Latest / Becker’s Payer Issues Podcast / Jarrod McNaughton, CEO of Inland Empire Health Plan

Transcript

Jarrod McNaughton, CEO of Inland Empire Health Plan · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  and people forward.
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  This is Haley Recker with the Becker's Payer
• 0:31
  Podcast, and we are recording live at the
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  Becker's third annual spring payer issues roundtable.
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  I am thrilled today to be joined by
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  Jared McNaughton, who is the CEO of Inland
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  Empire Health Plan.
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  Thank you so much for having this discussion
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  with me today, Jared. Can you go ahead
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  and introduce yourself and share a little bit
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  about your background? Well, thanks, Hailey. It's great
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  to be with you.
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  I am with Inland Empire Health Plan. I've
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  been with the organization for about seven years.
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  And,
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  prior to that,
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  was on the provider side. So I was
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  in hospitals and health systems my whole entire
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  career. So it's been a lot of fun
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  to see the difference between the provider and
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  the payer side and how those two worlds
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  can do more together.
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  At our organization, we serve about 1,500,000
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  members in Southern California
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  and have about 9,000 contracted providers with about
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  eight and a half billion dollars in revenue.
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  Well, thank you so much for that brief
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  introduction.
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  Now to get started, there's been a lot
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  of talk about the imperative to reduce costs,
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  improve quality, and advance health equity, none of
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  which are small tasks. So how do you
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  approach aligning these priorities in your organization's strategic
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  vision?
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  Yeah. You know, part of the work that
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  we do, Haley, we always feel like
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  the number one thing for us, because we're
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  a public entity, we have no shareholder value,
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  it's really all about the members and the
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  providers,
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  is to make sure that we're approaching every
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  decision with our mission at heart. Our mission
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  is to heal and inspire the human spirit,
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  and we take that incredibly,
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  incredibly
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  impactful,
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  and we really take it serious. And so
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  for our organization,
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  every single decision that we come up with
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  is always guided by that principle.
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  How can we bring optimal care at the
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  same time as Vibrant Health,
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  to our region? And it's not really even
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  just about the Medi Cal lives that we
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  serve. It's about
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  raising, really, the tide for all boats.
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  Thankfully, we have three different lines of business
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  now, Medi Cal or Medicaid as it's known
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  across the country. We have the dual eligible
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  population
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  as well as now Covered California. It's our
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  first commercial product. And in all three of
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  those lines of business, we're always looking and
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  thinking about how can we make sure to
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  do the right thing for the members that
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  are in need. And the best way we
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  found to do that is by really getting
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  boots on the ground. Whether I'm out in
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  neighborhoods,
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  in the backyards of our members, learning directly
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  from them,
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  having monthly provider dinners where we're hearing directly
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  from the provider community on what we could
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  be doing better or different to serve them
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  and their and their patients,
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  whatever that is, the connection
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  and the relationship to the membership and to
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  the providers
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  is absolutely key for us. And one of
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  the best ways, Haley, that we found to
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  do that is through something we call our
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  global pay for performance program.
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  We we provide almost $300,000,000
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  a year to providers
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  who help us meet quality outcomes that the
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  states and the federal government,
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  really are pushing through HEDIS and MCAS measures.
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  And I am so thrilled that because of
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  our providers work in that space,
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  we've actually achieved our highest quality,
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  in our history, in our almost thirty year
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  history just this last year,
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  thanks to to their work through our pay
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  for performance program.
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  And the key with that is to share
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  the best practices that are happening,
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  to make sure that it's not just happening
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  in a silo but silo, but those those
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  practices are being duplicated across the entire network.
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  And that's what's so cool about that is
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  to be able to share that with other
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  providers so that you're helping them on their
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  journey as well.
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  Yeah. I'd like to keep that conversation on
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  health equity going, as it's become a critical
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  focus for many health plans. Can you share
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  an overview of a key initiative here that
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  you're involved in or particularly excited about, and
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  what are you hoping to achieve?
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  Yeah. You know, one of the things, Haley,
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  that I'm super stoked about
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  is that through our Pay for Performance program,
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  we kinda thought, what can we do to
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  leverage
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  some of the things that are happening in
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  the hospital space,
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  especially with the joint commission? Folks know the
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  joint commission is the a creditor for hospitals
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  all across the country, and they have this
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  really cool,
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  program,
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  this this certification
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  program that they actually provide certification to hospitals
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  that meet a certain threshold of performance.
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  And it's tough. I mean, it's really tough
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  to get this certification.
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  And so we thought, what would it be
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  like if a health plan
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  actually put inside of our pay for performance
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  a incentive
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  to hospitals
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  who are actually getting the accreditation through the
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  joint commission.
