Latest / Becker’s Payer Issues Podcast / Data Driven Leadership in Medicare Advantage with Jennifer L. Kowalski of Elevance Health

Transcript

Data Driven Leadership in Medicare Advantage with Jennifer L. Kowalski of Elevance Health · 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
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  payer and health plan executives and more than
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  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, Jennifer Kowalski, vice
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  president, Public Policy Institute over at Eleventh Health.
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  Jennifer, thanks so much for joining us. How
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  are you doing today? Good. Thanks for having
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  me, Scott. Of course. You know, we have
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  a lot of of big topics to to
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  get to, and we're definitely very excited for
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  you to be speaking with us at our
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  spring payer issues roundtable in April. But, before
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  we get to some of those topics I
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  wanted to ask you about now, I was
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  wondering if you could please tell us a
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  little about your background, your career in health
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  care.
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  Sure. Well, as you mentioned, I'm currently the
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  vice president of the Elevant Health Public Policy
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  Institute, or PPI,
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  where I've led a team of policy experts
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  and researchers for over eleven years.
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  And PPI's role is to conduct and publish
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  policy relevant and data driven research that helps
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  to inform health policy
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  discussions.
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  And prior to my career at Elevance Health,
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  I spent about a dozen years in health
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  care policy consulting,
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  advising a range of,
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  companies, health plans, pharmaceutical manufacturers, and so forth
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  on health care policy and strategy.
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  So
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  to follow-up your your background there, Jennifer, you
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  know, we always hear about how much how
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  important data is to health plans. But with
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  your role with all events, it it sounds
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  like it's it's extra important. Is that fair
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  to say? Yeah. I think that's exactly fair
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  to say. You know, that that is part
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  of, what my team brings to the company.
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  I sometimes
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  refer to us as a bit of an
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  internal think tank in helping to bring,
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  evidence, credible evidence to health policy conversations and
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  to help shape the future of, healthcare policy.
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  And the first thing I want to ask
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  you
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  is how do you describe the role within
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  Medicare Advantage
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  that it plays within
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  your overall health plan strategy?
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  Yeah. That's a great question, Scott. At Elevance
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  Health, our affiliated health plans really serve people
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  across every stage of life. So that includes
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  Medicare Advantage, but it also includes Medicaid managed
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  care,
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  individual marketplace coverage,
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  as well as employer sponsored plans.
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  So you can think of Medicare Advantage as
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  a critical part of that portfolio.
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  It allows us to support older adults and
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  people with disabilities
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  with coordinated and affordable care. And so in
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  that sense, Medicare Advantage plays a central role
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  in how we think about lifelong health and
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  whole person care.
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  What do people outside
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  the Medicare Advantage space
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  most often misunderstand about the program?
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  Yeah. I had, like, three core themes here
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  with respect to Medicare Advantage.
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  So one, value,
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  two, access to care,
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  and three, program efficiency.
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  So first, with respect to value,
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  today, more than half of Medicare beneficiaries
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  now choose Medicare Advantage as their,
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  coverage option. And I don't think that's an
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  accident.
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  So for sure, Medicare Advantage uses provider networks,
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  but members also get an out of pocket
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  maximum.
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  They get integrated prescription drug coverage often at
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  zero premium.
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  Medicare Advantage has coordinated care, and it also
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  includes extra benefits that aren't part of traditional
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  Medicare.
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  So through the Elevance Health Public Policy Institute,
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  we've studied these supplemental benefits. So things like
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  vision,
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  dental, transportation
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  assistance,
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  healthy grocery benefits.
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  And our research shows
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  that use of these benefits by our members
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  correlates with better health outcomes
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  as well as more appropriate health care utilization.
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  And so this is also particularly true for
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  people with chronic conditions
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  like diabetes.
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  So then second, access, I think is also
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  often misunderstood.
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  I think critics will point to networks as
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  a limitation of Medicare Advantage,
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  but some of our upcoming research
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  finds that after controlling four key factors,
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  Medicare Advantage members actually experienced shorter wait times
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  to see neurologists
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  compared to traditional Medicare beneficiaries
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  that had Medigap coverage.
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  Lastly,
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  program wide efficiency.
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  PPI research found that as Medicare Advantage penetration
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  grows in a market, total Medicare spending growth
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  slows.
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  And this is due in part to spillover
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  effects. So this means that, the incentives for
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  delivering high value care in Medicare Advantage
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  appear to influence how providers treat all of
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  their Medicare patients.
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  And, likewise, we've also sponsored independent analysis that
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  shows Medicare Advantage is more effective
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  at curbing fraud, waste, and abuse than fee
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  for service Medicare.
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  So it sounds like the program is a
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  lot more accommodating than some people might think.
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  Is that right? I think that's right. Yeah.
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  And I think it brings more value to
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  to members and to the Medicare program writ
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  large than people might realize.
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  The next thing I want to ask you,
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  Jennifer, is how are priority shifting
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  for health plans as the Medicare Advantage population
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  continues to grow?
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  Yeah. If any enrollment has grown,
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  I think one of the most notable trends
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  has been the increasing enrollment
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  among individuals who are dually eligible for Medicare
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  and Medicaid.
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  And if you're not familiar, these individuals often
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  have more complex healthcare needs. They tend to
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  have higher rates of chronic conditions,
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  and they also have to navigate these two
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  separate benefit programs. And I think that complexity
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  can create some real challenges.
