Latest / Becker’s Payer Issues Podcast / Mike Jasperson, Senior Vice President of Provider Network and Health Plan Operations at Priority Health

Transcript

Mike Jasperson, Senior Vice President of Provider Network and Health Plan Operations at Priority Health · Becker’s Payer Issues Podcast

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  Hello, everyone. This is Jacob Emerson with the
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  Becker's Pay Your Issues podcast.
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  Thrilled today to be joined by Mike Jasperson,
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  who is the senior vice president of provider
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  network and health plan operations
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  at Priority Health. Mike, thanks so much for
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  taking the time to be with me on
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  the podcast today.
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  Glad to join you. Thanks for having me.
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  So, Mike, before we dive into everything we
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  wanna talk with you about, can you tell
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  us a little bit more about yourself, your
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  background in the world of healthcare, and what
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  it is that you're doing today at Priority
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  Health. Sure.
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  So I've been in, health care for the
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  past,
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  25 years. I've had,
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  some stints on the delivery side, so working
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  for some large,
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  health systems.
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  I've also worked in the post acute,
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  space in hospice and palliative care, and I've
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  spent,
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  a great I I suppose the majority of
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  my career in health insurance,
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  working for a large, Blues plan as well
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  as my current role at Priority Health. And
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  so I'm the senior vice president of our
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  provider network and health plan,
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  operations for Priority Health. We're a large,
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  provider sponsored or provider owned health plan
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  operating,
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  in the state of Michigan and, actually, most
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  recently outside the state of Michigan in expanding
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  into Indiana
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  and Ohio as well.
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  My responsibilities
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  include, provider network development management,
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  value based health care.
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  I'm responsible for member and provider services,
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  claims, and other key operational areas of the
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  organization.
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  And I'm responsible for advancing, you know, automation,
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  AI,
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  quality and training within the operations and and
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  also planning for future business operational,
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  architectural and application needs.
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  Fantastic.
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  So, Mike, let's talk about Priority Health as
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  you know, being a pioneer within value based
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  care since the late nineties.
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  As I understand that the company has saved
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  over
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  $100,000,000 through alternative payment methods between
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  2019 and 2022
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  alone.
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  So what do you attribute these successes to?
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  And, ultimately, how have the approaches or the
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  company's strategies evolved over time to stay at
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  the forefront of what is a rapidly evolving
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  value based ecosystem?
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  Oh, great great question. And it's obviously something
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  that we're really, really proud of. We've been
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  doing value based care, as you mentioned, for
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  a long, long time.
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  So our success in value based care really
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  stems from
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  our early adoption
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  and continuous evolution of alternative payment models or
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  so called APMs.
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  So today, over 50% of our members are
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  cared for by providers who are
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  what we would call an advanced value based,
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  arrangements with us.
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  So over the years, we've developed a robust
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  framework that really supports providers in delivering high
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  quality
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  cost effective care.
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  And key to that,
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  to success in that is collaborative partnerships. So
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  we work really, really closely
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  with our provider partners to align on goals,
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  to share resources,
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  and providing advanced technical and analytical support, and
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  really having teams that engaged,
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  to ensure the success
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  and collaboration
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  together.
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  We have
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  strategic partnerships with
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  independent physician organizations.
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  We have them with integrated, you know, large
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  integrated delivery systems as well, such as our
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  own,
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  parent organization, Corwell Health, which really allows us
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  to implement comprehensive care models that focus
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  on the whole patient.
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  For example,
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  in 2020,
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  Priority Health and CoreWell Health
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  began a full risk contract together,
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  which resulted in positive results for both members
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  and providers,
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  including,
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  over $45,000,000
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  saved due to optimized
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  patient care.
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  So
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  these savings really come from members health, being
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  managed through coordinated primary care
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  and getting their health concerns addressed early
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  as well as when chronic conditions are managed
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  and visits to high cost facilities,
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  ER visits, inpatient stays are avoided.
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  So these savings mean
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  premiums and costs for our members and employers
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  are be able are able to be kept
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  down because of that collaborative
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  partnership.
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  It's really important that we also drive,
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  data driven decision making. So
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  we use an, APM readiness assessment to help
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  us partner with providers who are ready
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  to really tackle value based care. And our
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  analysis enable providers to identify opportunities, you know,
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  really clear opportunities for improvement
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  and to track performance metrics over time.
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  We also offer
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  significant flexibility in our models,
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  offering multiple levels of risk to kinda meet
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  the provider where they're at, from a value
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  based, perspective,
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  from no risk or limited risk to, you
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  know, the spectrum across the spectrum to full
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  risk, allowing providers to engage at a comfortable
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  pace while progressively taking on more and more
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  responsibility
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  over time as their capabilities evolve.
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  Wow. So clearly
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  a lot of savings
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  generated by working more closely with your your
