Latest / Becker’s Healthcare Podcast / Simplifying Healthcare and Tackling Rising Costs with Jessica Lopez-Liggett

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Simplifying Healthcare and Tackling Rising Costs with Jessica Lopez-Liggett · Becker’s Healthcare Podcast

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  - Hi, everyone. This is Elizabeth Cassello with the
• 1:00
  - Becker's Payer Issues podcast.
• 1:02
  - I'm thrilled today to be joined by Jessica
• 1:04
  - Lopez Liggett, commercial state plan president for Anthem
• 1:07
  - Blue Cross and Blue Shield in Indiana. Jessica,
• 1:10
  - thank you so much for joining us today.
• 1:12
  - Thank you, Liz. It's my pleasure, and I'm
• 1:14
  - excited to be here with you. Yes. I'm
• 1:16
  - really looking forward to this conversation.
• 1:18
  - And before we dive in, I would just
• 1:20
  - love to hear a bit more about your
• 1:22
  - role,
• 1:23
  - and your background coming into it and what
• 1:25
  - your current priorities are.
• 1:27
  - Absolutely.
• 1:29
  - So I have to kinda laugh at this
• 1:31
  - when I think about,
• 1:32
  - career and how I landed,
• 1:35
  - you know, where I'm at today. And
• 1:38
  - I think, like most, I I will share
• 1:40
  - with you, health care wasn't the original path,
• 1:43
  - that I was expected to take.
• 1:45
  - Early in my career, I thought that I
• 1:47
  - would,
• 1:48
  - go into law enforcement, and I really truly
• 1:50
  - had aspirations to to join the FBI.
• 1:53
  - And as I reflect on that, a big
• 1:55
  - piece of that was because I wanted to
• 1:57
  - make a difference in people's lives.
• 1:59
  - But as as, you know, it goes, life
• 2:02
  - happens,
• 2:03
  - things change,
• 2:04
  - and sometimes you have to pivot. And so
• 2:06
  - that is how I found myself in health
• 2:09
  - care.
• 2:10
  - And,
• 2:11
  - you know, it's easy now to reflect back
• 2:14
  - on the why for the law enforcement
• 2:16
  - and and my my goals and what I
• 2:18
  - was trying to do there and and to
• 2:20
  - translate that
• 2:21
  - into making a difference in people's lives through
• 2:24
  - health care. And so it's it's really easy,
• 2:27
  - to do that. I'll share with you, when
• 2:29
  - I started in health care, it was really
• 2:31
  - you know, I was, learning the groundwork
• 2:35
  - behind, like, the end users experience. So I
• 2:37
  - started answering phones. I was paying small claim
• 2:40
  - adjustments,
• 2:41
  - and just really learning the inner workings of
• 2:44
  - of the health care,
• 2:45
  - side of things, like I said, from the
• 2:47
  - end users experience,
• 2:49
  - you know, from the ground up. And I'm
• 2:51
  - proud of that because it makes me connect
• 2:54
  - through all the decisions and discussions that were
• 2:56
  - happening,
• 2:57
  - remembering and recalling that that end user's experience.
• 3:00
  - So that member that's at the end of
• 3:02
  - of everything that we do and in the
• 3:04
  - center of it. And,
• 3:06
  - and what I'll share is along the way,
• 3:08
  - I've been fortunate enough to have some incredible
• 3:10
  - leaders,
• 3:11
  - and those incredible leaders were willing to challenge
• 3:14
  - me and invest in me and and really
• 3:16
  - identify
• 3:17
  - and,
• 3:19
  - you know, see things in me that I
• 3:20
  - I didn't see in myself. And so that's
• 3:23
  - where the career growth really started to take
• 3:25
  - off, you know.
• 3:27
  - And so that experience, I would say, is
• 3:29
  - what shaped me into the leader that I
• 3:31
  - am today. So that's really what I believe
• 3:34
  - leadership's about. It's about creating those opportunities.
