Latest / Becker’s Payer Issues Podcast / Building Strong Provider Partnerships for Value-Based Care

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Building Strong Provider Partnerships for Value-Based Care · Becker’s Payer Issues Podcast

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This is where health insurance leadership comes together.
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Becker's fourth annual spring payer issues roundtable brings
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together over 400 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, 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, Christy Spencer, vice
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president of provider partnerships
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with Elevent's Health. Christy, how are you? Thanks
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so much for joining the podcast.
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Yeah. I'm doing great. It's great to be
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here with you today. You know, we have
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a lot of big topics, new year, but
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some some new topics and some old ones
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to get into
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in health care and with health plans. But
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before I kinda jump into those, Christy, I
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was wondering if you could please just share
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a little bit about your background and your
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career journey.
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Yeah. Absolutely.
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So as you said, I'm the vice president
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for provider partnerships at EleventHealth.
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In that role, I lead our national strategy
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for provider partnerships and value based care across
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our Medicare, Medicaid, and commercial lines of business.
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So really focusing on improving cost, quality, and
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our member experience.
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I I bring a unique perspective to this
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work because I've spent my career in health
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care
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viewing health care from multiple different angles. So
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I've held leadership positions at hospital systems,
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primary care organizations,
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health plans.
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I've run value based physician partnerships with full
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P and L accountability.
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I've worked directly with providers as they have
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transitioned from fee for service into downside risk
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models.
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So that really that experience really shapes how
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I approach the role.
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So I've seen firsthand that value based care
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only works when it's practical,
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when incentives are aligned,
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data is actionable, and providers are genuinely
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supported and not overwhelmed.
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So my focus at Allavance is on enabling
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provider success,
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reducing friction,
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and building partnerships that deliver measurable outcomes for
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providers,
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members, and for the business.
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Thank you, Christy. And I appreciate you sharing
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all that background info. And, yeah, we're you
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definitely have a unique perspective. And not only
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are you gonna lean on that for your
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with you, today in the podcast, but we're
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really looking forward to having you speak at
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our event, in April to spring payer issues
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roundtable. So excited to have you there. And,
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you you know, the first question I wanna
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get to from your perspective
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and something we hear about at our conferences
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especially
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is how relationships
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are
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changing a bit, evolving a little bit with
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health plans and providers.
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How are your relationship with providers changing as
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both sides face, you know, right now, cost
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pressure
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and workforce shortages?
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Yeah. That's such a great question. Those challenges
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are real.
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Provider relationships
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are becoming more pragmatic
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and interdependent.
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As we look at the landscape costs,
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workforce challenges, and just overall industry
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complexity,
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it's forcing us to shift away from transactional
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contracting
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to true partnerships.
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At a high level, success from my provider
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partnership background,
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it really requires
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three things working
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together, effective provider engagement,
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well designed incentives,
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and connected actionable data.
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When those elements are aligned, you can really
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begin to create a connected care ecosystem.
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So what's changing most is the conversation.
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Providers don't need more measures or reporting requirements.
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What they need is help removing friction in
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their day to day operations,
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as well as clarity on what actually drives
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outcomes.
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So that means designing incentives that are focused
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that focus attention on
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actions that matter most
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and invest
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in dedicated engagement teams that can meet providers
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where they are and delivering data through unified
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platforms that providers can actually use.
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When you combine that with innovative use of
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technology
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and artificial intelligence,
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you can really start to lower cost, improve
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outcomes,
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and reduce burden all at the same time.
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Our strongest provider relationships today are the ones
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that are built on trust and shared accountability
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and a real commitment to making it easier
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to deliver care, not making it more complex.
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Absolutely. I I think those are a lot
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of things that'll definitely strengthen that provider,
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relationship with with health plans. And, Christy, do
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you have is do you have an example
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of of you you know, I I think
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it was a great point you made. Do
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you have an example of, like, an action
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driven
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incentive
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that that you're trying to incorporate or have
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incorporated?
