Latest / Becker’s Payer Issues Podcast / Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross

Transcript

Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
• 0:02
  innovation to create world class pharmacy care and
• 0:05
  benefit solutions. Our connected health services make the
• 0:09
  treatment, prediction, and prevention of health care's most
• 0:12
  complex conditions
• 0:13
  easier and more accessible as we drive organizations
• 0:16
  and people forward. Ever North Home Based Care
• 0:19
  provides value based care that helps patients with
• 0:22
  multiple chronic conditions
• 0:23
  and social determinant of health barriers get the
• 0:26
  care they need and the personalized experience they
• 0:28
  deserve. We serve patients who struggle to navigate
• 0:31
  the health care system by bringing high quality
• 0:34
  primary
• 0:34
  and preventative care services to the home. By
• 0:37
  providing clinical care and support services that provide
• 0:40
  whole person care, we improve health equity,
• 0:43
  access, and outcomes for the populations we serve.
• 0:48
  This is Gracelyn Keller with the Becker's Healthcare
• 0:50
  podcast, and we are live at the 2024
• 0:52
  payer issues roundtable.
• 0:54
  I'm joined currently by Jeremy Wigginton, who is
• 0:56
  the chief medical officer at Capital Blue Cross.
• 0:59
  Thanks so much for being here, and let's
• 1:00
  start our conversation today by having you introduce
• 1:03
  yourself and tell us a little bit more
• 1:04
  about your role.
• 1:05
  Thank you. Yes. Doctor Jeremy Wigginton, the chief
• 1:08
  medical officer for Capital Blue Cross out of
• 1:10
  Harrisburg, Pennsylvania.
• 1:11
  And in my current role, I lead all
• 1:12
  of our health plans clinical operations, including utilization
• 1:16
  management,
• 1:16
  care management, our behavioral health, clinical programs and
• 1:20
  strategies,
• 1:21
  all of our clinical data reporting, our total
• 1:23
  cost of care, and our clinical strategic alignment
• 1:25
  across the enterprise.
• 1:27
  Wonderful. Well, thanks for being here. And let's
• 1:29
  start our conversation
• 1:31
  talking about growth goals. So from improving member
• 1:34
  experience, expanding value based care,
• 1:37
  and controlling costs, payer executives have ambitious growth
• 1:41
  goals for the rest of this year and
• 1:42
  the new year looking ahead. In your role,
• 1:44
  what is your top priority and how are
• 1:46
  you planning to get there? That's a great
• 1:48
  question. And there
• 1:50
  actually are a lot of ambitious growth goals
• 1:52
  and plans. And so my top priority is
• 1:54
  really identifying our population's really the the top
• 1:57
  greatest needs, and then working with our provider
• 2:00
  partners to help deliver solutions to those needs.
• 2:02
  And those things include
• 2:04
  areas of overutilization,
• 2:06
  such as emergency room care, but also areas
• 2:08
  of poor health outcome
• 2:10
  health outcomes, such as things like sepsis
• 2:12
  or even inpatient surgical infection rates, those things
• 2:15
  that are really driving the worst outcomes but
• 2:17
  for the highest cost.
• 2:18
  And I really think by looking at the
• 2:20
  intersection of those costs and outcomes, we can
• 2:22
  start to drive those more meaningful discussions with
• 2:24
  our provider partners about the ways that we
• 2:26
  can partner together
• 2:28
  to really find real solutions to those problems,
• 2:31
  and how to align incentives to bring those
• 2:33
  solution those solutions to fruition.
• 2:36
  A 100%.
• 2:37
  And at an industry level, how would you
• 2:39
  describe the biggest barriers to effectively serving and
• 2:41
  engaging members? And what opportunities do you see
• 2:44
  for large scale improvements? And how are you
• 2:46
  applying this in your current strategy?
• 2:48
  It's It's a great question as well. Well,
• 2:50
  one of the biggest barriers to effectively
• 2:52
  serving and engaging our members, in health care
• 2:55
  in general is really navigating the complexity of
• 2:57
  the health care system.
