Latest / Becker’s Payer Issues Podcast / Payer Operations, Provider Partnerships and the Future of Health Plans with Sheri Johnson

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Payer Operations, Provider Partnerships and the Future of Health Plans with Sheri Johnson · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400
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  payer and health plan executives
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  and more than 100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone. Welcome to Becker's Healthcare podcast. I'm
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  Scott King, thrilled today to be joined by
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  a very special guest, Sherry Johnson, former vice
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  president of member enrollment and billing with UCare.
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  Sherry, how are you doing? Thanks so much
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  for joining us. Hi, Scott. I'm doing doing
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  great.
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  But we're doing our best in the cold
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  as we were saying before the before the
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  show. It is freezing in in Minneapolis where
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  you are and near Chicago where I am,
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  but we're gonna get through it. We have
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  a lot to talk about. And I also
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  wanna say you're gonna be speaking at our
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  spring payer issues roundtable. Really looking forward to
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  that, Sherry, as well. Yes. I have been
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  there several times, and I'm super excited. It's
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  coming up quickly. It is. It's sneaking up
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  on us. Can't wait to have you back.
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  And, you know, before we dive into some
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  topics I I wanna get your perspective on,
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  I was wondering if you could please just
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  share a little bit about your background and
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  your journey in health care. Yeah. Absolutely. So
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  I've been in health care for it's probably
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  been thirty years now. I can't believe that,
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  but I've worked in all aspects of health
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  care, payer side,
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  health system side, vendor side.
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  So I've really seen, you know, seen it
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  from all sides of the industry.
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  But, also, I'm a consumer of health care,
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  and I and I wanna bring some of
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  that perspective to our conversation today too.
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  Most recently,
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  I was with UCare, a regional plan out
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  of Minneapolis,
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  and my position was the vice president of
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  member enrollment and premium billing. So the operational
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  side of the health plan, which I think
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  we'll also get into discussing today.
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  Absolutely. Thanks so much for sharing your background,
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  Sherry. And to get to our first topic,
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  I was wondering if you could please
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  just tell us, you know, about kind of
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  the relationships with
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  providers
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  and payers. You know, we're we're seeing a
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  change as as both sides,
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  face cost pressure and workforce shortages. So are
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  you seeing that relationship change, because of those
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  elements and how?
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  Yeah. Absolutely. Having worked both on a health
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  plan and a health system, I've certainly seen
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  things change over the years, and
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  this is where I wanted to bring in
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  a little bit of my consumer
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  perspective as well.
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  Most recently, I had I called it the
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  gift that kept on giving.
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  Just before Christmas, I had a kidney stone
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  with complications,
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  and I ended up in the hospital a
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  couple times. And I've just been so surprised
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  at how quickly
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  the health system has build the health plan
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  and how quickly the health plan has processed
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  the claims for the health system and then
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  how quickly the health system has,
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  billed me.
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  And it's really been a change over the
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  years because I remember working in a health
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  system and it wasn't unusual for someone to
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  get a bill three, four, or five months
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  after they'd had service,
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  And there also were complaints about the health
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  plan and how they deny everything and it
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  was seen as a delay tactic.
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  So I think one of the ways that,
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  they've started working together is really with that
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  efficiency and accuracy
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  around payments
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  so that the payments are flowing
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  to the health system
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  and then the health system can bill the
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  patient and the money's coming in the door
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  more quickly.
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  So it was just a recent experience that
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  reminded me how both, I'll call it sides,
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  are really focused on that operational
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  efficiency
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  and accuracy.
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  And,
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  both entities
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  are really looking at payment integrity
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  so that the health systems are able to
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  get, you know, every penny they're contractually
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  obligated to receive,
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  and the health plan also doesn't wanna pay
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  any more than it's contractually obligated to pay.
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  So I've really seen a change in how
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  those financial
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  payments,
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  the timeliness of those, I guess.
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  Would you also say, Sherry, that just because
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  of, you know, the regulations everyone's up against,
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  the
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  the the payer provider relationship, it just kind
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  of does it seem less transactional now, maybe,
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  than it used to?
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  Well, you know, that's an interesting question because
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  I think it is still, you know, quite
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  transactional when we talk about, you know, claims
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  processing and whatnot.
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  But I do think that people have started,
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  and it probably depends on the plan and
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  the system, of course. But I think people
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  have started to recognize, like, hey. We're in
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  this together.
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  Yep. Yep. How do we work together to,
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  you know, our our mutually
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  beneficial success?
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  So I do think it has become,
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  more relational in a transactional
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  business, if that makes sense. Yeah. Absolutely. Yes.
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  Thank you. And where do you see the
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  biggest gap today between payer strategy and operational
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  execution?
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  I really like that question too. And and,
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  again, you know, it probably varies by plan,
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  but what I've seen sitting on the operation
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  side of the house is
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  quite often we have so many initiatives
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  that we're trying to implement
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  in support of the strategy.
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  And so I find where the gap is
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  is taking on too many things,
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  not having a good prioritization
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  system,
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  a good governance system by which you decide
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  which initiatives are coming first, second, third.