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  parent health system, Mike. And I and to
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  follow-up with you on that, how would you
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  say that Priority Health is is further shaping
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  its programs,
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  its products
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  to better address evolving patient needs and community
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  health across,
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  your market and and the landscape that you're
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  seeing.
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  Yep.
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  So today's health care landscape
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  requires us to be more adaptive and responsive
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  really than ever, before.
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  So we're continuously
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  refining,
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  programs to meet the evolving needs of patients
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  and communities through,
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  many initiatives.
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  Some,
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  clear examples
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  include, you know, patient centric approaches. So our
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  APM support a holistic treatment model that considers
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  not only quality and cost of care, but
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  social determinants of health as well, which we
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  know have a profound impact
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  on outcomes and health care costs as well.
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  We're ensuring
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  enhanced patient care coordination.
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  So we focus on improving care coordination across
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  primary care, specialty care,
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  post acute care,
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  which really enhances patient outcomes and reduces costs
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  overall.
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  Advanced primary care clinics is one example of
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  something that we've taken on in partnership with
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  Corwell Health and with other partners as well.
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  So these are specifically designed clinics for Medicare
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  members
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  with chronic diseases.
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  These clinics provide longer appointment times,
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  comprehensive care planning
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  to address the holistic needs of of Medicare
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  beneficiaries with significant,
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  health
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  needs. Community engagement is important as well. So
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  programs like,
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  a community medicine clinic for Medicaid beneficiaries
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  address specific health care needs and barriers as
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  well
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  and, offer tailored support to our multidisciplinary
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  team,
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  managing that patient in a holistic way. And
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  then, of course, innovative tools are important
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  to drive, those outcomes. So by way of
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  example,
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  we have a partnership with an with, Epic
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  and the Epic pair platform,
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  and we use also other data sharing tools
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  as well to help more easily exchange data
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  with providers while improving care coordination
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  and also reducing administrative burdens, on on busy
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  practices as well.
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  Interesting. Interesting. And I I wanna ask you
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  a little bit about your provider partnerships,
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  outside
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  the CoreWell umbrella.
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  As priority continues to expand its value based
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  initiatives,
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  what are some of the key challenges, Mike,
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  that you foresee both operationally,
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  and within your provider relationships
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  to meet the growing demand
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  for, what patients are demanding in terms of
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  more personalized and more efficient
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  health care? Yep. So some of the challenges
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  are are operational, you know, as we scale
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  our programs and seek to maintain quality and
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  efficiency.
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  So So it really does require a robust
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  infrastructure and continuous innovation and care,
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  delivery models. We do have to meet these
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  organizations where they're at as well in terms
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  of their own evolution. So not
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  every partnership is
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  built the same way, so we have to
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  offer that,
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  flexibility.
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  Another challenge is is provider interest. So
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  this is also an opportunity to really educate
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  providers about,
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  APMs and ensure that they have access to
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  tools and resources to help them be,
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  successful.
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  Technology
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  integration is another challenge, you know, leveraging
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  advanced data analytics and AI to predict patient
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  needs and to streamline care coordination.
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  I had mentioned already community partnerships. So I
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  continue to expand collaborations with
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  local organizations
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  to address social determinants of health and the
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  disparate needs
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  of these patients and and our members to
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  treat them holistically.
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  And then, of course, policy advocacy. So
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  working with policymakers
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  to support value based care frameworks and to
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  incentivize
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  incentivize providers to continue to move forward and
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  to evolve.
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  So, Mike, before we go, what else are
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  we missing? You've got the ears of a
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  lot of health plan leaders from all over
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  the country. What are some last bits of
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  advice you wanna share with them?
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  So,
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  value based care really is a journey that
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  requires a commitment,
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  innovation and
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  collaboration. So
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  at Priority Health, we're dedicated to transforming healthcare
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  delivery by prioritizing value
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  and focusing on the health and the well-being
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  of our members.
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  So our successes to date give us confidence
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  that we can continue
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  to lead,
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  in this space with progressive partners,
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  on the on the care delivery on the
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  provider side and continue to improve outcomes and
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  reduce costs for the communities we serve. So
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  it really is about a partnership. It's about
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  engagement.
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  It's about finding,
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  common ground and being able to move, the
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  organization forward in the interest of the communities
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  we,
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  serve together.
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  Wonderful. Well, Mike, thank you so much for
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  taking the time to sit down with me
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  and for sharing your insights with our audience.
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  We really appreciate it. My pleasure. Thank you,
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  Jacob. If you'd like to listen to more
• 10:30
  podcasts from Becker's Healthcare, you can visit beckers
• 10:32
  hospital review
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  dotcom.