Latest / Becker’s Payer Issues Podcast / Katherine Barresi, Chief Health Services Officer at Partnership HealthPlan of California

Transcript

Katherine Barresi, Chief Health Services Officer at Partnership HealthPlan of California · Becker’s Payer Issues Podcast

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  This is Laura Dirda with the Becker's Healthcare
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  Podcast. I'm thrilled today to be joined by
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  Catherine Barresi, chief health services officer at Partnership
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  Health Plan of California.
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  Catherine, it's a pleasure to have you on
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  the podcast today.
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  Likewise. Thanks for having me.
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  Absolutely. Now I am looking forward to digging
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  into some of the cool things that you're
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  doing out there in California, as well as
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  what you're planning for the future. But before
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  we dive in, could you please introduce yourself
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  and tell us a little bit about your
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  background?
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  Great. Thanks, Laura, and thanks again for having
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  me.
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  So, again, I'm Catherine Brassy. I'm a nurse
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  executive,
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  at Partnership Health Plan of California. And in
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  my current role, I'm the chief health services
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  officer.
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  And what that means is that I oversee
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  a huge,
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  piece of clinical operations and and strategic initiatives,
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  for the health plan, really with the focus
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  of including the out, and improving outcomes of
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  our members.
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  I be began my career as a nurse,
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  and worked specifically in case management and public
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  health. And this gave me a really strong
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  clinical foundation,
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  and and structure,
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  for what members experience,
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  in the outpatient world, in health care.
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  Well, that's great to hear. And, you know,
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  really cool that you've got this,
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  role now at Partnership Health Plan of California.
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  Could you tell us a little bit about,
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  some of the biggest issues that you're following
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  in health care and where it's headed in
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  the new year?
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  Yeah. There's,
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  as you know, health care really is top
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  of mind for everybody, especially after, the latest
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  election cycle. And really, the top five things
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  that I'm following and my teams are following
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  both at Partnership and in our work are,
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  of course, first and foremost, the big changes
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  or impacts to Medicaid,
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  with the new administration.
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  While we hear rumors, at this point, we
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  don't have any specific
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  policies or guidance. We know that the budget
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  reconciliation process is is upon us,
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  and there's discussions going on at a federal
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  level.
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  California has a lot of individuals on Medicaid
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  or Medi Cal as it's known in our
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  state.
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  In fact, I think the latest poll shifts
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  something around the order of about 14,000,000,
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  Californians are on Medicaid.
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  Partnership, we cover 24 counties in Northern California
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  with about 900,000
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  lives,
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  providing services and benefits,
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  and high quality health care. So this is
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  something
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  that we are are watching and tracking very,
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  very closely.
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  The other big focus for partnership,
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  as I just described, we are in Northern
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  California, and we have very large communities that
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  are rural communities,
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  that often
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  experience health disparities,
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  just due
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  to scale of cost,
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  economy.
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  And so for us, this is even more
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  important to make sure
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  that
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  infrastructure and healthcare delivery such as our rural
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  hospitals and our public hospitals in those communities
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  are are not disproportionately affected by some of
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  these policy and access changes.
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  And then the two and three other areas
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  that we're focusing on, obviously, improving access to
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  health care in general across our 24 county
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  network with things and innovations using technology like
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  telehealth,
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  with creative solutioning with our specialty network and
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  our primary care providers,
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  but also,
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  with strong emphasis on member engagement and member
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  experience,
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  and use of those those new technologies.
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  And then the two or three other areas
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  that we're looking at, as I just described,
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  AI. We've got an AI committee at partnership,
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  and looking about, how that technology can improve,
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  the operations within the health plan and the
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  service and experience and quality of care that
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  our members experience,
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  and then member choice and member voice
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  as they experience health care.
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  Because, again, I think that ultimately,
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  everybody in the health care space knows the
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  system only works when the system works for
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  for the people it serves. And so how
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  we engage and elevate them in in every
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  aspect of the work we do is is
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  a high focus for us.
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  That's great to hear. And, you know, really
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  helpful to understand some of the challenges that
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  are ahead. I know as you mentioned, it's
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  a lot of uncertainties
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  right now with how things will proceed in
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  the health care space.
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  And and how do you look ahead, at
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  some of these initiatives that you're talking about,
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  expanding access to care and planning for the
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  future,
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  while knowing, you know, that things could change
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  at any moment?
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  I think we we we stay true to
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  the partnerships that we've built and the communities
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  that we partner with to do that,
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  and we look towards the opportunities.
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  Granted, yes, it's it's a lot of change
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  management and it's a lot of uncertainty.
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  But the goals and values are the same
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  no matter which community you look at, when
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  it comes to health care. People want
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  doctors and specialists and providers and hospitals that
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  they can access easily when they need to.
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  People want low cost health care.
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  That doesn't mean lesser quality. It just means
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  lower cost, whether it be for prescriptions
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  or for,
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  specialist visits.
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  Our members on Medicaid, Medi Cal, many do
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  not have a a share of cost because
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  they qualify for income or disability.
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  And so
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  that is,
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  a common thread. And I think as long
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  as we remain focused on that work,
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  where the policy lies in that, as long
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  as our principles are the same, we'll get
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  to that end goal together.
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  That is a really great perspective, and I
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  I think a strong way to approach times
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  like these. Now looking ahead, what are you
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  most excited about, or what makes you nervous?
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  I'm most excited,
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  in three areas. I think first would be
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  the technology.
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  We've seen some rapid gains,
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  as I mentioned earlier with AI, but also