• 2:59
  Members face daily challenges,
• 3:02
  and with health literacy,
• 3:04
  and really understanding their own health conditions, their
• 3:07
  care plans, what they need to do to
• 3:08
  improve their own health. So really, there's a
• 3:11
  lot of opportunity there around members' self, you
• 3:13
  know, self awareness and their own health literacy.
• 3:16
  They're faced with extremely complex financial and logistical
• 3:20
  challenges around finding the right health care providers,
• 3:23
  getting the necessary preventative care and really knowing
• 3:25
  what resources are available to them under their
• 3:27
  health plan when they need them. So I
• 3:29
  see really significant opportunities
• 3:32
  for large scale improvements and strategies on how
• 3:34
  we approach care navigation
• 3:37
  and individualized member support, so advocacy programs.
• 3:40
  And I think by helping individual members really
• 3:43
  understand and navigate these complexities,
• 3:45
  we can really start to serve their needs
• 3:47
  better and help them to achieve better health
• 3:49
  outcomes together.
• 3:51
  Absolutely. And shifting gears just a little bit
• 3:54
  toward,
• 3:55
  growing leadership.
• 3:56
  Keeping pace in today's dynamic health care landscape
• 3:59
  is very challenging. So what is a piece
• 4:01
  of advice you'd share with peer leaders to
• 4:03
  grow their businesses while keeping members top of
• 4:05
  mind?
• 4:07
  My advice as a physician leader is to
• 4:09
  continue to focus on and investing in providing
• 4:13
  benefits for whole person care and integrated care.
• 4:16
  And this includes investments in people, processes, technology,
• 4:19
  to really further integrate members' behavioral, emotional and
• 4:23
  social needs into clinical programs. So I really
• 4:26
  think we've got to continue to really focus
• 4:28
  on the whole person health.
• 4:29
  And by approaching our members' needs holistically,
• 4:32
  we will be able to provide more impactful
• 4:34
  and personalized support. So, for example, in my
• 4:37
  own health plan, starting 1onetwenty
• 4:40
  5, Capital Blue Cross is gonna have a
• 4:42
  completely in source and integrated model of care
• 4:45
  that's gonna cross all of our plan functions,
• 4:47
  including customer service, utilization management, care management, provider
• 4:51
  partnerships.
• 4:52
  So I think these types of investments are
• 4:54
  really gonna help members lead those happier, healthier
• 4:56
  lives with access to more resources and really
• 4:59
  a stronger relationship with their care team across
• 5:02
  the health care ecosystem. And so I think
• 5:04
  investing in that,
• 5:05
  whole person model is really critical.
• 5:08
  Absolutely. And as we wrap our conversation, I'd
• 5:11
  love to dive into technology just a little
• 5:13
  bit. So what role is technology playing in
• 5:15
  your organization's growth strategies? And I would love
• 5:18
  to hear a specific example. Sure. Well, technology
• 5:20
  actually plays a really critical
• 5:22
  role in our growth and retention strategies.
• 5:25
  Members and clients want information and service when
• 5:28
  it's convenient for them, and we know that
• 5:30
  employer groups want the same on demand access
• 5:32
  and support for their plan and membership.
• 5:35
  So a prime example of this is through
• 5:36
  the creation of a digital front door. So
• 5:39
  that allows access to benefits and services, as
• 5:41
  well as claims and financial data. And then
• 5:44
  by overlaying things like a digital front door
• 5:46
  with supplemental AI,
• 5:48
  you know, large language models,
• 5:50
  we can really offer 20 fourseven access to
• 5:53
  needed resources. So by offering that consolidated view
• 5:57
  of the most important information to our members
• 5:59
  and clients, we can really help to both
• 6:01
  grow and retain,
• 6:02
  but also, again, improve those health outcomes.
• 6:05
  Wonderful. Well, Jeremy, thank you so much for
• 6:07
  sharing your insights today on the Becker's HealthCare
• 6:09
  podcast. Again, we are live at the 2024
• 6:11
  Payer Issues Roundtable.
• 6:13
  Thank you.