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Yeah. One of the things that we're doing
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is really focusing around quality outcomes
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and looking at how do we reward providers
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for closing quality care gaps. So we in
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in this year are beginning to
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expand our reach
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of inviting providers in to participate in our
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pay for quality program
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that really incentivizes
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providers to
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close care gaps and aligns and simplifies the
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work for them to actually do that. So
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we're super excited about being able to expand
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that program this year.
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Where do you see the biggest gap
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right now between payer strategy and operational
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execution?
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Yeah. I I don't know that I would
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describe it necessarily
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as a gap,
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maybe more as a moment of transition for
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the industry.
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Okay. The the future of health care really
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has to be built around outcomes. We've focused
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so much on transactions
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in the past. And moving forward, I think
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we really have to focus on
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aligning around incentives that improve health
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versus just
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just focusing on delivery of services.
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Value based care for Elevance Health, it isn't
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a pilot. It's not a side initiative.
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It's truly how we operate.
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And you can see that embedded in our
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provider
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partnerships,
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in the way that we're designing our products,
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in how we're engaging our consumers.
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And the results that we're seeing are real.
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In 2024,
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65.5%
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of our total medical
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spend was aligned to value based care, and
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37%
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of that was in shared risk, which is
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an increase over the prior year.
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And the impact,
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of that, the outcomes are really impactful.
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In our, Medicare Advantage plans, we're seeing that
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value based providers
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demonstrated
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3.9%
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lower MLR
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compared to non value based providers,
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and they've outperformed
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year over year on nearly 74%
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of our STARS quality measures.
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Additionally,
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76%
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of our value based practices improved their overall
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stars performance
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in that same period.
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So the strategy is right, yet it it
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really only works
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when it shows up simply and clearly. Ideally,
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it's directly within the provider's work flow
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where it can can really reduce complexity.
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And so that's where the next phase of
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operational excellence
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really matters.
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Along the same lines of reducing complexity, Christy,
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what's one investment or initiative you believe will
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most reshape how health plans operate over the
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next two to three years?
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That's a great question. As I stated in
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my intro, I've worked across
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multiple,
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components of the health care ecosystem, hospitals,
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physician groups, health plans.
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And that's that perspective has reinforced one thing
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for me. Partnerships have been done well or
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one of the most powerful levers that we
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have.
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Many providers,
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particularly smaller and independent groups,
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are operating in constrained environments.
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They have the ability to succeed in value
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based care, but they often just don't have
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the scale, the infrastructure, or the support that's
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needed
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to make that transition effectively.
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That's where our national value partners play a
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really critical role. So we work with these
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partners to extend capabilities
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to smaller provider groups,
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and they help those smaller provider groups standardize
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data
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flows, close care gaps, and prioritize
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interventions that actually move outcomes at a clinical
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level.
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The goal isn't
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to favor larger providers. It's really about lifting
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performance
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across the overall ecosystem
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to make value based care accessible and sustainable
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for providers of all sizes.
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So when when payers and these national
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value partners
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team up with our local providers and share
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knowledge
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and operate in an integrated system,
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everyone benefits, providers get the tools and support
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they need,
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health plans see better cost and quality performance,
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and members receive more coordinated and proactive care.
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So it's a true partnership model that's focused
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on enabling.
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That's really what's gonna help reshape
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how health plans operate over the next few
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years.
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Yeah. I really like that point about lifting
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performance across the board and kind of focusing
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there and not just, you know, it's just
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not just about paying attention to the big
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ones. I think, yeah, everyone benefits from that,
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and that it's such a great, you know,
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use of time and effort to focus on
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that.
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If you could change one
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regulatory or industry practice tomorrow to improve affordability
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and access,
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what would it be and why?
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Yeah. That's another great question. Yeah. I think
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there's such a need for simplification
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in the industry. So I would simplify
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and standardize administrative requirements across the industry,
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particularly
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around two areas, prior authorization
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and quality reporting.
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Traditionally, health plans have focused on paying for
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care, managing costs, and ensuring quality.
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Today, though, we recognize that most of the
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drivers of health happen outside of the clinical
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setting.