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  And so as a result, both states and
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  CMS, the Center for Medicare and Medicaid Services,
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  as well as health plans themselves,
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  are increasingly focused on better integrating these benefits
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  for, dual eligible individuals.
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  One key vehicle for that integration
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  is known as Medicare Advantage Dual Eligible Special
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  Needs Plans or more simply DSNPs.
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  And DSNPs are plans that are designed
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  specifically to meet the medical and social needs
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  of people who are dually eligible.
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  And so these plans emphasize coordinated care,
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  they simplify navigation,
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  and they take a whole person approach to
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  care. And they can vary somewhat in their
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  degree of integration. So the most fully integrated
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  plans will also include long term services and
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  supports.
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  And upcoming research from the PPI
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  focuses on really measuring and demonstrating
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  the value of increasing integration of those benefits
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  and for the members, of course, but also
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  for the programs,
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  writ large.
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  I was just curious. What were some of
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  the challenges you referred to in trying to
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  then walk that line and keep the balance?
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  Oh, yeah. I think, you know, for dual
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  eligible members,
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  I think what some of the challenges are
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  that there's a set of benefits and a
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  set of, providers
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  that take Medicare coverage. And then there may
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  be a whole separate set of rules with
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  different benefits, different provider networks in the Medicaid
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  program. And so absent,
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  a plan or a care coordinator
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  to help manage that those two separate programs,
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  it can be challenging for an individual to
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  navigate on their own, particularly if that individual
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  also, you know, needs a lot of
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  health care services or is,
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  you know, has a chronic condition of some
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  sort.
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  Yeah. I could definitely say that it could
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  be, difficult for someone to navigate on their
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  own.
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  Where do you see the biggest opportunities for
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  health plans
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  to better serve Medicare Advantage members?
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  Yeah. So I frame the opportunities
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  in Medicare Advantage around two themes,
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  affordability
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  and ease of navigation.
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  So first, with respect to affordability,
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  one example here is that health plans can
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  help guide members to lower cost sites of
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  care that have comparable quality when it's clinically
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  appropriate for that member. So for example,
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  recent research that we conducted found that non
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  oncology infusion therapies
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  that are delivered in physician offices,
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  ambulatory infusion centers, or even at home were
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  associated with lower costs, but similar or better
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  outcomes when compared to hospital outpatient departments.
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  And now this study focused on commercial members,
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  but I think the lessons are still relevant
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  for Medicare Advantage.
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  And then second is navigation.
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  We can do more to make the health
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  care system easier to use, and there's lots
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  of examples of this. We could, provide clear
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  information on out of pocket costs and quality
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  with digital tools.
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  We can help members choose providers.
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  We can support preventive care,
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  with simple reminders, such as about flu shots
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  or cancer screenings.
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  And then to bring it back to supplemental
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  benefits, I think they're an opportunity here as
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  well. So benefits like dental coverage,
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  healthy grocery allowances,
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  and things like transportation assistance all help address
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  the full range of factors that influence access
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  to care along with health and well-being.
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  And what does success in Medicare Advantage look
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  like
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  from, a leadership perspective? Obviously, this you know,
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  to to structure these programs the right way
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  and and for them to be as accommodating
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  as they are takes a a big amount
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  of of the right kind of leadership. Right?
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  Absolutely.
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  And from my perspective and, you know, from
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  my role at Elevance Health, success in Medicare
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  Advantage really means leading with that credible data
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  driven evidence that will ultimately support our members
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  and living healthier lives.
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  And so that can include producing rigorous research
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  that informs our engagement with policymakers and regulators
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  and other stakeholders
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  as they're shaping the future of the MA
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  program.
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  It also means using the evidence that we
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  produce internally.
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  So whether that's to inform strategy, or to
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  help identify opportunities
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  to improve care for our members.
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  But ultimately, we really wanna use PPI's research
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  to shape thoughtful public policy
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  that supports innovation in Medicare Advantage, that promotes
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  sustainability for the program, and that creates value
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  for the Medicare Advantage members that we serve,
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  and, of course, for the Medicare program over
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  the long term.
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  And, Jennifer, when you look back at your
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  career and, you know, specifically with the things
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  you're you're working on now, how do you
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  think you've evolved as a leader?
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  You know, I think over the last, you
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  know, twenty five years or so of my
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  career, I've certainly gone from being in the
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  weeds and really knowing all of the details
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  of policies and programs
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  to taking a much, you know, kind of
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  higher level strategic look at how it all
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  fits together and how I can support the
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  members of my team
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  in really, you know, shining and being experts
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  in their own right and, you know, having
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  the opportunity to grow and learn as well.
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  Yeah. So there's there's a lot of strategy
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  in involved
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  in this this program, obviously. Right?
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  Exactly.
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  Exactly. And from an MA perspective,
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  I sort of started my career in consulting
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  around the time that the Medicare modernization act
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  created Medicare Advantage as we know it today.
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  And so I I feel like the the
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  program has grown alongside my career and evolved
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  alongside my career, which has been kind of
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  fun. Yeah. Definitely some some big parallels there.
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  And, Jennifer, thanks so much for for joining
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  the podcast for a great conversation. Like I
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  said, really looking forward to speaking with us
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  in April and and looking forward to work
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  with you again soon. Thanks, Scott. I'm looking
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  forward to it as well. I appreciate the
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  conversation today.