• 3:37
  - For others, it's about building that trust, and
• 3:40
  - it's really about helping people become
• 3:42
  - more than they believe that they can become
• 3:44
  - in themselves. So
• 3:46
  - I think it's interesting that you considered law
• 3:48
  - enforcement in college. I really got interested in
• 3:50
  - forensic anthropology, so that kind of resonates with
• 3:53
  - me.
• 3:54
  - It still does, and I I still am
• 3:56
  - very engaged in a lot of podcasts and
• 3:59
  - things. So it's it's definitely still an interest,
• 4:01
  - but different direction for sure.
• 4:03
  - Very cool.
• 4:04
  - So given your commercial role and, you know,
• 4:07
  - you've been in this role for a few
• 4:08
  - months now, what are some of the biggest
• 4:10
  - challenges that you're seeing employers face in your
• 4:12
  - market?
• 4:14
  - Great question, Liz.
• 4:15
  - So as I stepped into the role, so
• 4:17
  - I'm just, about 120
• 4:20
  - into the new role.
• 4:21
  - And so what I've spent the first several
• 4:24
  - weeks
• 4:25
  - doing is just listening, and I think any
• 4:28
  - good leader would would do that in their
• 4:30
  - first days.
• 4:31
  - And the listening that I did was across,
• 4:34
  - you know, like, our associates,
• 4:36
  - our provider care partners in the community,
• 4:39
  - employers,
• 4:41
  - broker partners that we do business with, and
• 4:43
  - and community organizations.
• 4:45
  - And what's become very, very clear is that
• 4:48
  - the many challenges that we face and that
• 4:50
  - we're focused on here in Indiana are the
• 4:52
  - same challenges that are being felt in health
• 4:54
  - care nationally. So
• 4:56
  - for me, what I, you know, I'm grappling
• 4:59
  - with is
• 5:00
  - not only is the biggest challenge
• 5:02
  - the rising health care costs, it's also making
• 5:06
  - health care feel less overwhelming for the people
• 5:08
  - that we serve.
• 5:10
  - Think about when you have somebody that's dealing
• 5:12
  - with a new diagnosis,
• 5:13
  - you know, they're caring for an aging parent,
• 5:15
  - or quite frankly, just trying to choose a
• 5:17
  - health benefit for their for themselves and their
• 5:20
  - family.
• 5:21
  - Those individuals shouldn't have to become experts in
• 5:24
  - our industry
• 5:25
  - just to navigate the system.
• 5:27
  - And I was reminded of that this week,
• 5:30
  - ironically,
• 5:31
  - as I was preparing for this. I took
• 5:32
  - a a phone call from a family member.
• 5:35
  - The family member reached out because they know,
• 5:37
  - you know, what it is that I do,
• 5:38
  - the industry that I work on, and they
• 5:40
  - said, I have some questions for you. And
• 5:41
  - as they begin to describe the questions and
• 5:44
  - some of the things that they're dealing with,
• 5:45
  - I was reminded very, very quickly how complex
• 5:48
  - our system actually is. When an individual has
• 5:51
  - to go between and learn terms and about
• 5:55
  - codes and different ways claims are paid and
• 5:58
  - they're getting bounced all around,
• 6:01
  - that's not okay. And that's that's some of
• 6:03
  - the things that we need to we need
• 6:04
  - to solve for. So when I think about
• 6:07
  - lowering health care costs, when I think about
• 6:08
  - simplifying experience, I really kind of bucket it
• 6:11
  - into three
• 6:12
  - three lens, you know, looking at it through
• 6:13
  - three different lenses.
• 6:15
  - One is improving the cost of care in
• 6:17
  - general, and I think that we do that
• 6:19
  - through strong provider partnerships. And I have some,
• 6:21
  - you know, a great example of of something
• 6:23
  - that we're doing here innovative in Indiana.
