Latest / Becker’s Healthcare Podcast / Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA

Transcript

Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA · Becker’s Healthcare Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
• 0:10
  payer and health plan executives
• 0:12
  and more than 100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George w
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone. Welcome to Becker's Healthcare Podcast. I'm
• 0:36
  Scott King. Thrilled today to be joined by
• 0:38
  a very special guest, Sareya Sacaccio,
• 0:41
  chief medical officer, Essence Healthcare. Sariya, how are
• 0:44
  you doing today?
• 0:46
  I am doing well, Scott. Thanks so much
• 0:48
  for the opportunity to join you today.
• 0:51
  It's gonna be great. We have a lot
• 0:52
  of big topics and and talking points to
• 0:54
  to get to here, but we're really looking
• 0:56
  forward to having you speak at our spring
• 0:58
  payer issues roundtable in April as well. Can't
• 1:01
  wait. So before we get to the questions
• 1:03
  and topics, Sariya, I wanted to ask just
• 1:05
  kind of about your background. If you could
• 1:06
  please share, you know, a little bit about
• 1:08
  your your journey into, health care with us.
• 1:11
  You bet, Scott. I'm a family physician by
• 1:13
  training, and I have worked across the gamut
• 1:16
  of clinical care, whether it was in solo
• 1:19
  practice, teaching residency programs, and academic institutions.
• 1:23
  I've served as a chief medical officer in
• 1:25
  several different health systems
• 1:27
  and have been on the health plan side
• 1:29
  of the industry for the last several years.
• 1:31
  I so enjoy the work that we do,
• 1:33
  serving our members and ensuring everybody gets the
• 1:36
  right care, right place, right time, and has
• 1:39
  the right experience
• 1:40
  on their journey for health.
• 1:42
  Thank you for sharing that. And you the
• 1:44
  the first topic I wanted to get to
• 1:46
  with your perspective
• 1:48
  is how are your relationships
• 1:49
  with providers changing? You know, obviously,
• 1:53
  both sides are facing regulatory pressures, but specifically
• 1:55
  when you you look at cost pressure and
• 1:58
  and work for for shortages.
• 2:00
  Well, first of all, I am so
• 2:02
  glad that we're starting with relationships.
• 2:05
  This is the most critical part of the
• 2:07
  work that we do. And at the end
• 2:09
  of the day, we're in this together.
• 2:11
  We are here to provide exceptional care to
• 2:14
  patients and those who deserve
• 2:16
  that access to care.
• 2:18
  And so while perhaps it hasn't changed, there
• 2:21
  certainly is a palpable shift and that shift
• 2:24
  would be a deepening
• 2:26
  of collaboration.
• 2:27
  I can't overemphasize
• 2:29
  just how important that is and there are
• 2:30
  a number of ways that we do that
• 2:32
  in our business and with our partners.
• 2:35
  First of all, it starts with real time
• 2:37
  data.
• 2:38
  Everybody needs this accurate data. This is what
• 2:40
  I hear asked for the most and the
• 2:42
  appreciation
• 2:44
  that we have been able to deliver
• 2:46
  down to the member level. The data that
• 2:48
  impacts the care that our health systems and
• 2:51
  providers deliver
• 2:52
  in a way that is actionable
• 2:54
  so that we can impact that health.
• 2:56
  And transparency of strategy. We roll up our
• 2:59
  sleeves together
• 3:00
  as partners to address the cost of care
• 3:03
  of what we do, whether it's determining
• 3:05
  the appropriate prior authorizations,
• 3:08
  our pharmacy spend and the challenges there, as
• 3:10
  we know, we've all struggled with that recently,
• 3:12
  or expanding products within our health
• 3:15
  plan. That is so important to us. And
• 3:18
  finally, I'll say
• 3:19
  this is the most important part of this
• 3:22
  relationship.
• 3:23
  It's listening first,
• 3:25
  being curious about the current workflows and expectations
• 3:28
  that exist
• 3:29
  with our health system providers
• 3:31
  so that we can align with the work
• 3:33
  already being done. Because this is what we
• 3:35
  know. Whether a health system has 17 different
• 3:38
  contracts or 27 contracts,
• 3:41
  we have got to be a part of
• 3:42
  the solution
• 3:43
  in developing efficiency
• 3:45
  and reliability
• 3:47
  so that care is delivered consistently regardless of
• 3:50
  who the health payer is.
• 3:52
  Yeah. You know, that's really interesting. I I've
• 3:53
  heard from a lot of people on the
• 3:54
  payer side that that relationship
• 3:57
  has changed. Like you said, it's got more
• 3:59
  collaborative.
• 4:01
  I've heard some some people say it's because,
• 4:03
  you know, they think that just both sides
• 4:04
  are up against so many regulatory pressures that
• 4:07
  both are just trying to figure out a
• 4:09
  way to get things done. But your perspective
• 4:11
  is interesting because you think it's coming from
• 4:13
  a a data perspective, a need for both
• 4:16
  sides to kinda share and utilize data. Is
• 4:17
  that right? Well, sure. It's a huge part
• 4:20
  of the equation here because without information,
• 4:22
  you can't drive a strategy that delivers results.
