Latest / Becker’s Payer Issues Podcast / Harlon Pickett, President of Eagle Care Health Solutions

Transcript

Harlon Pickett, President of Eagle Care Health Solutions · Becker’s Payer Issues Podcast

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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, Harlan Pickett, president
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  of Eagle Care Health Solutions. Harlan, how are
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  you doing?
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  Hey, man. Doing great, Scott. It's, a pleasure
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  to be here, sir. No. Thanks so much
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  for joining us. Really looking forward to getting
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  your insight a lot of on a lot
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  of big topics,
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  in health care and with health plans. And
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  we're really looking forward to have you speak
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  with us. It's just just a few days
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  now when we record this. It's, almost our
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  spring payer shoes roundtable. It's gonna be a
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  great event. Yeah. Gonna be a great event,
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  and we're gonna touch on some of the
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  same subjects we're gonna talk about today too.
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  I can't wait. And then while I have
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  you here, let's wait. Can can you can
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  you just kinda share, Harlan, your background,
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  in health
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  care? Yeah. Absolutely.
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  Started out really as a traditional insurance broker,
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  if you can believe that. That's, what I
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  started doing almost twenty years ago. And as
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  my journey kinda
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  developed, I realized that there was a lot
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  of things that I could do
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  myself to build health plans that were not
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  done on in the traditional way. Employers needed
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  more options. Employers needed,
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  better access.
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  Their employees actually needed better access to health
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  care, and so we started down that pathway.
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  So while I still
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  wear that
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  broker hat some days, most of the time,
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  you know, president of Eagle Care where we
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  build health plans, provide access to health care
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  to folks, and it's not just regular health
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  care, it's quality health care.
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  Appreciate you sharing that background info, Harlan. And
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  getting to the first topic here, something I
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  really want to ask you about is, you
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  know, health literacy is one of those
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  you know, big barriers to members,
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  in getting value from their coverage. What does
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  your plan do to close that gap?
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  Yeah. It is amazing
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  that things that I I think we take
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  for granted
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  being in this industry
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  are just very difficult for people to understand.
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  And the the first thing that we have
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  to do is wrap our mind around that,
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  Scott, is that Yeah. There is really nothing
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  easy in the health care system.
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  Once we
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  it it it's also kind of interesting if
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  you have to deal with it
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  yourself. All the things that you thought that
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  you knew about the health care system just
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  leave your mind, and all of a sudden,
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  you feel like the people that are using
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  your health plan because
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  it's different to tell someone how to do
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  something than actually have to do it yourself.
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  So if you can keep those things in
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  mind and then
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  help people with the understanding
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  and
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  make them not have to do it on
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  their own, that's the key. That's to me,
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  that's where our health plans
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  really make that connection is the navigation side
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  of it. We don't leave
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  the folks alone. We don't make them just
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  handle this all on their own and say,
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  well, you know, you go over to this
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  website and it tells you everything.
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  No. We want them to engage with us
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  and make sure that they are guided in
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  the right direction to find the providers that
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  will work best for them, to help them
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  ask the right questions.
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  That's that's part of it. And it's not
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  just any navigators too.
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  If you use clinicians,
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  they have a better insight as well. So
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  we do our best to make sure that
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  our navigators are clinicians as well because that
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  changes the game too.
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  Yeah. I think it's wonderful to kind of
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  focus on that customer service aspect, and that
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  that really, you know, makes members feel like
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  your the plan is going the extra mile.
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  So, yeah, I think that's really well said,
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  Harlan.
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  And, you know, the it just kinda ties
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  in what we're talking about and, you know,
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  needing to assist some members more than others.
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  But with an aging population, you know, that
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  means
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  more members with complex
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  chronic conditions. How is that reshaping the way
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  your plan designs benefits and manages care?
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  Well, you you have to take that into
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  consideration. You know, we just happen to be
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  dealing with something right now with my mom.
