a reference based pricing
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  approach,
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  which is
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  limiting the, you know, the the cost
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  and just some of the,
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  kind of egregious nature of hospital pricing that
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  you could see in a broad panel network.
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  And so
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  it
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  I think the literacy side of what
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  members are struggling with is probably more around
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  uncertainty,
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  misunderstanding
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  of potential cost,
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  not really knowing what it's gonna cost for
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  a particular procedure or service. As as much
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  as we're trying to get the transparency
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  stuff out there
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  to help members in their quest to get
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  good care,
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  I think when you're in a broad panel
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  PPO environment,
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  you know, everybody's in. You're not quite sure
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  what you're gonna pay. You just know it's
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  gonna be expensive. And so
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  I think the more we can,
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  you know, educate folks that are in our
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  programs
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  that you're you're gonna have
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  the best rate,
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  you know, in your first attempt to work
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  with this particular provider
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  really alleviates a lot of the stress and
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  the concerns
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  just around
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  what are the barriers that they're gonna have
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  and what are the uncertainties they're gonna have.
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  And I think that
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  I honestly think it's probably less, you know,
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  just around
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  do they understand from a literacy perspective and
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  just are they can they afford to actually
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  utilize
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  and didn't know what it's gonna cost?
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  Absolutely. And and, you know, I I I
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  wanted to ask you obviously about the the
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  aging population, but before we go there,
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  just curious what you think about about the
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  health literacy for for seniors and and where
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  that's been at. Because I've heard from a
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  lot of health plan leaders that that digitally,
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  seniors are actually doing, like, a lot better
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  with with navigating their their, you know,
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  options as members than than people would think.
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  How do you think help literacy is for
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  seniors right now?
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  You know, I I think they're rapid adopters.
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  Right? And, you know, there's a lot of
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  people aging into Medicare
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  right now, right, that were
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  just beyond the baby boomers or pretty close
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  to being beyond the baby boomers. And that
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  and that generation grew up, you know, pretty
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  literate relative to using apps and using
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  the Internet. And so I I I feel
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  like if if it's something as important as
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  your health,
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  people now have pretty in intuitive
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  tools to use to access Medicare information,
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  Medicare Advantage type plan information,
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  and can do quite a quite a bit,
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  on their own. And I think those apps
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  are only getting better with AI.
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  And I think, right, user feedback,
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  like some of the big tech companies have
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  been doing for years, I think health care
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  is catching up
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  and quickly realizing that member feedback is, super
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  important. You gotta incorporate it into your, you
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  know, version one point o, two point o
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  of your applications and just listen to your
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  to your customers and clients as to what's
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  gonna make their life easier to access your
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  product.
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  You with that aging population, obviously, there's more
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  complex and and chronic
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  conditions.
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  Are you are you getting that type of
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  feedback when you talk about member feedback?
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  How how is that reshaping
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  the way your plan designs, benefits, and manages
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  care?
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  You know, for us, we're not in the
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  Medicare market space, so we're somewhat buttressed
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  from,
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  you know, having to deal with a lot
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  of seniors.
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  Having said that, there's a lot of folks
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  over age 65 that haven't chosen Medicare yet
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  because they're still working, and so they're on
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  our, you know, our clients' plans.
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  And then, you know, beyond that, like, you
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  know, this phenomenon
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  that we're all experiencing, which is a very
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  small percentage, call it one or 2% of
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  the population are consuming
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  50%
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  of the total spend.
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  So I think that's where,
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  we've gotta be super smart and be super
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  focused
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  on identifying people that have,
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  you know, early stage
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  potential,
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  situations, whether that's through medication
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  or symptom chronic,
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  disease states
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  that if they're left unchecked, unmonitored, frankly, unsupported,
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  and a lot
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  about what we do when we go see
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  one of our large employers and they say,
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  what are you doing for my high high
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  cost claims?
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  It's like, well, what we're trying to do
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  is identify
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  who the next
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  10% population is right now that's likely to
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  be in that one or two percent a
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  year from now. And the best way to
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  do that is by looking at things that
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  have historically,
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  you know, tended or driven towards higher utilization
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  like mental health.
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  And a lot of folks who are struggling
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  a bit with mental health or on mental
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  health medications
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  could use some
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  assistance in accessing care. So we reach out
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  and try to assist them to make sure
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  they are, you know, working with a psychologist
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  if that's the remedy or they're taking their
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  meds, you know, from a nurse's perspective, kind
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  of that confidential
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  checking in on you, how are things going
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  standpoint.
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  So from a proactive
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  perspective, I think just
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  knocking some of the historical barriers down
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  to one, what's the data telling us in
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  terms of, you know, people who have had
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  some mental health challenges over the past year
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  or being medicated for
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  anxiety or depression,
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  which we we know is very common, but
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  they're
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  much highly more likely to utilize the emergency
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  room or have an emergency situation
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  in the coming year. So, like, it's one
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  example of many
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  that with a really diligent set of clinical
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  people and good nurses,
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  you can get in front of it and
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  at least have the information there and take
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  some action
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  to try to support lower utilization in the
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  future. And that's the same gonna be with
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  with diabetics. It's gonna be the same with,
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  respiratory,
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  heart issues, and oncology. That those areas we
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  see as the high cost claims in a
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  traditional health,
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  self funded health plan. And so those are
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  some of the cohorts we're spending time trying
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  to figure out how predictable they are.