• 6:26
  - The second lens that I would I would
• 6:28
  - share with you is
• 6:30
  - the work
• 6:31
  - to help people stay healthy before they actually
• 6:34
  - need the health care. And that actually excites
• 6:37
  - me because we're thinking about health care now,
• 6:39
  - not just at the point that somebody gets
• 6:41
  - an, you know, gets an illness and needs
• 6:43
  - to seek care. We're trying to think about
• 6:45
  - ways and think about health care in the
• 6:48
  - sense of how do we keep these people
• 6:49
  - healthy? How do we keep them healthy? And
• 6:52
  - so you have to do that because by
• 6:53
  - investing in part prevention,
• 6:55
  - and you also have to invest in the
• 6:57
  - barriers that individuals experience in the community. So
• 7:00
  - food insecurity, housing, things that are outside of
• 7:03
  - the health care system, but that may impact
• 7:05
  - their ability to access it.
• 7:07
  - And then the third lens is all around
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  - the simplification.
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  - Experience?
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  - And when we talk about
• 7:22
  - technology,
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  - it's such a you know, AI is such
• 7:25
  - a buzzword for for many people.
• 7:28
  - But I think about
• 7:31
  - technology
• 7:32
  - making health care human. So you have to
• 7:35
  - make sure like, health care is extremely personal.
• 7:38
  - And so the technology should be used in
• 7:40
  - such a way that it makes the experience
• 7:43
  - human,
• 7:44
  - and it should work so well that they
• 7:45
  - they don't even know that it's that it's
• 7:47
  - happening. And so that's that's some of the
• 7:50
  - things that I, you know, feel like we're
• 7:51
  - we're faced with to solve for.
• 7:54
  - I think the encouraging part for me as
• 7:56
  - I step into this leadership role here in
• 7:58
  - Indiana is that I truly believe we're uniquely
• 8:01
  - positioned here in this state,
• 8:03
  - to lead this work and this effort,
• 8:05
  - not only,
• 8:07
  - you know, to to make an impact here,
• 8:09
  - but to be that fourth to to be
• 8:12
  - the leader in in solving for some of
• 8:14
  - this for the nation. And I think that's
• 8:15
  - because of the strong partnerships.
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  - We've got great employers, great community partners. We've
• 8:20
  - got great care par partners, and they're
• 8:23
  - all genuinely,
• 8:24
  - ready to help solve for this. So I
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  - think that's that's a great place for us
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  - to be.
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  - Yeah. So I have a few follow ups
• 8:31
  - from that. I know you mentioned you have
• 8:32
  - that provider partnerships
• 8:34
  - example, and you've previously chatted with Becker's about
• 8:37
  - the orthopedic network that you have going on.
• 8:39
  - So could you fill us in on, how
• 8:41
  - everything's been progressing on that front and what
• 8:43
  - you're looking to next?
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  - Absolutely. So that was one of the first,
• 8:48
  - discussions I was able to have with you
• 8:50
  - all, and it was very exciting in that
• 8:51
  - first thirty days. And the excitement around that
• 8:55
  - really truly, Liz, was because I was at
• 8:57
  - the beginning of of that work starting in
• 8:59
  - 2023.
• 9:00
  - I think I shared it was two years
• 9:02
  - in the making before it actually launched at
• 9:04
  - the beginning of this year. And how that
• 9:07
  - came to fruition was, employers came coming forward
• 9:10
  - and they were saying, listen. We need
• 9:13
  - to create some sort of navigation
• 9:16
  - to simplify the experience and get our members
• 9:19
  - to the highest quality,
• 9:22
  - low cost,
• 9:23
  - providers for
• 9:25
  - some of these centers of excellence. So you
• 9:26
  - have, like,
• 9:28
  - groups of, providers that maybe specialize in the
• 9:31
  - really good. Their, you know, efficiency, their effectiveness,
• 9:34
  - their quality rates are really, really high, but
• 9:36
  - they also have the ability to drive that
• 9:38
  - at a at a lower cost rate.
• 9:40
  - Employers know that we have access to the
• 9:42
  - data, so we should be able to identify
• 9:44
  - that and help steer their their members.
• 9:46
  - And so that's how that work started. We
• 9:48
  - quickly identified hips and knees. So orthopedics was
• 9:51
  - one of the the higher costing,
• 9:54
  - majority of, you know, high cost claims were
• 9:56
  - coming through. Large amounts, I think, for top
• 9:58
  - conditions was what I would say, not necessarily
• 10:00
  - high cost claims. Top condition that most employers
• 10:03
  - were experiencing.