• 4:25
  That is critical in the work that we
• 4:27
  do. And the more information available,
• 4:30
  it's part of our responsibility to make sure
• 4:32
  it's delivered in a way that we can
• 4:33
  do something with it.
• 4:35
  Sariya, where do you see the biggest gap
• 4:37
  today between payer strategy and operational execution?
• 4:41
  Goodness. There are so many gaps, and I'll
• 4:44
  say it's so many solutions
• 4:45
  that have developed. I will say what is
• 4:48
  most heated
• 4:50
  at the moment and the two challenges that
• 4:53
  I'm seeing here is
• 4:55
  member access
• 4:56
  to resources that they need when they need
• 4:58
  it. What I mean by that is more
• 5:01
  ambulatory access. So Scott, it's rather interesting to
• 5:04
  me, not surprising as we're all trying to
• 5:06
  shore up margins these days after COVID,
• 5:09
  but we saw
• 5:11
  a significant
• 5:12
  departure in ambulatory
• 5:14
  services
• 5:15
  and access to resources to health care.
• 5:17
  So and I'll give my mother as an
• 5:19
  example. She's Medicare Advantage age and has her
• 5:22
  own plan she works with, and I say,
• 5:24
  mom, the first thing you gotta do is
• 5:27
  find out where you can receive these services
• 5:29
  at an ambulatory
• 5:30
  site. And here's why,
• 5:33
  it hits the pocketbook of every member and
• 5:35
  frankly at every health plan when services that
• 5:38
  can be delivered in an ambulatory space
• 5:41
  is turned around, the lights turned out, literally
• 5:44
  lights turned out, and shifted back to a
• 5:46
  hospital with a huge parking lot, an overwhelming
• 5:50
  pathway just to get to the site of
• 5:52
  service you need with a significant
• 5:55
  price tag.
• 5:56
  I do recognize having been on the health
• 5:58
  system side
• 5:59
  historically
• 6:00
  that that's where margins are often shored up,
• 6:03
  is in an inpatient facility
• 6:05
  structure.
• 6:07
  And we feel the pressure from an administration.
• 6:09
  We know there's a change. We've got to
• 6:11
  get to a point where regardless of the
• 6:14
  site of care, that the service delivered that's
• 6:17
  the same, cost the same. So that's one
• 6:20
  piece. The other,
• 6:22
  I'll talk a little bit specifically about pharmacy
• 6:24
  gap, the cost of medications
• 6:27
  and the member responsibility
• 6:29
  and the health plan responsibility.
• 6:31
  We have these pressures for the right reasons.
• 6:34
  I say that because
• 6:36
  we know this. Medications are too expensive today
• 6:40
  and they're too expensive for everyone. So those
• 6:42
  are two gaps that we have got to
• 6:44
  find solutions for and find them quickly.
• 6:47
  In terms of finding solutions, what's one investment
• 6:50
  or initiative you believe
• 6:52
  will will most reshape how health plans operate
• 6:55
  over the next two to three years?
• 6:58
  Well, I'm gonna shift gears and think more
• 7:00
  global
• 7:01
  when it comes to an overall investment. And
• 7:04
  as a family physician, I'm gonna think population
• 7:07
  health first. And, Scott, this is what we
• 7:09
  know. More people die of heart disease
• 7:13
  than any other condition,
• 7:15
  both men and women. We know this. And
• 7:17
  in the spirit
• 7:18
  of February is heart month and we are
• 7:21
  in February,
• 7:22
  cardiometabolic
• 7:23
  investment is critical
• 7:25
  to the future in the quality of life
• 7:28
  for all Americans.
• 7:30
  So it's not just the medications. That's a
• 7:32
  piece of it. We know a driver of
• 7:34
  cardiometabolic
• 7:36
  impact is obesity. It often starts there. In
• 7:39
  fact, it's starting in the pediatric
• 7:42
  space and where it used to be in
• 7:44
  adulthood that we had to be concerned. So
• 7:46
  across that age span, we have got to
• 7:48
  be thinking about the investment of lifestyle benefits.
• 7:52
  Do people have safe places to walk? Is
• 7:54
  it part of the workplace,
• 7:56
  the employer space?
• 7:58
  How are we involving behavioral health? We know
• 8:01
  when people are less active, when they have
• 8:03
  chronic conditions such as
• 8:05
  diabetes,
• 8:06
  heart disease,
• 8:07
  heart failure,
• 8:08
  they are more likely
• 8:10
  to suffer from depression, anxiety,
• 8:13
  and other mental health challenges that make it
• 8:15
  even harder for their over health to overall
• 8:18
  health to improve.
• 8:19
  And then finally, those medication barriers.
• 8:21
  First one that usually comes to mind for
• 8:23
  folks are those GLP one agonists,
• 8:26
  and that is because they help reduce,
• 8:29
  the weight,
• 8:30
  but they also increase the cost of care.