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  She just spent a few days in the
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  hospital,
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  and
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  it's it's all part of what you just
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  said. It's that aging population
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  that this just came out of nowhere. And
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  now how do you handle this?
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  Well, the blessedly, she has someone,
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  me, to help her through this, but my
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  sister is completely lost. And it makes me
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  just once again realize how many times
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  we have folks out there that are that
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  way. And it really goes right back to
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  making sure you hold their hand and help
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  them through these processes.
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  The plan has to have
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  as few
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  barriers to care as possible,
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  and that means that you have to
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  to integrate things in there that maybe you're
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  not always out there.
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  One of the difficulties with
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  this is that
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  most folks that when they get to the
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  ages we're talking about have no choice but
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  to be on Medicare or some part of
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  Medicare.
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  So your plan has to be able to
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  work with Medicare. It's gotta be able to
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  have that interface and that that integration somehow,
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  some way, and that is not always easy
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  to make that happen. And that even makes
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  it more complex.
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  I don't know that anyone has got this
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  down perfectly,
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  but it's it's
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  it really does go right back to making
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  sure that you're engaging with the client, that
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  you're giving them every opportunity to use the
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  parts of your plan that are built specifically
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  for that. You know, we we really focus
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  on primary care and especially the folks that
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  are in that age group and that have
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  those chronic conditions. We wanna remove those barriers.
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  So it's it's it's zero cost
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  primary care across the board with, building relationships
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  with those physicians again. And a lot of
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  our,
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  older folks, they they're
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  they remember those days. They remember having doctors
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  that you could send a text to, that
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  you could call and be responsive
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  and not wait days before you hear back
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  from the office. So I think that's vitally
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  important that for them to understand that that
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  we've got their back.
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  You know, we kinda figured that prior authorization
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  is gonna be one of those huge topics
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  at at the conference coming up here, Harlan.
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  And
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  what does a better prior auth process look
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  like, and how you balance clinical oversight with
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  not creating barriers to timely care?
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  Well, that that's a great question because I
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  think that's gonna be a a focus for
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  everybody now. Obviously, the government's taken a huge
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  interest in in prior authorization and the way
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  it's streamlined and, the the way that we,
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  as plans,
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  look at that. One of the ways that
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  we have addressed that is we really don't
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  do prior authorization
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  in in almost every case. I mean, there
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  are still a few where there's something kinda
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  weird that comes up, and so we we
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  have to take second and third looks at
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  it. But in most cases, we just trust
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  our doctors to be doing the right thing.
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  When you align your incentives
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  in the way that you do with value
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  based care and you make sure that the
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  doctors you have in your networks are good
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  quality, high, you know, high performance
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  physicians, then it takes some of that concern
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  away.
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  The other part of that is, as I
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  mentioned earlier, is the navigation side. If you
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  have clinicians that are also navigating,
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  it's almost like a self check whenever they're
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  looking at these things and they're guiding someone
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  to make sure it is the appropriate care
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  that's being,
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  being recommended by the the physician.
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  What we don't wanna do is a plan
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  because this is another reason why we started
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  doing things differently, why I kinda got out
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  of it, is that most plans come between
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  physicians and the patient.
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  And we truly believe that the that health
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  care is between the physician and the patient.
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  The plan's job is just to make sure
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  everyone gets paid properly, but also that the
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  appropriate care is there. So without getting too
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  far into the weeds with prior authorization, we
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  just wanna make sure that someone's not recommending
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  something harmful,
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  but
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  that they're getting the right care. And and
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  I think having the right doctors and once
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  again align incentives
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  and getting out of the way of health
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  care and letting that be between the patient
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  and the doctor, that's gonna be paramount,
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  in the future.
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  Yeah. You you mentioned aligning incentives, which brings
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  us next to our next topic here. Even
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  value based contracts promise to align incentives around
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  outcomes over value, but where do you see
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  that actually deliver, and where does the model
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  still break down?
