Latest / Becker’s Payer Issues Podcast / Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare

Transcript

Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
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Becker's Pay Your Issues podcast. Thrilled today to
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be joined by doctor Sariya Cicoccio, who is
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the chief medical officer at Essence Healthcare.
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Doctor Cicoccio, thank you so much for taking
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the time to be with me on the
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podcast today. Yeah. Jacob, this is gonna be
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a lot of fun. Looking forward to it.
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Likewise. And and, Sareya, before we dive into
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everything we wanna talk with you about, can
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you first tell us a little bit more
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about yourself, your background in health care, and
0:26
what it is that you do today at
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Essence?
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You bet. So in my role as the
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CMO for Essence, I'm responsible for quality and
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ensuring that our members receive an excellent experience
0:39
every time in every encounter.
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So this includes population health management, care management,
0:45
certainly clinical
0:47
utilization
0:48
of the services we have and overall cost
0:50
of care. And as a family physician by
0:53
training, I've worn a few hats in the
0:54
past from being in solo practice, academics,
0:57
a CMO on the health system side to
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truly understand how health care is delivered in
1:03
our communities, and, of course, on the health
1:05
plan space, which has been so enjoyable and
1:08
an opportunity to integrate all of these perspectives.
1:11
It can defocus on the patient, the members
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that we serve.
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Wonderful. Well, Sareal, like I said, we really
1:17
appreciate you taking the time to chat with
1:19
us today. I wanted to get started, by
1:21
talking a little bit about Medicare Advantage star
1:24
ratings. Of course, we're right in the middle
1:26
of the open enrollment period. Star ratings are
1:28
now out. Essence did fantastic. Once again, yeah,
1:32
you've got 80% of your members in four
1:34
and a half star plans for 2026.
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So talk to us and our audience a
1:39
little bit about some of the strategies that
1:40
have been most effective internally for achieving that,
1:43
for maintaining
1:44
those high star ratings,
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particularly given the fact that you operate in
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multiple competitive markets like St. Louis, Chicago, Louisville.
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What's what's gone into those ratings?
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You bet. And, Jacob, I'll just say we
1:58
are so very proud. I am particularly proud
2:01
of our health plan that can consistently deliver
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high quality care. So thank you for the
2:06
call out and the opportunity
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to represent
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why we do what we do. And most
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importantly here is how we do it.
2:14
So how we do this is with strong
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collaboration
2:18
and relationships.
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That is critical.
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Whether we're working with a multi
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health system group that reaches across The US
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or we're dealing with
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local
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independent physician
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advisory or or association,
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it's critical that we understand how they deliver
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care.
2:39
First and foremost, aligning with processes and workflows
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they have in place,
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that's so important.
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I call this the we see you piece
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of the work that we do and understanding
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that relationship.
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We're one of many health plans out there,
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and we will be ultimately successful if we
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find ways to align with the best practices
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that are already in play.
3:00
Now what we bring to the table as
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a Medicare Advantage health plan is real time
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data access.
3:06
We have partners
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that have full risk.
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And, of course, in a full risk relationship,
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we're accountable for transparency
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and that real time data for those gaps
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in care to close
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and sharing those best practices to help them
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achieve those goals.
3:23
Because listen, at at the same time, they
3:25
care about the same thing we do, and
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that's the patient receiving high quality of care.
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So we embrace that. We take that forward
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with a multidisciplinary
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team on our end. So we know that
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STARS is more than just HEDIS. It's more
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than just the quality, the prevention,
3:42
the chronic disease that's important, but it's also
3:45
the medications that our members take and ensuring
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that they have access to those when they
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need them, how they need them. Health outcomes,
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these are the other pieces of the puzzle
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of what includes their exercise, their mental health,
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and all the other pieces of that health
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outcome survey that matters to us and matters
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to our partners and certainly to our members.
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And then finally with operations and improvement. And
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I mentioned each one of these components within
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STARS
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because you can't do just one well. You
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can't just do quality.
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You have to take care of the entire
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experience
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and help these members navigate their path to
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create the the highest quality of life possible.
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So you can't do member care without the
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members at the center,
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and this is a complex
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significant role in health care across the board,
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and that includes member outreach.
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But we're not the only ones as a
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health plan. We ensure that we partner
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with those health care providers
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so that we're not duplicating messaging, but we're
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aligning messages together. That includes a systematic and
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also personalized
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outreach in the work that we do. So
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and finally, what I'll say in this section
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of what helped us be most effective in
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our higher star ratings
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is aligning
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the benefits with the needs of our members.
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If you don't understand the communities in which
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they live and where you're serving,
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it creates a challenge in ensuring that the
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benefits match
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what the members need. And that's what we've
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done really well.
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Absolutely. And I I appreciate the detail there,
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Sariyah, in terms of it's it's really understanding
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the member. It's those strong provider partnerships and
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then those really regimented processes,
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that you talked about to really achieve these
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ratings, which for any of our audience, our
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audience that might not be familiar, you know,
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a four and a half star rating or
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having the majority of your members in in
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such high rated plans is is very difficult,
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as you know. There's really only a handful
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of of health plans around the country that
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have achieved this.