• 10:05
  - We leaned into a provider partnership. OrthoIndy was
• 10:07
  - the first to the table,
• 10:09
  - and they were willing to sign on. First,
• 10:11
  - they had to meet the quality metrics. Once
• 10:14
  - we got through that, they were able to
• 10:16
  - sign on. And what we were,
• 10:18
  - expecting is up to a 50%
• 10:20
  - reduction
• 10:21
  - for those particular procedures by going through the
• 10:24
  - centers of excellence. So it was OrthoIndy.
• 10:27
  - Fast follow was Franciscan Forte, and I'm proud
• 10:30
  - to say there's going to be another, orthopedic
• 10:33
  - center that's also going to join.
• 10:35
  - And,
• 10:36
  - what we're seeing now is early savings of
• 10:38
  - about 15,000
• 10:40
  - per
• 10:41
  - orthopedic case that is coming through that employers
• 10:44
  - are experiencing through our HealthSync network. So
• 10:47
  - it's
• 10:48
  - it's taken off.
• 10:50
  - I I think I announced at that time
• 10:51
  - too, this is one lever, and now we're
• 10:53
  - at the point where it's like, okay. What's
• 10:55
  - next? And employers are asking, what's next? And
• 10:57
  - so we're looking at expanding that to GI
• 11:00
  - services,
• 11:01
  - cardiac services,
• 11:03
  - some other, you know, elective procedures like colonoscopies.
• 11:06
  - So we wanna continue to expand that because
• 11:09
  - of the early successes that we're already seeing.
• 11:13
  - That's really exciting to hear the next possible
• 11:15
  - directions there.
• 11:17
  - Another thing you mentioned at the beginning was
• 11:20
  - making health care human and thinking about really
• 11:22
  - responsible ways of deploying technology and AI.
• 11:26
  - Do you have an example of where you
• 11:28
  - think that investment
• 11:29
  - translates to making health care more human?
• 11:32
  - What's your what's front of mind for you
• 11:34
  - as you think about what's next with AI
• 11:36
  - use?
• 11:37
  - Absolutely. So I I talked about that being
• 11:39
  - more human and that it should work so
• 11:41
  - well that people don't even know that it's
• 11:43
  - working. So it should be so behind the
• 11:45
  - scenes that it's it's not even a a
• 11:46
  - topic. The people should just feel it.
• 11:49
  - And,
• 11:50
  - I think a couple of examples I have
• 11:52
  - is, one, we have a digital claims experience.
• 11:55
  - And so
• 11:56
  - what we are really investing in is AI
• 11:59
  - and technology that can speed up the efficiencies
• 12:02
  - for our associates. So, again, we're we're keeping
• 12:04
  - people in in the center of this. It's
• 12:06
  - not about technology and systems taking over.
• 12:10
  - So if you can support our people to
• 12:13
  - get to,
• 12:14
  - answers more quickly,
• 12:16
  - then you can improve,
• 12:18
  - timely pay you know, claim payments,
• 12:21
  - which is sometimes a a burden that providers
• 12:24
  - will complain about that they don't have timely
• 12:26
  - payments. And so that's one of the ways.
• 12:28
  - Very basic, very simple. But, again, Liz, people
• 12:31
  - shouldn't even know. It they should just feel
• 12:33
  - it that it's working.
• 12:35
  - Another area is through services.
• 12:37
  - So,
• 12:38
  - again, taking the work off of our clinical,
• 12:42
  - you know, individuals, our doctors, our nurses that
• 12:44
  - are having to review those cases to determine
• 12:47
  - medical necessity.
• 12:48
  - In old days, they would have to go
• 12:50
  - through and flip through, you know, medical policies,
• 12:54
  - hundreds of pages. It could take them, you
• 12:56
  - know, days sometimes to get through all of
• 12:58
  - that to get to a a decision. So
• 13:00
  - what we're doing now is deploying technology behind
• 13:03
  - the scenes to get that information to them
• 13:05
  - more quickly so that they can make decisions
• 13:08
  - more timely. So improving those,
• 13:10
  - those approval processes,
• 13:12
  - again, making and creating more efficiencies. So those
• 13:15
  - are just two very basic ways, but I
• 13:17
  - think it's a good example of
• 13:19
  - how it should just work and and people
• 13:22
  - shouldn't feel it.
