Latest / Becker’s Payer Issues Podcast / Affordability, Access, and Operational Excellence at MetroPlusHealth with Lila Benayoun

Transcript

Affordability, Access, and Operational Excellence at MetroPlusHealth with Lila Benayoun · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
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  payer and health plan executives
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  and more than 100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone. This is Elizabeth Caslow with the
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  Becker's Payer Issues podcast. I'm thrilled today to
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  be joined by Lila Benahoun,
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  chief operating officer at MetroPlus Health. Lila, thanks
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  so much for chatting with us today. Thank
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  you so much for having me. Very excited
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  to be here. Thank you.
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  Great. So before we jump into the conversation,
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  I would love to hear a bit more
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  about you and your health care career background
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  and just an overview of your current role
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  at MetroPlus Health.
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  Sure. I'm Lila Benyon. As and as you
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  mentioned, I'm the chief operating officer at MetroPlus
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  Health. We are a health plan that services
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  approximately 700,000
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  members in New York City in all five
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  boroughs.
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  I have been in the health care space
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  for over twenty years,
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  very specifically in managed care. And so it
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  has been very interesting to see the managed
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  care environment evolve over the span of twenty
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  so years.
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  And so it's pretty exciting to see the
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  different regulatory environment shifting and changing and how
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  that plays out to our members.
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  I joined MetroPlus
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  Health in 2021,
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  and we really focus on various products to
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  service our members. And I really focus on
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  operational and service excellence. It's just always keeping
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  the members and our providers at the center
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  of everything that we do.
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  And today, we wanted to have you on
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  because your team recently released the CareCrunch Index.
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  So what are some of the biggest takeaways
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  for insurance leaders to take note of from
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  this research?
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  Yes. And so thank you for that question.
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  One of the clearest takeaways is that health
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  care affordability is no longer an abstract
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  concern. It is actively reshaping household decision.
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  So what we found was that forty two
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  percent of New Yorkers told us that they
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  have to cut back on leisure
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  or lifestyle spending because of health care costs.
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  And nearly half of them said that they
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  cannot afford a thousand dollar medical bill without
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  going into debt. So so it is a
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  major concern in terms of cost and and
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  the impacts
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  of New Yorkers.
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  Another important signal for insurance leaders is that
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  affordability
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  pressure is widespread.
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  So it's not just limited to to the
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  lowest income bracket, but it's also we're seeing
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  that blend over and bleed over to the
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  middle income earners, which is telling us that
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  it's really important for us to consider,
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  the benefit design,
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  making sure that the information that we,
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  deliver to our members have clear and concise
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  and that we are mindful of any out
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  of pocket,
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  cost of expenditure so that the predictability
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  is there so that when our members are
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  budgeting, they they know how to better budget.
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  And finally,
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  there is a disconnect between confidence and clarity.
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  Many people feel that they understand insurance,
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  but when when when push comes to shove,
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  they still struggle with a very basic,
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  time sensitive moments like open enrollment. And so
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  that was eye opening to us as well.
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  So to follow-up, you know, based on your
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  role as COO, how do you translate
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  survey data showing these affordability
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  concerns
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  into concrete changes?
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  So for us, for Measure Plus, we use
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  data like a road map,
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  and sort of illuminates a path forward to
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  us in making decisions on how we can
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  better service our members,
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  and making sure that we are true value
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  to them. And so when we see that
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  people are worried about unexpected costs, we look
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  at where we can reduce that friction and
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  that surprise.
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  Meaning, we look at the way we design
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  our plans, making sure it's low to no
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  premium,
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  predictable co pays, and benefits that support everyday
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  needs, not and not just clinical care.
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  Where health plans often fall short is assuming
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  that access equals understanding.
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  Coverage can be technically affordable, but if members
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  do not know how to use it, when
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  to enroll, or where to go with questions,
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  the system will still fail them. And so
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  we have to be very, very aware of
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  who our members are,
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  and just making sure that we're meeting them
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  at their level so that they understand
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  certain important events like open enrollment so they
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  get the health insurance that they need.
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  Operationally, we focus on simplicity,
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  high touch support.
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  We try to go to where members are.
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  Right? We have community offices throughout the five
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  boroughs.
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  We're we're at facilities.
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  We're one phone call away. And so we
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  really wanna make sure that
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  our members know that we are there to
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  support them and their life changes.
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  That makes a lot of sense. And speaking
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  about knowing your members, the survey did highlight
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  racial and ethnic disparities with affordability.
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  So what are the biggest operational challenges
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  in delivering truly low cost care to populations
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  that are more likely to face these concerns?