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In
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excessive administrative burden, it really pulls time and
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resources away from where it matters most.
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At Elevent's Health, we're using advanced digital tools
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and artificial intelligence to make health care simpler
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and more affordable and more personalized.
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This empowers our care providers to enhance health
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outcomes.
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So, for example,
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we're using digital tools to help identify care
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gaps quickly
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and support treatment decisions,
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and that really is helping improve health outcomes.
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We're also appropriately
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leveraging
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digital technologies
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for tasks like
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claims review and provider data updates,
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and it's helping us to ensure smoother and
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faster service.
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So as a result,
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AI enabled tools are cutting down on time
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consuming tasks
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so care providers can focus
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more time with patients.
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So my hope is that a more holistic
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and streamlined approach becomes the norm,
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one where digital advances are used to personalize
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care and eliminate friction, not not add to
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it. We have enough adding to friction in
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the industry.
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So so again, success really, really comes back
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to those three key elements working together in
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concert.
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Effective provider engagement,
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well designed incentives,
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and connected data working together.
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So the big picture is then a connected
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care ecosystem.
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Yeah. I think digital tools are obviously making
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a huge difference for health plans right now
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in so many regards.
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What digital tool do you think has helped
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the LVNs the most?
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Yeah. I think that that we're really focused
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on there's there's several digital tools that we're
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work working through. One of them is that
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we are using digital technologies to automate
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our post call,
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wrap up summaries,
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and we're incorporating
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issue detection and smart routing into each of
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those calls that which really helps to improve
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our associates' ability to manage large call volumes
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and enhance the customer experience.
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So each month, we're averaging about 1,000,000
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post call
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wrap up summaries, which translates into really meaningful
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time savings and better experience.
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And then we're using those same capabilities
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externally
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to help providers spend less time on administrative
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work and more time with patients. So that
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whether it's
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time spent reviewing claims or processing provider data
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updates or identifying care gaps, the goal is
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really the same. We're simplifying how we work,
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we're
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personalizing
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experience,
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and really empowering
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providers to enhance health outcomes.
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That's incredible. Not only think about how much
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time was is saved with with that, but
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what people can do with that time. That's
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I think it's phenomenal.
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The last question I have for you, Christy,
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what issue is putting the most pressure
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on health plan margins right now, and how
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are you responding differently or how will you
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respond differently in in 2026
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here? Yeah. And we we touch on that
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a little bit. Yeah.
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Health care costs, they're shaped by many forces.
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Hospital prices, pharmaceutical
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costs, health insurance costs,
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advances in technology,
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changing regulations.
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We we all have a role to play,
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across the entire health care ecosystem
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to help make sure that members are receiving
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the care that they need at the most
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affordable cost. It's it's a really important
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focus for Elevance.
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In 2026,
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my provider partnership team is focused on
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optimizing our value based portfolio
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and scaling
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risk where providers are ready and investing in
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enablement to really truly drive health care,
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outcomes and affordability.
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And as we've talked about previously,
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technology and AI are such a critical part
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of that.
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And it's not about creating tech for tech's
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sake. The main goal really is about improving
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the health care experience
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for both providers and members.
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So I talked a little bit about internal
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automation and how much time we're able to
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spend
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or how much time we're able
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to save by removing those manual tasks and
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allowing greater focus, for our members and for
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their experiences.
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And we're deploying those,
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same capabilities
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for our care providers to really do the
15:09
same and and really in enabling them to
15:13
focus their time with patients.
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So margin improvement,
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from my view, comes from
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enabling the right partnerships
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at the right level of risk with the
15:25
right support
15:26
and measuring success by outcome and not activity.
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So again, success comes from
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those three elements working together:
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effective provider engagement,
15:38
well designed incentives, and connected actionable data. When
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those elements are aligned,
15:44
you can really start to create a connected
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care ecosystem
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that produces better outcomes and affordability for our
15:51
members.
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Christy, thanks so much for joining the podcast.
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It was a great conversation. I look forward
15:56
to working with you again soon.
15:58
Likewise. Thank you so much for your time
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and for having me today.