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  And so this is really cool. I just
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  have to share this with you.
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  Only there's there's only two advanced certifications
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  in heart failure in the state of California,
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  and and
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  we actually have one of those two
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  in our program. So out of the entire
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  state of California, there's only two. One of
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  them is in the Inland Empire, and the
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  only hospital in California with pneumonia certification
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  by the joint commission is actually in the
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  Inland Empire.
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  And so for us, when you look at
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  that, it it really is making it one
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  out of only seven in the entire United
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  States is in the Inland Empire.
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  So that, for me means that hospitals are
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  paying attention because they're getting a little boost
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  in their dollars. It's good for everybody who
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  comes in through the front door of the
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  emergency room of a hospital if they have
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  that certification,
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  and it's a great example of a partnership
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  where it's really good for us. It's great
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  for the hospital, great for the community. It's
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  a win win for everybody when they have
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  those certifications. And so those kinds of partnerships,
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  I would just challenge my payer colleagues
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  to get in the weeds and and get
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  those kinds of partnerships happening in their communities
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  as well. Yeah. That's absolutely so important. And
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  thank you so much for painting a picture
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  for us there. I'd like to pivot the
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  conversation a little bit to member satisfaction.
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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? Yeah. You know, this is
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  a tough one because as folks know, different
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  surveys that measure member satisfaction, whether it's caps
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  on the consumer awareness side, all the way
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  through to member satisfaction that happens within our
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  providers or hospitals or even at the health
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  plan, it can be tough because you get
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  you have one interaction
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  that a member has with maybe a a
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  physician or a hospital or even a team
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  member of ours that doesn't go great, and
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  that's what they think about. So they could
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  have nine great interactions,
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  but they have one bad one, and that's
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  all you think about. And so when they
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  take the survey, that's what they're thinking about.
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  So it's really imperative for us to make
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  sure that everybody is on their game when
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  they're connected in with the members or and
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  or the providers.
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  So one thing that we've done is to
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  really leverage something called the community health worker
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  program,
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  also known as CHW.
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  In California, our state has really been on
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  the forefront of being able to make these
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  community health workers available to the community. And
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  the part that I love about this program
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  is it's not somebody that's necessarily just on
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  the phone, which is important at times to
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  to have that interaction, but they're also on
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  the ground. They're boots on the ground actually
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  connected directly with
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  the member
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  and their whole family to say, hey. How
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  can I help navigate you through this very
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  complex health system? And the cool part about
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  that is the lasting impression that takes place
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  with the member and the family is now
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  with that community health worker because they're the
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  real face of the health plan. And so
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  I love that program, Haley, because I think
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  not only is it going to improve our
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  overall
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  satisfaction that our members experience, but more importantly,
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  they're actually helping navigate
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  in a system that is arguably one of
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  the most complex and unwieldy systems
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  ever created in our country, health care. And
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  so that's really a cool thing, really a
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  value add for the membership.
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  Well, before we wrap up here, I'd like
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  to talk about the future of the payer
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  space.
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  So looking ahead, what do you see as
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  the biggest opportunity for payers to lead the
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  charge in transforming care delivery and driving better
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  outcomes for all stakeholders, and how could leaders
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  take a step in this direction now?
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  Yeah. Well, I'm a big advocate,
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  for culture. I think the culture of the
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  organization
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  is absolutely paramount.
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  Stay true to your mission. Make sure that
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  it's on the forefront of every decision that's
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  being made.
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  I really, really can't stress enough that that
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  whole adage of of culture eats strategy for
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  lunch is so true. If you've got a
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  wacky culture or a culture that's just not
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  in line with your mission, it's very difficult
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  to move your strategic objectives forward while keeping
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  your team members at the forefront of the
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  of the decisions that they're trying to make.
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  So for me, culture is a huge one.
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  Of course, staying true to your mission is
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  huge. And then I I would really challenge
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  folks to just think bold and audacious during
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  this time. There's so much change
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  happening in the federal landscape with health care
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  and the state, and I actually think it's
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  a a great time,
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  to be innovative,
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  to think differently than the way we've thought
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  before,
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  to launch those new lines of business that
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  maybe you've been thinking about because there will
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  be space open for people that are thinking
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  boldly and innovatively
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  as other people are starting to constrain back.
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  And I would encourage my colleagues to just
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  make sure you're staying in the game, staying
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  relevant, and always, always keeping your mission at
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  the forefront of every decision.
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  Well, absolutely. That's so important.
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  Thank you so much for joining me today
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  on the podcast. Again, this is Haley Recker
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  with the Becker's Payer Podcast
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  recorded live at the Becker's third annual spring
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  payer issues roundtable.
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  Jared, thank you so much. Thanks so much,
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  Haley. Have a great day.