• 13:23
  - And thinking big picture about your role, what
• 13:27
  - surprised you in the first few months of
• 13:28
  - you having this title,
• 13:30
  - and what are you looking forward to diving
• 13:32
  - in more with as you go forward?
• 13:35
  - Surprises? I don't know if it's necessarily in
• 13:37
  - a surprises. I've been fortunate enough to be
• 13:39
  - with the organization for nineteen years.
• 13:41
  - And so and, you know, I've been in
• 13:43
  - Indiana for three and a half years,
• 13:46
  - coming over from the Missouri market.
• 13:48
  - And so I don't know that there's necessarily
• 13:51
  - surprises,
• 13:52
  - but I think what excites me is that,
• 13:55
  - again, talking about Indiana kinda leading the way,
• 13:57
  - we have a lot of innovative partners here.
• 14:00
  - I believe
• 14:02
  - what we have is an opportunity not only
• 14:04
  - to shape where the health care future is
• 14:06
  - headed,
• 14:07
  - but to shape how we get there as
• 14:08
  - well. I mean, leaning into that, that's that
• 14:11
  - is what excites me and wakes me up.
• 14:12
  - It energizes me every day. I think about
• 14:14
  - the incredible provider partners, some of the work
• 14:17
  - that we're doing there.
• 14:19
  - The employer is not backing away or shying
• 14:21
  - away from innovative ideas. They're open to a
• 14:23
  - lot of a lot of different ideas. We've
• 14:26
  - got passionate associates. My team members, they volunteer.
• 14:29
  - There's, you know, a number of hours every
• 14:31
  - single month that are spent,
• 14:33
  - giving back to the community that we work
• 14:35
  - with and then all the community organizations and
• 14:37
  - partnerships that we have there. So I just
• 14:39
  - I think by bringing all of those, groups
• 14:42
  - together, that collaboration and that partnership, and, again,
• 14:45
  - going back to not just shaping where we're
• 14:47
  - headed, shaping how we get there. And and
• 14:50
  - that's really truly what excites me.
• 14:52
  - Do you have any advice for any other
• 14:54
  - people who work in the commercial space as
• 14:56
  - they are navigating,
• 14:58
  - you know, the cost trends that we've been
• 15:00
  - seeing and the pressures that employers are facing?
• 15:03
  - I would say,
• 15:05
  - we don't all you know, you can't
• 15:07
  - we don't all have the answers individually. That's
• 15:09
  - the first thing I would say.
• 15:11
  - You need all of the partnerships that I've
• 15:13
  - mentioned a couple of times now. You need
• 15:15
  - the provider partners. You need,
• 15:18
  - the legislators, the policymakers.
• 15:20
  - You need, the community organizations. You need the
• 15:23
  - employers. We need all of those individuals to
• 15:25
  - sit down at the table and lean into
• 15:27
  - the conversations and work together collectively to solve.
• 15:31
  - No one organization
• 15:33
  - is going to have the answer to solve
• 15:35
  - and be able to reduce health care costs
• 15:37
  - and create a simplified experience alone, and I
• 15:40
  - think that's the advice and recommendation.
• 15:42
  - If you if you believe that you're gonna
• 15:44
  - go in and you have the answer for
• 15:46
  - all,
• 15:47
  - I think you'll find out that you don't.
• 15:49
  - You really do need those partnerships.
• 15:51
  - And so that's that I believe that's the
• 15:52
  - advice I would extend. Is there anything else
• 15:55
  - that you wanna share while I have you
• 15:56
  - here, Jessica?
• 15:58
  - I think, you know, just you know, you
• 16:00
  - talked about employers and and the the difficulty.
