Latest / Becker’s Payer Issues Podcast / Shawn Shuman, Director, Medical Management, Peak Health

Transcript

Shawn Shuman, Director, Medical Management, Peak Health · 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.
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  Barriers to care can lead to gaps in
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  Our connected health services make the treatment, prediction,
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  and prevention of health care's most complex conditions
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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 we are recording live at the
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  Becker's third annual spring payer issues roundtable.
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  Today, I am thrilled to be joined by
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  Sean Schumann, director of medical management at PEAK
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  Health. Thank you so much for joining me
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  today. Can you go ahead and get us
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  started by telling us a little bit about
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  yourself, your background, and your organization?
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  Absolutely. Good afternoon, and thank you for having
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  me on today's podcast.
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  I appreciate being here. I am from PEAK
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  Health. PEAK Health is a provider payer. We
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  started in operations three years ago,
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  and we service the market of West Virginia,
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  and surrounding communities.
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  Well, thank you so much for that introduction,
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  and I'd like to get our conversation started
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  by talking about the ever evolving regulatory landscape.
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  So what best practices or tools does your
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  organization rely on to keep quality of care
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  at the forefront?
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  At Peak Health,
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  our whole goal is to improve the health
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  outcomes and the health trajectory of the residents
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  that live within the state of West Virginia,
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  and our whole goal is really to work
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  towards
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  improving the lives of the people that we
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  serve. We do that through a variety of
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  ways. Internally, we look at what utilization looks
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  like. Is it standard? Is there anything that's
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  outliers?
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  We also look at quality of care. We
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  do chart audits on our team to make
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  sure that we're providing the best service possible.
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  And then also, we are working with our
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  providers, making sure that our members have access
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  to the highest quality of care possible. And
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  then also, we look with our fraud, waste,
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  and abuse team, working with compliance,
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  etcetera, making sure that we are providing the
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  highest level of service and quality to the
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  members that we serve.
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  So going off of that a little bit,
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  I wanna talk more about member satisfaction,
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  which would probably most likely have to do
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  with the quality of care at the forefront.
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  So what experience or engagement strategies have proven
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  effective for your organization, and how are you
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  measuring that success?
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  Sure.
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  At Peak Health, member satisfaction is the highest
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  priority.
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  We see that as our differentiator.
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  We know that health care is hard, and
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  we know that there's a lot of barriers
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  to accessing health care. Our goal at peak
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  health is how do we remove those barriers?
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  So we work with our members,
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  around care management,
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  and we access we help them access care,
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  and we help them get in a more
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  streamlined fashion. So making sure that we connect
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  them with the community resources that are available
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  and then how we can make sure that
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  they get the appointments and the services they
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  need in order to live their best life.
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  And we have a great team of folks
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  that have assembled around care management, utilization management,
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  and quality that really wrap around a member
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  to provide the highest level of services.
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  Well, that's amazing to hear. And I can
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  imagine that reducing costs and improving quality
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  and advancing health equity have a lot to
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  do with that member satisfaction.
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  So how do you approach aligning these priorities
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  in your organization's strategic vision?
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  Thank you for that. We do,
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  look at ways to
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  increase quality, decrease cost overall. And as an
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  organization, we do that
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  by a variety of ways.
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  One of those ways is upon enrollment before
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  people enroll in our plan. Have they had
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  any interaction with our health system partners?
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  And how do we work to get them
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  enrolled into care management programs? Those folks that
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  are unwilling to go into care management programs
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  that are high utilizers,
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  we put them in a program we call
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  PEAK CARES.
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  And PEAK CARES is sort of a comprehensive
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  care management program that wraps around a member.
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  They have one care manager, one number to
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  call, and then that care manager navigates
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  for the member on the member's behalf
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  to the health care ecosystem.
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  And we work with that member, and we've
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  been having positive results around that. But it
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  allows us the ability to not only
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  address the,
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  health,
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  inequity,
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  of individuals that live in the Appalachia region,
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  as well as in West Virginia,
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  and it allows us to make sure they're
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  connected to the care and services that they
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  need. Absolutely.
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  Now for my final question today, looking ahead,
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  what do you see as the biggest opportunity
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  for payers to lead the charge in transforming
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  care delivery and driving better outcomes for all
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  stakeholders? And how can leaders take a step
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  in this direction now?
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  Sure. Absolutely. I think the biggest opportunity for
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  payers is to have line of sight into
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  the member experience, member satisfaction. I think if
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  you get that right, everything else will fall
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  on the line.
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  And I think, from a health plan care
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  perspective and a vision perspective, I think leaders
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  need to take bold steps in addressing
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  how and what their members are experiencing from
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  health plan operations to
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  provider
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  that are available in the network, how members
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  navigate the system. And if the health plan
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  plays a central role, which we are trying
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  to do at Peak Health,
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  that's what would be a winning strategy in
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  order to approve the health trajectory of the
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  members that we serve.
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  Well, I've really enjoyed our conversation today. Again,
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  this is Haley Recker with the Becker's Payer
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  Podcast,
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  recorded live at the Becker's third annual spring
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  payer issues roundtable. Thank you so much, Sean,
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  for joining me today. Thank you for having
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  me. Of course.