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  Right. So one of the biggest challenges is
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  that cost pressure does not exist in isolation.
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  Communities that are more likely to report affordability
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  concerns are also navigating language barriers,
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  work schedules,
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  that limit flexibility,
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  transportation challenges,
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  and just a lower trust and confidence in
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  health care system overall,
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  making sure that they have access to care
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  when they need the care.
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  From an operation standpoint, delivering low cost care
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  means investing beyond the traditional insurance model.
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  It means culturally competent outreach, multilingual support, and
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  benefits that address social needs like food and
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  transportation.
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  So we wanna make sure that a good
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  portion of our workforce
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  speak various languages so that when a member
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  calls, we could really communicate with them at
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  their level. That's such an important,
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  way that we operate.
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  And also requires sustained engagement. So you cannot
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  solve disparities with a single enrollment period or
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  campaign. We need to continue to be a
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  presence in the in the communities,
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  making sure that our members know that we're
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  available in there and letting them know where
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  they can where and how they can reach
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  out to us.
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  And so that's very important to us.
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  How have you built out just to follow-up,
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  how have you built out those community efforts
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  in recent times, and what languages
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  are you placing
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  the most investment in right now? You're seeing
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  a lot of your members,
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  needing those resources.
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  Sure. So
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  we are trying to have
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  Spanish speaking individuals,
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  Mandarin and Chinese,
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  Urdu. So we we identify the top
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  five or so languages that are commonly spoken
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  in our population.
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  And then also those individuals that are in
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  the community, we have community office locations throughout
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  all five boroughs,
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  and, we let the our members and consumers
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  know that we are there for them.
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  And we also let the language speaking individuals
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  there as well so that
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  they're not timid or intimidated to come over
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  to MetroPlus
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  and ask the questions,
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  and that we are a valued partner in
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  their life and and that we want to
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  make sure that they can rely on MetroPlus
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  in supporting them in their times of needs,
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  health care, whatever the case may be.
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  So another thing you mentioned earlier with the
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  general findings was the survey found that seventy
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  nine percent of respondents feel they understand insurance,
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  but only 60%
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  know when open enrollment happens.
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  So what's the hardest part about that simplification
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  you talked about earlier
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  with open enrollment, especially when it comes to
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  younger and lower income populations?
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  Yeah. That's a really good question. So open
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  enrollment is one of the most important moments
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  in the insurance experience,
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  but it's also one of the most complex.
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  You're competing. We have all this information coming
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  at you, and it's very hard to decipher
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  which one would would be the best fit
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  for the individual.
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  Also, timelines vary. Terminology is confusing. The process
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  often assumes people have the time and the
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  bandwidth to navigate this on top of their
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  day to day activities. Right? And so for
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  younger and lower income populations,
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  competing priorities are a real barrier.
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  Health insurance
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  may not feel urgent until something goes wrong.
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  Add add adding in the digital fatigue or
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  lack of clear reminders,
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  it's very easy to miss the open enrollment
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  period. And so crucial that individuals
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  select their insurance carrier during that open enrollment
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  period. So we really have
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  to set the reminders, making sure that the
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  individuals understand this very important event.
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  The hardest part is cutting through the noise
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  with clear,
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  repeated, and human communication.
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  So at MetroPlus,
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  we focus on making enrollment feel approachable, not
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  intimidating, and ensuring members know there is a
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  real person that they can talk to whenever
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  they need,
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  and get their questions answered.
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  Absolutely.
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  I I love the point about digital fatigue.
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  I think that's something that we see so
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  often, especially with those younger populations.
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  I was just wondering if you have any
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  final thoughts or advice for industry leaders
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  and how you recommend translating these findings beyond
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  the New York market. Yeah. So it's really
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  important to know and remember that our members
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  are the center of everything that we do.
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  And so we need to listen
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  and pause and recalibrate our approach and service
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  offerings so that we are meeting the needs
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  of our member at that point in time.
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  And so and that and that we need
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  to consider not just the demography of the
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  members, the income level of members, but also
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  the the various life stages of the member,
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  and we have to meet them there.
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  And so that's an important, I think, an
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  important lesson that we've learned,
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  and that we carry through in our day
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  to day operations. And so I just think
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  in general, it's important for us to take
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  pause and really listen to what our members
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  need.
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  Well, Lila, thank you so much for joining
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  us today. It was great having you. It
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  was a pleasure. Thank you for having me.
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  Awesome. Well, to our listeners, if you'd like
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  to listen to more podcasts from Becker's Healthcare,
• 10:11
  you can visit beckershospitalreview.com.
• 10:14
  Thank you.