• 16:03
  - I think just going back to understanding the
• 16:05
  - why behind the work that we do. So
• 16:07
  - it's not just the employers. It's the member
• 16:09
  - experience. It's the administrative burdens that we're trying
• 16:11
  - to solve for our provider partners.
• 16:13
  - Let's not forget the why.
• 16:16
  - I think the other thing that I would
• 16:17
  - leave you with and, we didn't really touch
• 16:20
  - on it is one of the, I believe,
• 16:22
  - overlooked strategies that we haven't spent a lot
• 16:25
  - of time talking about is,
• 16:28
  - recognizing that health
• 16:30
  - starts long before somebody enters the health care
• 16:33
  - system.
• 16:34
  - And,
• 16:35
  - what we show is statistics
• 16:37
  - show 80% of someone's health happens outside of
• 16:40
  - the health care system. So I think that
• 16:42
  - we need to have more focus
• 16:44
  - and more attention and more time spent understanding
• 16:48
  - what the individuals are facing, those barriers that
• 16:51
  - that are preventing them from accessing the health
• 16:53
  - care or getting getting to the health care,
• 16:56
  - before
• 16:57
  - it it's too far or, you know, a
• 16:59
  - health condition has went too far. And so
• 17:01
  - I think that that's,
• 17:03
  - something that I would leave us with as
• 17:05
  - a challenge to lean into that conversation more
• 17:08
  - because I do believe it's overlooked.
• 17:10
  - And maybe just as a follow-up to that,
• 17:12
  - are there certain patterns you've noticed with the
• 17:14
  - commercial population
• 17:16
  - in regards to things that could be preventable?
• 17:19
  - Are there conditions? Are there just gaps in
• 17:22
  - access?
• 17:23
  - Anything you can think of that you've seen
• 17:24
  - as a trend. I feel like I have
• 17:25
  - a lot of these conversations in the Medicaid
• 17:27
  - space, so I'm just curious about the commercial
• 17:30
  - market in particular.
• 17:32
  - That's a great question. So we have an
• 17:34
  - experience center that we will bring employer groups
• 17:36
  - through, and we personalize that. We upload their
• 17:38
  - data,
• 17:40
  - from their employee demographics. And one of the
• 17:42
  - most profound moments throughout in that experience center
• 17:45
  - is near the end when we put up
• 17:48
  - a heat map that identifies the social determinants
• 17:51
  - of health and the concerns that their specific
• 17:55
  - employee population may be dealing with. And it
• 17:57
  - it's really an moment because what they'll see
• 18:00
  - is that they have employees that live in
• 18:02
  - food deserts.
• 18:03
  - They don't think about
• 18:05
  - health care access or benefits
• 18:07
  - that,
• 18:08
  - that solve for that. You have,
• 18:11
  - employees that live in areas where transportation
• 18:14
  - isn't is an issue. So that's what we
• 18:16
  - mean. You know, I say, like, this is
• 18:18
  - overlooked
• 18:18
  - a lot. If you have somebody that's worried
• 18:21
  - about,
• 18:22
  - can they keep a food a roof over
• 18:23
  - their head? Can they can they put food
• 18:25
  - on the table? Or can they even get
• 18:27
  - a ride
• 18:28
  - to work? If they're worried about those things,
• 18:31
  - they're not worried about scheduling a preventive exam.
• 18:34
  - They're not worried about
• 18:36
  - checking the symptoms that potentially means they have
• 18:39
  - high blood pressure and, you know, could lead
• 18:40
  - to bigger issues. So
• 18:43
  - that's,
• 18:44
  - you know, I think that's something that, you
• 18:46
  - know, is profound,
• 18:47
  - and we need to spend some more time
• 18:49
  - looking into.
• 18:51
  - Well, Jessica, thank you so much for taking
• 18:53
  - the time to chat with me today.
• 18:55
  - Absolutely. It was my pleasure. Thank you for
• 18:57
  - having me. Of course. And to our listeners,
• 19:00
  - if you'd like to hear more podcasts from
• 19:02
  - Becker's Health Care, you can visit beckershospitalreview.com.
• 19:06
  - Thank you.