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  And if,
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  if as an organization, you say, you know,
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  no. We can't do one thing at a
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  time. We really have to do two or
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  three things at a time. Then how are
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  those funded and resourced? Because if you're using
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  the same resources to try to do all
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  three, it's either gonna be at the risk
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  of quality
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  or at the risk timeliness or at the
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  risk of spend. So I do think that
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  there's a big gap around, you know, what
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  are the priorities
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  and how are we going to accomplish those.
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  Yeah. Absolutely. I think you're right with that.
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  And and then I also want to ask
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  you, what's one investment or initiative you believe
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  will most reshape how health plans operate over
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  the next two to three years?
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  Yeah. Probably not a surprise.
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  I'll say AI. I'm a strong
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  supporter, advocate of AI.
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  I certainly understand the risks there, and I
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  also think that people have to be,
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  thoughtful around, you know, how they use it
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  and how they're going to use it. I
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  I think what's happened is, you know, people
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  have clamored and said, we need AI, and
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  they don't know how to use it. So
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  I also believe we need an investment
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  in the people who can straddle
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  technology and operations.
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  And I know in my own experience,
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  when we wanted to implement some robotic process
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  automation,
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  the IT team came in and said, you
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  know, okay. What do you want us to
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  do? And my team was like, well, what
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  can you do? You know? We didn't know.
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  We didn't know what was possible.
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  So we really needed those people who could
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  look at the operations and say, here's an
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  opportunity,
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  and then, you know, the IT people who
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  could then go forth and build that. But
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  I do think AI is gonna be really
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  helpful in in so many ways. And I
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  also think that's an opportunity
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  for the payer,
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  health system partnership
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  because perhaps it's the payer who invests in
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  AI who can then provide data to the
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  health system in terms of outreach and
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  and patients at risk, etcetera. But I do
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  think AI is gonna be a game changer.
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  With AI, you know, I kinda for everyone,
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  but especially on on the payer side, do
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  you think it's one of those things that
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  as more uses are rolled out for it,
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  you know, to to save time, there should
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  be more education and and more training too?
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  Should companies invest in that as well?
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  I think so. I I think you're spot
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  on. And
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  how do you,
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  how does one share those cases that have
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  been really successful? I think that's another challenge
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  that maybe one department or one functional area
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  has really leveraged. Either it's, you know, robotic
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  process automation,
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  leveraged,
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  either it's, you know, robotic process automation, AI
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  globally, whatever it is. But how does the
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  rest of the organization know what was done
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  so that they can start thinking about, oh,
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  how might that apply to me? And then
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  you get that spread. So I do think
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  it's both the, education
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  on how to use it, but also the
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  communication on how it's been used.
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  If you could change one regulatory or industry
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  practice tomorrow to improve
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  affordability and access, what would it be and
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  why? Magic wand time. Right? Get out that
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  magic wand.
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  I don't have one specific regulation.
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  What I've said for a long time is
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  that I think we need to decide who,
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  and I'll say air quotes, owns the patient
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  or the member.
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  We have the health system that's managing the
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  care. We have the health plan who's trying
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  to manage chronic disease.
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  Much of these things are because of of
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  regulation
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  that we're both obligated
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  to do that. And I just think it
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  adds cost to the system, and I'm not
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  sure it,
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  benefits outcomes to have two parties
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  trying to manage that.
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  And I use an example of of my
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  mother-in-law.
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  She's,
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  98 years old, and she has a care
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  manager from her health system, and she has
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  a care manager from her health plan. If
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  you talk to her, the nurse called. She
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  doesn't realize she has two nurses. She doesn't
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  know they're from different places. And so I'm
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  fairly certain that neither nurse has gotten her
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  full,
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  health picture
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  because she thinks she already told the nurse
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  that. And that's just a small example of,
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  you know, that's duplicative
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  spend on a care manager by both the
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  health system and the health plan. So I
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  would love to see
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  the health systems
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  plans along with regulators
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  coming together and saying, you know, who actually
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  owns this relationship
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  and who supports the relationship.
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  And I think we could take out a
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  tremendous amount of spend in the system.
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  Yeah. I think that's a great personal example
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  of some things that obviously can be ironed
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  out with all that. So thank you for
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  sharing.
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  And the last thing I wanna ask you,
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  Sherry, is what issue do you think is
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  putting the most pressure on health plan margins
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  right now?
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  And how would how would you respond differently
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  to that in in 2026?
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  Oh, that's a difficult question.
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  I think everyone
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  is
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  challenged on the health plan side by the
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  rates, especially
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  if you're in a,
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  med if you have a Medicaid membership and
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  certainly Medicare too,
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  the rates are challenging.
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  And,
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  you know, there's always the advocacy
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  banding together maybe as,
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  plans within a
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  geographical area or with, like, membership to advocate
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  together so it's not, you know, one plan
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  saying this isn't enough. I think that's really
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  important.
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  I also think, you know, the rates are
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  the rates. And so given that those are
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  the rates, what can we do internally
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  to actually,
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  you know, try to work within those rates?
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  But I do think that the
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  the rates are something I continue to hear
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  from plans across the country.
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  Well, Sherry, thanks so much for joining us
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  on the podcast and for a great informative
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  conversation. We're looking forward to having you speak
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  with us again in April.
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  Absolutely. I'm looking forward to it. So I'll
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  see everyone in Chicago in April.