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  Absolutely. I think those are great things to
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  focus on in regards to to members and
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  and what they're dealing with.
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  And and, Jeff, you know, obviously,
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  prior authorization is a huge topic right now.
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  What does a a better prior auth process
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  look like, and how do you balance clinical
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  oversight
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  with not creating
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  barriers to timely care?
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  Yeah. It's super frustrating for both parties. Right?
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  It's it's frustrating for a member, family member
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  to have to wait on an outcome.
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  It's frustrating for somebody who's, you know, in
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  the business delivering care and providing care every
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  day, having to justify themselves.
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  And, you know, I think
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  we think it's overused.
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  You know, our we have a very limited
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  amount of preauthorization
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  requirements in our program,
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  and it's because we really already feel good
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  about the price that somebody's gonna pay for
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  the services rendered,
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  and there's not a three or four or
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  fivefold variance that could occur,
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  based on how we how we we we
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  reimburse our allowable claim.
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  So I think it takes some of the
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  just general worry
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  out of trying to catch something in advance
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  when you kinda know you've gotten a fair
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  maybe there's some things around the edges we
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  can do for somebody who may need a
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  more
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  experienced specialist or center of excellence. But for
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  the most part, at least from a plan
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  cost perspective,
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  there's not as much of a need for
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  a pre authorization filter
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  because they're already getting a really good price.
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  I wanna ask you about value based contracts
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  as well. Value based contracts,
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  promise to align incentives around
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  outcomes over volume.
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  Pardon me. But where have you seen that
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  actually deliver, and and where does that model
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  still break down?
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  We we have not seen it deliver
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  much,
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  in the self funded market. So put yourself
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  in the shoes of an employer.
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  You know, they've got a thousand employees.
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  They
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  have say a 35%
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  annual turnover
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  in three years. There's a good chance that
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  whoever's on their health plan today will not
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  be there in three years. That's about the
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  time where some of the value based
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  solutions would either, you know, have ups or
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  downs
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  in terms
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  of what actually occurred,
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  but the population
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  turns over populate the population in a self
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  funded also
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  is, you know, they're working people, and they're
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  showing up at work every day. Very few
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  people, right, have a ton of comorbidities, and
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  they're not more,
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  you know, they're not seniors necessarily where there's
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  just a lot more utilization,
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  of of facilities and docs and specialists, etcetera.
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  So I
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  what we have found is if you're trying
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  to put some type of value based
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  over the top of
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  the traditional PPO framework
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  and then trying to give, you know, good
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  guys and bad guys depending upon the outcomes
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  looking back three years,
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  it's not all that effective because you're you're
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  already dealing with something that's
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  fairly expensive to start with. You're really not
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  getting at the unit cost challenge. And even
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  if there's a ton of incentives
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  because of performance was good, you know, you
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  may come down from an average of 250
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  of Medicare. Maybe it gets you down to
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  200,
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  which is which I'm not knocking. That's good.
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  It's progress. But still,
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  the idea of floating something on top of
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  a really inflated cost to begin with,
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  It it just doesn't make a lot of
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  sense for the reasons that, you know, I
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  I I hit on earlier, high turnover,
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  employers
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  may not see the benefit, right, of the
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  value care that they're delivering or getting. And
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  just this notion of doing that on the
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  framework of a of a PPO framework is
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  is not the best use. We we don't
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  think of,
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  value based contracts.
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  And lastly, Jeff, obviously, everyone knows how crucial
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  data is for
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  for health plans. How does Imagine three sixty
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  use the data it collects to make the
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  experience feel more personal and proactive for members?
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  Yeah. You know,
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  our advocates,
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  are are really good about,
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  assessing
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  utilization,
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  whether that's drug utilization,
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  primary care utilization,
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  telehealth utilization,
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  and using that to, be a bit of
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  a canary in the coal mine around what
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  our harbinger of things to come for members,
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  and being proactive in in reaching out and
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  engaging and just asking the second and third
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  question, whether that's a call inbound to us
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  or a call outbound,
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  you know, to them. And so it starts
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  with just utilization data.
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  And then they kinda build their own,
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  mini plan of attack based on the conversations
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  they have with members and what their needs
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  are. And I think a lot of open
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  ended questions,
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  a lot of listening,
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  and,
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  and then, you know, trying to be collaborative
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  and not in a big rush,
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  and really just there for members to engage
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  with from a clinical perspective,
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  where historically you don't get a lot of
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  that. You know, you're you're kinda rushed through
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  an appointment. You're rushed through a particular call
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  transaction because everybody's watching the clock. We try
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  to just
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  slow it down,
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  do more listening,
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  and use that as the impetus to get
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  to know members and hopefully use their data
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  to help them.
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  Sounds great, Chad. Thanks so much for joining
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  us on the podcast, and we're looking forward
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  to seeing you next week at the conference.
• 13:29
  Yeah. We are too. And thanks again for
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  the time today.