• 8:33
  Addressing the barriers in all of these spaces,
• 8:36
  investing in a comprehensive approach is something that
• 8:39
  we have to do in partnership
• 8:42
  across the entire industry.
• 8:44
  If you could change
• 8:46
  one regulatory
• 8:48
  or industry practice tomorrow to improve a 4,000,000,000
• 8:50
  access,
• 8:51
  what would it be and why?
• 8:53
  Well, I hinted at this just a moment
• 8:55
  ago. In fact, it was probably more than
• 8:57
  a hint. It was an obvious nudge. Site
• 9:00
  neutrality
• 9:01
  is what's frankly best for our patients
• 9:04
  and for overall Americans.
• 9:07
  Receiving
• 9:08
  the same care at the same price regardless
• 9:11
  of the address
• 9:12
  really matters to people and really matters to
• 9:14
  the increasing cost of care that we see
• 9:17
  today. The other is pharmacy,
• 9:19
  flattening the cost. How do we identify those
• 9:22
  biosimilars
• 9:23
  for these fantastic
• 9:25
  new life saving and life changing drugs
• 9:28
  for these diseases where people have struggled for
• 9:30
  so many years? We've got to be quicker
• 9:33
  to
• 9:34
  provide those biosimilars
• 9:35
  for generics to be available and for specialty
• 9:38
  cost drugs out of the gate. We have
• 9:40
  some therapies now that cost a million dollars
• 9:43
  a year.
• 9:45
  Now, as we know, fewer and fewer people
• 9:47
  will have access to health care
• 9:49
  and more people will be uninsured in 2026
• 9:52
  and onward.
• 9:53
  There will be more people who cannot afford
• 9:55
  that million dollar therapy. Again, that can be
• 9:58
  life saving, life changing. So those are the
• 10:01
  two things, site neutrality and pharmacy flattening of
• 10:03
  costs, and we would see a healthier America.
• 10:07
  A 100%. And there's certainly a lot more
• 10:09
  work to do with with pharmacy costs as
• 10:11
  you're alluding alluding to. Another thing is gonna
• 10:13
  be a big topic at our Spring Payer
• 10:14
  Issues Roundtable.
• 10:16
  The last thing I wanted to ask you,
• 10:18
  what issue
• 10:19
  do you think is putting the most pressure
• 10:21
  on health plan margins right now,
• 10:23
  and how are you responding differently, for 2026?
• 10:27
  Well, for us at Essence and for me
• 10:30
  as a clinician,
• 10:31
  it always ends with
• 10:33
  quality. Quality of care, so I think of
• 10:36
  star performance.
• 10:37
  There's a tremendous amount of pressure to maintain
• 10:40
  where we are. We're a four and a
• 10:42
  half star HMO plan. In fact, in all
• 10:44
  of our markets, we're the highest rated plan,
• 10:46
  very proud of that because that is the
• 10:48
  care that our members are receiving and can
• 10:51
  rely upon that they will receive by our
• 10:53
  providers. It's because that strong relationship and collaboration
• 10:56
  we have with our partners. Now that being
• 10:59
  said, the bar will continue to rise
• 11:02
  in a good way. I remind folks of
• 11:05
  this all the time.
• 11:06
  We should not be practicing medicine the way
• 11:08
  we did five years, ten years ago. We
• 11:10
  should get better year after year after year.
• 11:13
  What will continue to challenge us
• 11:16
  are the social conditions that people are experiencing,
• 11:19
  less money in their pocket,
• 11:21
  less,
• 11:22
  food on the table that's healthy for them
• 11:25
  in a way that people can afford these
• 11:27
  medications
• 11:28
  and their
• 11:29
  nourishment.
• 11:30
  That's really important. And the investment in services
• 11:33
  that close-up all of those gaps in care.
• 11:36
  So so many folks forget that
• 11:39
  STAR includes
• 11:40
  the gaps in care, the operations of the
• 11:43
  business, the improvement year over year, and that
• 11:46
  finally the experience.
• 11:48
  I mentioned my mother a moment ago, and
• 11:50
  I always consider what would Mimi do, how
• 11:53
  would Mimi feel if she was in a
• 11:55
  situation
• 11:56
  needed help to health care? And did she
• 11:58
  have someone to hold her hand
• 12:00
  through the process? And that's what we're here
• 12:03
  to do. That's what we should all be
• 12:04
  doing is holding the hands of our patients
• 12:07
  and ensuring they have an exceptional experience,
• 12:10
  know that they're taken care of and can
• 12:12
  receive the highest level of care, again, regardless
• 12:14
  of location, because at the end of the
• 12:17
  day, this is what we do and we
• 12:18
  do it together
• 12:20
  in health care.
• 12:21
  Saree, thank you so much for joining us
• 12:23
  on the podcast and for a great conversation.
• 12:25
  And, again, we're really looking forward to you
• 12:27
  speaking with us in April. Thank you, Scott.
• 12:29
  This is important work, and I am grateful
• 12:31
  to do it every day.