Latest / Becker’s Payer Issues Podcast / Scott D. Schweiger, VP of The Clinic by Cleveland Clinic

Transcript

Scott D. Schweiger, VP of The Clinic by Cleveland Clinic · Becker’s Payer Issues Podcast

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  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. Our connected health services make the
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  treatment, prediction, and prevention of health care's most
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  complex conditions
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  easier and more accessible as we drive organizations
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  and people forward. Ever North Home Based Care
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  provides value based care that helps patients with
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  multiple chronic conditions
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  and social determinant of health barriers get the
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  care they need and the personalized experience they
• 0:28
  deserve. We serve patients who struggle to navigate
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  the health care system by bringing high quality
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  primary
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  and preventative care services to the home. By
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  providing clinical care and support services that provide
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  whole person care, we improve health equity, access,
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  and outcomes for the populations we serve.
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  This is Gracelyn Keller with the Buckers Healthcare
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  Podcast, and we are live with the 2024
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  payer issues roundtable.
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  I am joined right now by Scott Schweiger,
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  who is the vice president at the clinic
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  by Cleveland Clinic. Scott, thank you for being
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  here, and let's start off by having you
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  introduce yourself and telling us a little bit
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  more about your current role. Sure. Thank you
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  for the opportunity to, chat with Becker's.
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  Scott Schweiger vice president
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  at the Clinic by Cleveland Clinic. We provide
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  virtual second opinions
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  across accessing our 35 100 specialists and 550
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  subspecialists at the Cleveland Clinic.
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  Wonderful. Well, thank you for being here. And
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  let's talk about
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  member engagement to start our conversation here. So
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  at an industry level, how would you describe
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  the biggest barriers to effectively serving and engaging
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  members? And what opportunities do you see for
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  large scale improvements, and how are you applying
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  this your current strategy? Sure. Thank you. So
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  there's a couple of a couple of viewpoints
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  here. So in terms of barriers, if you
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  look at the payers,
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  there are thousands of digital health solutions to
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  navigate from, from
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  telehealth platforms
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  to advocacy and navigation solutions, which would include
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  everything from diabetes, cardiometabolic,
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  oncology,
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  neuro, GI, etcetera.
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  And payers face a patchwork of all these
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  disparate tools,
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  right? One report identified over 1400
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  digital health ventures worldwide.
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  Another reported more than
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  350,000
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  mobile health apps and there are 11,000
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  point solutions in the market which payers have
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  access to.
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  From a member perspective, they're equally frustrated, feeling
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  confused about their plans' offerings, and even facing
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  delays in care as a result.
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  So this, you know, we kind of call
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  that member abrasion. From a payer perspective, it
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  could be argued there's point solution fatigue in
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  the market and how do you bring all
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  these things together. The fatigue can leave patients
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  struggling to navigate the healthcare maze while leaving
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  payers with underutilized solutions
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  that failed to deliver the intended value.
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  On a personal
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  level, I often ask people, who are you
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  insured with? And they'll give me their insurer
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  and I'm like, are you aware of all
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  of your benefits available?
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  And I encourage them to go look in
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  the little magnifier
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  of their app and go plug in whatever
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  you want to do, diabetes control, weight loss,
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  whatever. And most of them have no idea
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  that even these payers offer premium discounts
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  to go after
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  the certain conditions that they want to get
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  in control.
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  So, opportunities for improvements, where do they lie?
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  You know, omnichannel strategy in the payer world
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  with the member is all about
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  being there for the member and their channel
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  of choice
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  at their time of need. So, how do
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  you do that? You know, for the payer,
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  as an example, this could mean enabling partners
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  and investments
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  together to collaborate on their solutions for integration
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  support
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  across the population,
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  across certain chronic conditions.
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  So, I would always encourage payers to say,
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  If you're being approached with
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  the broad areas of oncology, don't be afraid
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  to bring your partners together
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  because it could be single sign ons underneath
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  them.
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  For the members, they will see the result
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  of a platform integration,
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  more personalized support and allowing them to understand,