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And so I wonder because it's been getting
5:55
more difficult year after year to maintain and
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achieve
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such high ratings,
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what what are some of the biggest challenges
6:01
right now,
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either this year or or as you think
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about, years to come in achieving these ratings?
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Because I know that's already starting and in
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place.
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What are some of the biggest challenges Essence
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is navigating in this space right now?
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Well, first and foremost, I could just say
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repeat
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when it comes to the challenges. So the
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areas where we excel with the strong relationships
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and the multidisciplinary
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teams and that specialized message. We have to
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continue to evolve and get better at the
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work that we do and why we continuously
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learn from what we did last year. What
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we did for our work plan for 2025
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has changed significantly
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in 2025,
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and our team knows in 2026,
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it will continue
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to look different. And that's because not only
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are we striving for perfection, that's what's important
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here, Every member deserves a 100% quality of
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care and the experience that they deserve it,
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and we'll have to keep changing. Now that
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being said, everybody else is as well. That
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means the cut points change on stars. This
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we know, And that can be a frustrating
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point, which I understand,
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and I always reflect back to our board
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and to our team members that this is
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a good thing. Right? I I think we
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would all agree that it's critical
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that we continue to perform better. And not
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only Essence Healthcare, all Medicare Advantage plans, and
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in fact, every health plan and every provider,
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it is imperative that we continue to look
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for the best ways to deliver that care
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because that's what our members deserve at the
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end of the day. Absolutely. And speaking of
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good things, I mean, these high ratings means
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more funding for you to invest back into
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better benefits.
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So what does that mean moving forward? How
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how does achieving these ratings,
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so high, how does that influence benefit design
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and member engagement moving forward for you all?
7:53
Well, I appreciate the insight, and you're absolutely
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right. Year over year should indeed build on
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top of a previous successful experience for members.
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Now that does require money to invest back,
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which means we've gotta put the right care
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in the right place
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at the right time.
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Because in order to invest back in, you've
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gotta be able to meet the the margins,
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frankly.
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Now that being said, what I am thrilled
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about for 2025
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for particularly
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our low income subsidized members
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is we went back and we asked the
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physicians, physicians,
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what do your patients need?
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And what we heard loud and clear is
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transportation
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matters,
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food matters, social determinants of health across the
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board are what make a difference. So we
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have dialed in with our care management team,
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our social workers
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to ask them, what are you hearing? What
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are you experiencing?
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And what are the members need? And I
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think this will become more complex
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as we hear. I mean, you can't
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avoid listening regardless of if it's social media
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or the news or wherever you get your
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information.
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People are struggling
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and for many reasons. We need to make
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sure they have food in their bellies because
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they shouldn't have to make the decision
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between medications
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and their food because food is also medicine.
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That means we also have to think about
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cost effective
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pharmacies that work and community engagement.
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So, yes, we focus on official benefits, and
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I named a few just a moment ago,
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But we have connected
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more deeply with our mission,
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Jacob. We are so focused on the communities
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in which our patients
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and our members live. And for that reason,
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we have identified community partners that are helping
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us understand
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how these members within their neighborhoods
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receive the best care. And the best care,
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as I mentioned, is not just medicine.
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It's also food. It's shelter. It's security across
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the board.
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So those are things that we don't always
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talk about, but I'm seeing more and more
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in a very positive way that my peer
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health plans are doing the same. Let's care
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about community
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and serve up an environment that is most
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beneficial for our members.
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Absolutely. Addressing those social determinants among your members
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is is clearly crucial here, and it obviously
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reflects in your ratings.
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I wonder, Sariya, I I wanna ask your
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perspective given that you've been in this industry
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in different parts,
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and leading such large organizations
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or or in parts of them, how do
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how are you thinking about the relevance
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of star ratings right now in terms of
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truly reflecting health plan quality? Do you think
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that the existing methodology
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is is effectively capturing the complexities of of
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care delivery, of coverage,
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especially for such vulnerable populations that you serve?
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What's what's your perspective on on the star
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ratings process right now?
10:49
Well, thank you for this question, Jacob. And,
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frankly, we could do a whole podcast
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on this alone. I'm considering it.
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Right? How was it calculated and what we
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shoot for here?
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But it boils down to this for me.
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And what I
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try to inspire
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my team members to consider and those that
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we support,
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at the end of the day, what CMS
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is doing here and, frankly, other health plans
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including us, is let's do what matters.
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And you could take any of these measures
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of all the components and relate it back
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to why it matters for health.
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Do I always agree with, gosh,
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missing a star by minus
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point four zero four? No. But I do
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understand why we have to have cut points.
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I do understand why we focus on prevention
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of cancer.
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It's a significant cost of care, but it
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is ultimately an impact on the quality of
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life that we have on this earth. In
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chronic disease management for the same reason, if
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you know or have diabetes yourself, you know
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that that is a challenging disease that it
11:58
it is incumbent upon us to make sure
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that we're delivering comprehensive care.
12:03
Now that being said, the experience is just
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as important and every member
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matters.