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  Yeah. So that that's that's really interesting because
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  we build most of our plans around direct
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  primary care. And direct primary care as a
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  model is is very different in the fact
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  that it's not fee for service. So we're
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  paying
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  our primary care doctors in this case, which
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  they are doing a whole lot more than
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  just regular primary care. They're really practicing to
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  the extent of their license. We pay them
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  a monthly fee per member.
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  And there is no incentive for them to
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  do anything extra. There's no incentive for them
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  to not do enough.
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  In other words, they're gonna get paid,
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  and they're gonna see that client as many
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  times as they need to see that client,
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  that patient,
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  but their goal should be to keep them
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  healthy.
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  Obviously, if I'm getting paid every month for
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  a healthy client that is not seeking my
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  services all the time, I have a a
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  a that that's better for me. That that's
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  outlining the incentives. That's truly building value based
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  care. And then we'll also see that there
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  is a reduction in chronic
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  illnesses. There's also a reduction in medications, which
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  is is crazy because these doctors have no
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  incentive to give them more medications.
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  Now where does it break down sometimes? This
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  has been a difficult lesson for us to
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  learn in this case. Most direct primary care
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  doctors that have stepped into this model that
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  are tired of the old fee for service
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  and they don't wanna be in networks like
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  that anymore,
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  They don't
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  have huge overhead anymore because they don't have
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  a lot of help there. And so tracking
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  claims, we still have to know what happened
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  in that doctor's office. How how do we
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  know what's going on? Even if it's a
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  $0 claim, which is what we are doing
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  now is we're tracking and having $0 claims
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  so that at least we know what's happening.
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  So making sure that they have an EMR
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  that, can be interconnected and do API transfers,
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  making sure that we have actually some record
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  of what's happened and going on with that
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  client so that we know, how it's gonna
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  work with the rest of the plan. And
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  if they do need a specialist or if
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  they do need some kind of surgery, we
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  have some record of what's happened. As silly
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  as it sounds,
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  we didn't think about that when we first
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  started building these plans around direct primary care.
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  We were just so happy to get people
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  the care they need without the the roadblocks.
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  Even if it's just a $50 co pay,
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  sometimes that's just too much that we didn't
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  think about. Well, what if they need something
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  else? How's the plan gonna know, and how's
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  it gonna know if it's appropriate? So for
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  us, that was the crazy thing that we
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  didn't see coming.
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  And,
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  we fixed it, pretty much now, but that's
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  where it can fall short if you're not
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  ready for it.
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  Yeah. Absolutely. I appreciate you sharing the, specifics
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  there.
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  And, you know, I saw Howard
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  or I'm sorry. Harlan wanted to ask you
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  about
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  network design
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  is one of the most consequential decisions,
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  you know, a health plan makes and
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  and one of the least visible until someone
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  can find a doctor. How do you balance
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  network adequacy against affordability?
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  Yeah. One of the great things about
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  working in the employer space
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  is that
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  network adequacy is not a rec a required
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  thing the way it is for, say, Medicare
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  Advantage and some of the other, you know,
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  other plans, ACA plans and such. And, therefore,
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  we're able to build high quality networks. It's
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  it to us, it's not really about
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  having, you know, every doctor
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  in the area. It's about having all the
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  quality doctors
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  in the area. And so we we go
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  down that pathway. And there there's a number
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  of of of people that have already done
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  some of this work for us.
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  But if we go into a certain area
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  that doesn't have what we feel like is
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  adequate enough, especially in the,
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  facility, usually, we have enough physicians in an
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  area. But if if there's not enough facilities,
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  then we'll start working, directly with hospitals to
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  build, you know, contracts as well.
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  Con you know? And that is, that's kind
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  of another point there is hospitals are getting
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  a little
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  more agreeable, I guess, you can say,
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  to
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  carving out certain facilities.