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  other technologies and technology partners in this space
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  bringing new solutions into health care.
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  Health care is, by far and wide, no
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  matter where you're at within the delivery system,
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  whether you're in an outpatient setting, a hospital
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  setting, on the payer side,
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  The data and the exchange of information is
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  becoming more and more relevant and key to
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  optimizing clinical decision making outcomes,
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  risk adjustments, payments, better use of resources. And
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  so it's great to see technology partners in
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  that space to enhance the work that we
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  do and not hamper clinicians or or operations.
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  I'm also really excited about rural health support.
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  I I think when,
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  groups or coalitions use words and terms like,
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  equity or disparity,
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  we often use that in connotation
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  of, you know, somebody's
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  race or ethnicity.
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  I think of rural health disparities. I think
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  of community disparities,
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  areas where there has been lack of infrastructure
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  investment,
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  business opportunity growth,
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  for example.
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  And how they experience and use,
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  and navigate health care is very different than
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  suburban or urban settings.
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  And so there's some really great best practices
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  coming out of there that I'm excited about
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  working and potentially scaling those, not just across
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  partnerships,
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  network, but really elevating those as a best
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  practice within Medicaid.
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  And then lastly,
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  our member engagement.
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  Again, member voice is incredibly important, and I
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  think there is a disconnect between what people
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  understand health care to be,
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  and how it is currently working for them
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  and and that translation and bringing them to
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  make sure that they have a seat at
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  the table and that they understand things
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  about how how benefits get decided, how,
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  how prior authorization works, what, you know, who
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  qualifies for what.
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  The system is set up ideally to be
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  working for them, and right now, it's not.
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  And so having those voices at the table
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  as as key partners is is actually really,
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  really exciting because the insights they lend
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  only improve the the quality of the output.
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  And then it's really great to hear. I'm
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  curious.
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  You know, in talking about the ability to
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  connect with, the broader community and engage with
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  them and and and,
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  figure out, you know, how you can improve
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  and have additional engagement. Is there anything you
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  learned from some of those efforts? Or how
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  did you go about,
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  making those connections, in a way that yielded
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  results?
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  Well, in terms of the, you know, the
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  member engagement piece, partnership has a multitude of
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  existing committees and coalitions
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  made up of,
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  stakeholders for the the folks that we serve.
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  So, in fact, even our our board of
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  commissioners is comprised of county behavioral health directors,
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  hospital CEOs, clinic CMOs,
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  community based organization partners and leaders. And so
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  it really is a tapestry
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  of everybody
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  within the community and and health care delivery
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  network that is meeting,
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  deciding,
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  leading efforts to improve care. And in terms
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  of our members, we have a community,
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  advisory group where we've got our actual members
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  who sit in and provide feedback directly to
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  the health plan on what we are doing,
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  whether it be policies or benefits or experience.
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  We have three of our members on our
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  board as well,
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  who who sit and power share along with
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  our board of commissioners around our finances and
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  strategic operations and vision.
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  So it's it really is ingrained in in
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  our company's culture and mission to make sure
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  that,
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  that engagement piece is there.
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  Lastly, I will add, we have special
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  committees of, subpopulations within our membership,
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  that are unique, that that need,
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  a more strategic and intentional focus. So for
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  example, in California, there is a program called
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  California Children's Services, and it is for children
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  and youth and young adults with, special and
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  complex healthcare needs. And at Partnership,
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  we are,
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  we have a majority of them within our
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  membership in the counties that we serve. And
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  so, we have a special committee of just
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  those clients, their parents, and or their caregivers,
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  to have bidirectional feedback about about their experiences
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  and how we can improve their health care
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  outcomes being that they are unique within the
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  health care delivery system and they are also
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  high users of health care delivery. And so
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  who best to talk to than them, in
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  terms of making sure that we're getting it
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  right?
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  That's such a great point. Thank you for
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  walking us through that. Now before we wrap
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  up our conversation, I'm wondering, what will the
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  most effective health care leaders need in order
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  to be successful in the next two to
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  three years, especially given some of the big
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  themes we've talked about today?
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  Yeah. I
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  first and foremost, my best piece of advice
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  is health care leaders, as always, you've gotta
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  be agile.
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  Things are constantly changing in health care and
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  and more so. The pace feels more more
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  frenetic.
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  But, agile, tech savvy, and financially strategic,
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  and deeply committed to the member voice, as
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  I explained,
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  with having them always at the center for
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  for high quality outcomes.
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  The best leaders will champion quality and accessibility,
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  with personalized approaches.
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  And they're they're gonna need to stay ahead
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  of these policy changes,
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  compliance requirements, reimbursement models.
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  That that's going to be a key component,
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  in order to leverage
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  the existing funding streams and and key partners,
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  that are out there.
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  With the rapid shifts in potential regulations that
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  are coming,
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  leaders in healthcare are really going to have
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  to kind of think outside
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  their existing coalitions,
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  for for broader opportunities for partnership.
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  I think and believe and have seen that
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  we are more more alike than we are
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  different.
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  And so we're gonna need health care leaders
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  that that can work together on the similarities,
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  resources more appropriately.
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  Catherine, thank you so much for joining us
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  on the podcast today. This has been such
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  a fun and fascinating conversation, and I look
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  forward to connecting with you again soon.
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  Sounds great. Thank you so much, Laura, for
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  having me.