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And I oftentimes think of my own mother.
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I call her Mimi because that's what my
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kids call her, and she is in her
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seventies. She is the prime Medicare Advantage patient.
12:20
And I often ask her, Mimi, what does
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this mean to you? How would you respond
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to this type of situation?
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When you go to speak to your family
12:30
doctor, what do you ask? What do you
12:32
need to know? What do you need to
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hear from them? And it has given me
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an incredible
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and realistic view
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of how difficult it is to navigate care.
12:43
Because every one of us is different, and
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not all patients with diabetes respond the same,
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need the same care plan. And we could
12:50
walk through health equity for the same reason.
12:53
Every member voice matters, and what's critical for
12:56
us is that
12:58
we do focus on every voice that comes
13:00
in. But that's what CMS wants to do.
13:03
It's challenging to do population health when at
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the same time, it's critical to personalize that
13:08
care.
13:09
But at the end of the day, I
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think that's what you would want for your
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care. That's what you would want for family
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and what I certainly expect for mine.
13:17
Absolutely. And I appreciate you sharing that personal
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anecdote, with your mother,
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Soria. It's a it's a great example. And
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I and I think that leads me into
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my my last question for you in terms
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of,
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how are you perceiving members' actual awareness and
13:32
utilization
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of these ratings when they're selecting these plans?
13:36
Because as you just explained,
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the the methodology, the the cut points, for
13:40
example, it's it's very important to somebody in
13:42
a role like yours, but that, you know,
13:44
the person on the ground, the Medicare Advantage
13:46
enrollee likely doesn't know, anything about cut points
13:49
and how that trickles down to a final
13:51
star rating. So what are what are you
13:53
hearing out there about how members are engaging
13:55
with these ratings today?
13:57
Well well said. We have to bring it
13:59
back to the language that matters to them.
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If you straight out give a star performance,
14:03
that doesn't mean a whole lot. But when
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you can reflect back in your communication of
14:08
why it matters,
14:09
that your diabetes is controlled and we're able
14:12
to save your eyesight, when we can focus
14:14
on
14:15
your blood pressure and why that matters and
14:17
finding a health plan that also believes that
14:20
that's important. We know that we've reduced heart
14:22
attacks and strokes, and everybody understands the impact
14:26
of cancer because you've either had it yourself
14:28
or you know someone personally
14:30
who has been on that journey.
14:31
So this is part of understanding what the
14:34
individual expects
14:36
and what members are wanting.
14:38
I have tuned in very closely to our
14:40
members at this time of year as, of
14:42
course, we're in the annual enrollment period, and
14:45
they're telling us. They told us what they
14:47
care about pharmacy plans. They wanna know that
14:49
they're remaining stable.
14:51
When it comes to the benefits available to
14:53
them or let's say a flex card, they
14:54
wanna know that it's gonna be consistent next
14:56
year. And as we see tremendous
14:59
disruption
15:00
across the market
15:02
during this annual enrollment period,
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it's because
15:06
members have become more educated
15:08
and know what they want. And, frankly, they
15:10
know what they've had most recently.
15:13
And whenever we pull back benefits,
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it pullbacks pulls back the benefit to the
15:18
member.
15:19
And that's what we need to be mindful
15:21
of, being stable because that's what they want
15:23
from us. I don't believe members choose
15:26
to change plans every year, but their experience
15:29
is guiding their way. So let's keep it
15:31
simple in language they understand
15:34
and language that we understand together and drive
15:37
back to what impacts their quality of life
15:40
and their ease of accessing their benefits.
15:44
Well, Sareya, but before we go, you've got
15:46
the ears of a lot of other industry
15:48
leaders listening in from all over the country.
15:51
Any final thoughts for them? Final bits of
15:53
advice you wanna share as they navigate,
15:57
similar challenges
15:58
in the year ahead?
16:00
Sure thing. And I'll keep it simple.
16:02
At the end of the day,
16:05
people want to be heard,
16:07
and it's incumbent upon us
16:09
to listen
16:11
and then to respond appropriately.
16:14
And so as I've joined SSENSE and it
16:16
brings a huge smile to my face when
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I hear repetitively
16:20
across departments now, we use the language,
16:23
you spoke, we listened, here's what's happening.
16:27
Hearing people out,
16:29
listening and processing what matters most, and then
16:32
reflecting back what's changed because of their input
16:35
creates the strongest relationships
16:38
and what we're committed to. And I'm very
16:40
proud of our team for that. It takes
16:42
the entire team. We also say teamwork truly
16:45
makes that dream work. So I'm grateful for
16:48
our teams
16:49
for the opportunity to celebrate their success
16:53
and share that message with our members as
16:55
well.
16:56
A simple message, but a very impactful
16:59
one. Doctor Sacoccio, thank you so much for
17:01
taking the time to join us on the
17:03
podcast today and for sharing your insights with
17:06
our listeners. We really appreciate it.
17:08
My pleasure. And thank you, and be well.
17:11
You as well. And to our listeners, if
17:13
you'd like to listen to more podcasts from
17:15
Becker's Healthcare, you can visit beckershospitalreview.com.