Latest / Becker’s Payer Issues Podcast / Angie Kalousek, Senior Director, Clinical Strategy and Programs at Blue Shield of California

Transcript

Angie Kalousek, Senior Director, Clinical Strategy and Programs at Blue Shield of California · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy, care, and
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  benefit solutions.
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  Barriers to care can lead to gaps in
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  easier and more accessible as we drive organizations
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  and people forward.
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  This is Haley Recker with the Becker's Payer
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  podcast. And today, we are recording live at
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  the Becker's third annual spring payer issues roundtable.
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  I am thrilled today to be joined by
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  Angie Kalousek,
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  senior director of clinical strategy and programs at
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  Blue Shield of California.
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  Angie, thank you so much for being with
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  me today. Can you go ahead and introduce
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  yourself and share a little bit about your
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  background?
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  Absolutely.
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  So,
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  like you said, Angie Kalousek. I'm with Blue
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  Shield of California. I've actually been with Blue
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  Shield for about fifteen years.
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  So I had a really
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  great long tenured career there and have done
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  a lot of different things.
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  Right now, I'm working on our clinical strategy
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  and programs, which is really an effort
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  to prioritize
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  clinical priorities,
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  based on,
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  need. So what is the prevalence? What is
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  the cost drivers?
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  And it's been really interesting
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  work to dive into that.
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  Previously,
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  I was the wellness,
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  program director at Visa, and I also have,
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  a fitness background. I was a personal trainer
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  and,
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  helped others,
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  get to their best health as well.
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  Well, thank you so much for that introduction.
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  Now I'd like to get things started by
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  asking you about balancing affordability and quality.
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  So this is a constant challenge for health
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  plans. So how is your organization
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  innovating to manage the cost of care
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  while maintaining or improving member outcomes? Yeah. It's
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  a absolutely great question, and it really is
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  a double edged sword between affordability
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  and quality. But I really do think you
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  can have both.
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  One of the ways that we are tackling
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  this conundrum
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  is by really doubling down on
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  value based care. So we are working with
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  a lot of our providers across our network
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  as well as vendor contracts,
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  and sort of the,
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  clinical
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  program contracts as well
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  to always
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  create
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  a payment structure that incentivizes
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  the provider
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  to deliver outcomes. And then when you're aligning
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  the cost with the outcomes,
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  you are then getting to a place where
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  your care is more affordable
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  and also higher quality.
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  I think the other thing that we can
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  really take a look at and focus on
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  is, does our medical policy
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  align
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  with reducing
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  unnecessary
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  procedures, reducing waste?
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  You know, you think about,
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  people who are
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  going getting an injury and going straight to
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  surgery instead of doing the physical therapy first.
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  You know, we see up to, like, fifty
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  percent reduction
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  in surgery if people are doing physical therapy
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  first. So, again, just aligning that medical policy
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  so that,
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  the best clinical care
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  is
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  utilized.
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  I think the final thing, and I think
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  this one's really important, is really focusing on
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  prevention,
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  prevention,
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  early screenings,
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  and lifestyle based programs. So if all health
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  plans were working to
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  optimize the health of their members,
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  then all members, no matter which health plan
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  they went to, would show up at at
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  the lowest possible risk.
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  Getting ahead of chronic conditions like
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  obesity, type two diabetes, hypertension,
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  these are things that downstream
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  can
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  drive a lot of the cost in the
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  system.
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  And if we can get ahead of it,
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  that's certainly the best approach.
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  Well, that was just fascinating. Thank you so
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  much for going into detail there.
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  I'd like to pivot the conversation a little
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  bit since there's a lot of talk about
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  imperative to reduce costs, improve quality, and advance
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  health equity,
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  none of which are small tasks. So how
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  do you approach aligning these priorities in your
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  organization's
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  strategic vision?
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  Yeah. Well, our our mission is to deliver
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  affordable health care to our, members
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  in a way that is worthy of our
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  family and friends. And so,
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  I always kind of keep that at heart.
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  One of the things that we are doing
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  right now is we are shifting our approach
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  to a very specific line of business approach.
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  And I was talking about how I'm beginning
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  to work on some of the clinical priorities
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  and, strategizing on how we do that.
