Latest / Becker’s Payer Issues Podcast / Dr. Brian Smolich, Vice President, Health Alliance Quality and Managed Care Operations, Carle Health

Transcript

Dr. Brian Smolich, Vice President, Health Alliance Quality and Managed Care Operations, Carle Health · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
• 0:02
  innovation to create world class pharmacy, care, and
• 0:05
  benefit solutions.
• 0:07
  Barriers to care can lead to gaps in
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  care, which can drive up the total cost
• 0:10
  of care. Our capabilities work seamlessly together to
• 0:13
  create innovative pharmacy care and benefit solutions for
• 0:17
  today and tomorrow.
• 0:18
  Our connected health services make the treatment, prediction,
• 0:21
  and prevention of health care's most complex conditions
• 0:24
  easier and more accessible as we drive organizations
• 0:27
  and people forward.
• 0:29
  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 care issues roundtable.
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  Today, I am thrilled to be joined by
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  Brian Smolich,
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  VP of quality and managed care operations at
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  Health Alliance Medical Plans. Brian, thank you so
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  much for being with me today. Yeah. Thanks.
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  Good morning. Good morning to you too. So
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  before we begin, I'd like to have you
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  just introduce yourself and share a little bit
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  more about your background and your organization.
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  Sure.
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  So my name is Brian Smolich.
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  I serve as vice president of quality and
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  managed care operations for Healthline's medical plans
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  and First Carolina Care. We're part of the
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  Carle Health System, and we serve patients
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  that are primarily located in, Central And Southern
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  Illinois as well as North Carolina.
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  I have responsibilities
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  of,
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  pharmacy,
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  medical management,
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  quality,
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  and our member relations,
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  appeals team
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  at our health.
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  Well, thank you so much for sharing a
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  little bit about your background. Now to begin
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  our conversation today, I'd like to kick it
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  off by talking about balancing affordability and quality.
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  So how is your organization
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  innovating to manage the cost of care while
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  maintaining or improving member outcomes?
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  Yeah. So at Health Alliance Medical Plans and
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  First Carolina Care, quality is at the center
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  of everything that we do.
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  You know, you you really have to put
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  quality
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  in front of cost and affordability.
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  But, you know, we we do realize that
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  if if you're not financially sound and and
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  you're not able to balance
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  premiums and and revenue with rising cost, then
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  it's gonna be difficult to, you know, offer
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  the plans and and benefits that you want
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  to members.
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  But for us, I mean, our people are
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  exceptional. They
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  have
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  a wonderful,
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  engagement with our members, our customer solutions team,
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  our case management team, and our clinical platforms
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  really take the view of working collaboratively with
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  the provider to ensure patients have the best
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  care.
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  So far as innovation,
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  you know, we've put a lot of focus
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  in the biosimilar space at least on the
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  pharmacy benefit side. That has really helped us
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  reduce costs on medications
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  without compromising
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  patients'
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  access to care or helping us to afford
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  additional therapies that are newer or novel.
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  I'd like to explore that a little bit
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  further on the basis of member satisfaction as
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  a whole. So what experience or engagement strategies
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  have proven effective for your organization, and how
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  are you measuring that success?
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  Yeah. So our organization,
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  tracks not only, on our our vertically integrated
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  health system, the provider side MPS four, but
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  we're also tracking health plan MPS four.
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  And I think we do an exceptional job
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  of engaging members through our customer solutions team.
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  They also
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  have the resources to tap into our clinical
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  experts,
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  So there's a lot more
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  collaboration
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  on individual patient cases,
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  connecting the dots and getting patients access to
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  our medical management team, a pharmacist,
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  our population health or care coordination team. I
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  think really making it easier for patients to
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  navigate has been helpful.
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  We've also utilized digital solutions
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  and vendors,
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  some of which, you know,
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  have gamified,
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  health care and and
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  healthy behaviors like medication adherence,
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  and we're seeing a lot of positive outcomes
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  from member engagement through those digital platforms.
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  The other benefit they provide for us is
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  their high touch. You know, members will be
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  in apps daily
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  completing tech,
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  activities and and earning rewards. And we can
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  also then engage them with prompts and gaps
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  in care and things that they need to
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  do where that becomes much more difficult when
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  you're trying to engage a member just telephonically
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  and,
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  the hesitancy
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  to to pick up a phone. So I
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  think we've really seen how how the digital
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  solutions that we employ can supplement
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  all the great work that our people are
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  doing at the planet.
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  Absolutely. And I'd like to pivot our conversation
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  just a little bit to the imperative to
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  reduce costs, improve quality, and advance health equity.
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  So how do you approach aligning these priorities
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  in your organization's strategic vision?
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  I think it all goes back to quality,
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  and,
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  I I think our geography in in Central
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  Illinois as well as in North Carolina,
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  you know, our being a regional health plan,
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  we
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  directly interact on a daily basis with individuals
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  that have our health care coverage. So I
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  think that becomes the center of what you
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  do. You you know that, you're improving the
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  care within your communities, and that makes the
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  work that we do very rewarding.
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  I think,
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  overall,
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  we we look at approaches to reduce costs
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  within,
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  what we can control,
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  but I think the general philosophy
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  improving the care and access to health care
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  in our communities and bettering,
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  the population is kind of our North Star
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  in knowing that this
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  is health care that impacts those that we
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  work with, our family, our friends, and and
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  I think that really becomes impactful when you
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  think about
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  quality,
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  in the patients we serve.
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  And looking ahead, I wanna talk a little
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  bit more about the future of the payer
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  space. So what do you see are the
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  biggest opportunities
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  for payers to lead the charge in transforming
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  care delivery and driving better outcomes for all
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  stakeholders?
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  And how can leaders take a step in
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  this direction now?
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  Yeah. I think,
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  a big area of opportunity is to continuing
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  to bridge the gap between providers and health
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  plans.
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  You know, for years
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  and
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  even today, there's oftentimes an adversarial
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  approach, and I think that puts the patient
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  in the middle of a lot of dynamics
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  that make,
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  navigating health care more difficult.
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  I know at our health care organization, we're
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  trying to work collaboratively with providers to pass
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  more information,
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  to make,
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  you know, access to information that the health
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  plan has easier and to reduce some of
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  the burden in prior authorization,
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  but really involving the provider and and finding
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  a solution where we can work collaboratively with
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  them to have a win win situation and
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  and make
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  all of the navigating of health care and
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  promoting,
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  you know, providers as as
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  key resources in in a patient's health care
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  journey as well as the provider recognizing that
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  the health plan is trying to do the
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  best interest in the patient and making sure
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  that health care remains affordable. I'd like to
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  see that dynamic happen, and I think it's,
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  just continuing to build bridges with providers, trying
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  to see how we can make their lives
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  easier on providing
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  access to care and reducing some of the
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  the challenges that they face on a daily
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  basis.
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  Well, Brian, thank you so much for taking
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  the time to have this conversation with me
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  today. Again, this is Haley Becker with the
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  Becker's Payer podcast recording live at the Becker's
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  third annual spring payer issues roundtable. Thank you
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  so much. Thank you.