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  get the outreach they need. And oftentimes,
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  payers don't have the resources to outreach those
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  members.
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  So another piece that we look at is
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  you hear a lot about member engagement,
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  but it needs to go one step further.
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  I can reach out to you and tell
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  you there is a diabetes program for you.
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  I am engaging you, but how am I
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  enabling you to do that? How are you
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  going to reciprocate
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  by taking action? And so those are some
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  of the things that are ongoing
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  in the market. And as for the clinic,
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  when we talk chronic conditions,
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  high cost, complex, rare conditions that we can
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  help members
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  become aware of or control their journey, we
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  actually use nurse care navigators to reach out
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  to them
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  and help them in their journey.
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  Wonderful. And switching gears a little bit to
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  leadership growth, keeping pace in today's dynamic health
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  care landscape is challenging. So what is a
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  piece of advice you'd share with peer leaders
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  to grow their business while keeping members top
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  of mind? Yeah. Health care is a noble
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  business, but a business nonetheless. And to kind
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  of pivot off
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  of the recent world series in baseball, you
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  know, games are won on singles and doubles.
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  Rarely are you gonna win on a home
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  run. And similar in health care, if you
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  listen to what's going on at the Becker's
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  conference today, there's very few payers who are
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  getting up and saying, We solved this problem
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  and figured something out and it saved us
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  $81,000,000,000
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  right? It's, We found a solution aimed at
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  members and we're saving 1,000,000 here or millions
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  there or we're helping
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  thousands of patients and members here and there.
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  So, it's really breaking it down. So, the
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  theme there is
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  prioritize adaptability by investing in scalable,
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  member centered solutions, and look at your partner
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  base and bring them together.
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  And switching gears toward health equity, as this
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  becomes increasingly centered in payer strategies, how is
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  your organization addressing health disparities? And can you
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  share examples of measurable successes to date?
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  Sure. Two parts to that. The clinic by
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  Cleveland Clinic gives access to specialty care,
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  including
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  for people in rural or underserved areas.
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  Patients don't experience barriers like travel costs, limited
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  specialist availability,
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  or administrative red tape. The solution provides misdiagnosis
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  and unnecessary
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  treatments. The clinic offers member cost savings and
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  reduced out of pocket expenses.
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  So some of the statistics there are 60%
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  of Americans
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  have a chronic disease.
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  50% of that population has a subchronic
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  condition going on.
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  Misdiagnosises
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  lead to 750,000
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  deaths or disability each
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  year, and 51,000,000
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  inpatient surgeries
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  could have had an alternative
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  treatment plan. And that's really what we're doing.
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  And the last piece is everybody is aware
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  of the importance of care deserts in the
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  rural or underserved areas.
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  So virtual health in a number of areas,
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  reaching out to them can help that.
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  And as we think about quality,
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  in an ever changing
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  regulatory
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  environment,
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  what tools or key strategies have helped your
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  organization improve quality and clinical outcomes for members
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  while staying compliant?
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  Sure. The clinic's value is to unlock access
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  for the member and give them the ability
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  to have an informed
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  decision on their healthcare journey.
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  And as you look forward to
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  value based care and where that's going, you
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  know, it's the 3 legged stool. Can we
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  get the member? Can we get the provider?
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  And can we get the payer
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  all sitting on that same stool and being
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  aware of what's going on in their own
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  journeys? From secure telehealth platform members,
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  that powers the member experience,
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  to our approach ensuring physicians have a broad
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  licensing perspective and are able to meet that
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  need for the majority of people who come
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  through the program.
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  And we're fortunate enough to have
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  the 35100
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  plus physicians of the Cleveland Clinic to help
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  with that approach.
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  Wonderful. Well, Scott, thank you for joining me
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  today on the Becker's healthcare podcast. Again, we
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  are live at the 2024 payer issues roundtable.
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  Thank you.