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  The truth is depending on the line of
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  business,
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  the priorities might be a little different. So
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  when we look at prevalence and we look
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  at high cost drivers,
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  there are some of the usual suspects that
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  show up kind of across all the lines
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  of business, like cancer, often MSK,
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  and, of course, cardiovascular.
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  But beyond that,
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  priorities change. For example, Medi Cal may have
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  a higher maternity need.
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  There might be more in the digestive health
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  space
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  with,
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  our our commercial membership.
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  Medicare may have its own considerations because we're
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  dealing with the senior population.
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  So I think it's it's crucial to
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  align the the action that you're taking and
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  the focus that you're you're driving towards with
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  the actual
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  line of business. And I think by doing
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  this and being more targeted and more precise
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  in how we're approaching these lines of business,
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  we are also able to address health equity.
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  As I mentioned, you know,
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  the Medi Cal line of business has its
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  own unique
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  needs,
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  based on some of the underserved populations. And
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  so we're able to address health equity by
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  being precise in how we deliver clinical care.
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  Looking ahead, what do you see as the
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  biggest opportunity for payers to lead the charge
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  in transforming care delivery and driving better outcomes
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  for all stakeholders?
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  And how can leaders take a step in
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  this direction now?
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  Yeah. I think,
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  digital care and virtual care are here to
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  stay. And when we when we talk about
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  the care delivery
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  kind of vehicle or how we're delivering care,
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  if we can inject virtual care and digital
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  care,
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  more upstream
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  and early on in the intervention,
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  we can save costs by reducing the point
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  of service,
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  expense. Right? And and so I I think
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  delivering
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  on virtual care and digital care in the
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  right way,
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  is gonna be critical to transforming
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  care delivery.
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  I also believe that health plans are notorious
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  for
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  not being super transparent
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  and,
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  treating health care like it's this very confusing
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  topic, and
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  most consumers are very confused by health care.
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  So I think we could all do a
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  much better job of treating
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  the member or the patient
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  like a consumer. You know? What would a
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  a normal consumer
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  retail site do to engage the customer,
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  drive them in, help them understand how to
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  use the site? And if we could sort
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  of mimic that in the health care space,
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  we'd go a long way to improving the
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  way that we deliver care.
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  Alright. And just to wrap up here, I'd
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  like to address health equity, which has become
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  a critical focus for many health plans.
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  Can you share an overview of a key
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  initiative here that you're involved in or particularly
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  excited about, and what are you hoping to
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  achieve?
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  Yeah. I mean, we have a lot of
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  health equity initiatives, and so I'll just maybe
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  pull out two or three that we're working
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  on. One that we have sort of ongoing
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  all the time is for our Medi Cal
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  line of business.
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  We are
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  focused in the San Diego and Los Angeles
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  County area,
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  and so we have,
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  a number of community resource centers
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  that are available to not only our members,
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  not only our Medi Cal members, but all
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  members of that community. And at those community
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  resource centers,
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  you can get help with advocacy for your
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  health plan. Again, we're talking about how confusing
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  health care is. So you can go there
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  and get help on
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  how do you utilize your plan. But there's
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  also health educators there that are doing coaching
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  and classes. There's fitness classes,
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  cooking classes,
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  child activities. So a lot of different things
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  for the community that we have across
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  San Diego and,
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  Los Angeles County.
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  We're also,
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  implementing
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  doulas for the medical population. That has become
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  a benefit that has really helped improve,
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  maternal health.
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  And,
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  finally, we are doing a pilot also in
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  the counties surrounding our Medi Cal line of
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  business area, San Diego and Los Angeles,
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  where we're partnering with the local Walmarts. And
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  so,
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  the members can go to the Walmart. They
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  can get their blood pressure checked. They can
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  get nutrition counseling,
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  and they can get
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  rewards
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  to shop for healthy foods at Walmart. So
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  kind of tackling it from all different angles.
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  There are many more, but it those are
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  just a few that I'd like to highlight.
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  Well, Angie, thank you so much for having
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  this conversation with me today. Again, this is
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  Haley Recker with the Becker's Payer Podcast recorded
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  live at the Becker's third annual spring payer
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  issues roundtable.
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  Thank you so much. Thank you.