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  Not all of them not all of them
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  wanna do that, but but many of them
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  are now allowing us to carve out the
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  the facilities that we want,
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  that are higher better performing facilities and and
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  kinda leaving the other ones out.
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  So it it is a it is a
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  big deal, but,
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  you know, we are we are very blessed
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  that we don't have to deal with some
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  of the adequacy things by law as it
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  were and and have CMS breathing down our
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  necks. But that is a that, you know,
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  I I would like to hear even from
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  some of the other folks that are gonna
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  be there that have to deal with that
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  how they're balancing that as well. But for
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  us, it's just,
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  making sure that we have high quality physicians
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  and
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  and high quality
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  facilities in our network.
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  Absolutely. Yeah. Very important focus to have. And
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  and, Harlan, the last thing I have for
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  you, you know, just curious
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  how your org,
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  plans to use data collects to make the
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  experience feel more personal
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  and proactive for members? You know, we always
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  talk about how important data is with with
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  health plans.
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  Yeah. Data is is paramount. Right? Data is
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  everything. If we don't if we don't know
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  what's happening, we don't know what services people
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  are using or not using,
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  then we're in trouble because
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  what may look really good to us
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  just may not be working out. So we
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  we have to know. That was, you know,
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  one of the funny things is, with our
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  direct primary care model, we had no data.
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  We we had great things of seeing well,
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  people are people are taking less medications.
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  And,
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  but that what does that mean? What what
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  why why is that? Well, we didn't know.
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  We didn't know.
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  It
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  we did because we know that the direct
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  primary care model goes that direction, but we
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  didn't know any of the real data. We
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  couldn't put our hands on that. So the
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  data is paramount to see what's going on
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  in there. I think one of the things
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  that surprised us is one of our bigger
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  groups
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  that we have with a multi
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  facility direct primary care. I think they have
• 14:05
  44
• 14:06
  locations.
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  We were really surprised
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  not just at
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  the engagement they had because we had we
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  had great,
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  over 60%
• 14:17
  of folks were in engaging. So we had
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  great participation,
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  and we were really happy with that. That
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  number showed us, hey. This is working.
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  But the number that I think startled us
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  the most was that over 80% of those
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  visits were televisits
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  or virtual visits.
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  And
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  it made us kinda rethink the way
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  that we are approaching that telemedicine
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  and really start talking a little bit more
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  about it and the things that you could
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  do.
• 14:48
  People got it even before we did, which
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  I thought was kind of interesting because
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  if you really think about it, Scott, who
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  wants to go to the doctor if they
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  can take care of it over the phone
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  or they can take care of it virtually?
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  And it made perfect sense, and the data
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  backed it up.
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  If we don't have and we don't use
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  that data and then adjust our health plans,
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  adjust our engagement,
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  then we're gonna get left behind. And once
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  again, we're not gonna know what's really happening
• 15:13
  with our plans. We've got to take that
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  data.
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  And I think the other thing that we
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  have to do with it is share it.
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  We have to share it with the employers,
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  which we do. We have to make sure
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  that everyone is involved in this. Whether it's
• 15:26
  the employers, the TPA,
• 15:28
  the PBM, whoever we're working with, we need
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  to make sure that we're sharing all this
• 15:32
  data with each other. That's the only way
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  that we can all work together and provide
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  the absolute best services,
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  to our our clients.
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  Yeah. That that's just a great example of,
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  you know, using the data to kinda get
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  a sense of what members
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  want and need and then kind of having
• 15:46
  to make a necessary pivot. And, Harlan, thank
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  you so much for for joining us on
• 15:50
  the podcast and for all your great in-depth,
• 15:53
  expertise. Really appreciate it. I'm looking forward to
• 15:55
  having more of it at the conference next
• 15:56
  week. Yes, sir. Look forward to seeing you,
• 15:58
  Scott. You guys, always put on a great
• 16:01
  show, man. Thanks so much, Arlen. Appreciate it.