Latest / Becker’s Payer Issues Podcast / Angela Perri, President, Medicare Products

Transcript

Angela Perri, President, Medicare Products · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
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  and social determinant of health barriers get the
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  care they need and the personalized experience they
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  deserve. We serve patients who struggle to navigate
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  the health care system by bringing high quality
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  primary
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  and preventative care services to the home. By
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  providing clinical care and support services that provide
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  whole person care, we improve health equity, access,
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  and outcomes for the populations we serve.
• 0:47
  This is Gracelyn Keller with the Becker's healthcare
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  podcast, and we are live at the 2024
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  fall pay issues roundtable.
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  I am joined right now by Angela Perry,
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  who is the chief Medicare officer at UPMC
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  Health Plan.
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  Thank you so much for being here, Angela.
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  Would love to have you start off by
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  introducing yourself and telling us a little bit
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  more about your role.
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  Sure. Again, I'm Angela Perry. I'm the chief
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  Medicare officer for UPMC Health Plan and UPMC.
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  We are a payer provider organization.
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  So we have both health plan and several
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  hospitals and physicians.
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  My role there is I'm responsible for the
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  Medicare products division.
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  We have approximately
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  200
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  and almost 20,000
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  members
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  in Pennsylvania.
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  We focus on both from a Medicare Advantage
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  perspective,
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  non SNP, which is our HMO and PPO
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  products, as well as our special needs plan,
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  our D SNP product.
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  We have about a 140,000
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  members in our non SNP and about 40,000
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  numbers in our D SNP product.
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  Wonderful. Well, thank you for being here. Mhmm.
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  And let's start our conversation today talking about
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  growth goals. So from improving member experience and
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  expanding value based care to controlling costs, Payer
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  executives have ambitious growth goals for the rest
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  of the year and looking into 2025.
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  So in your role, what is your top
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  priority, and how are you planning to get
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  there?
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  Sure.
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  So from a goals and a growth
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  perspective,
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  every Medicare Advantage Plan is looking to grow.
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  And the last couple of years in the
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  post pandemic
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  era
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  has been challenging to say the least.
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  So our goals
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  continue to be focusing on innovative benefit design.
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  Again, focusing from a
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  quality and and a risk adjustment point of
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  view.
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  So a lot of the policies from a
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  government perspective have changed.
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  And
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  being able to not just comply with some
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  of those
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  changes from quality and stars to risk adjustment,
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  the health equity index that's a part of
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  that. All of these things are our goals,
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  not just to comply with them, but to
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  really understand how we're gonna
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  better impact the health of our communities.
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  We are primarily in Western and Central Pennsylvania.
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  And so being a regional health plan, we
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  are
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  highly engaged in our communities. And our goals
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  are really to connect people from an access
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  and affordability and a stability point of view.
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  Absolutely.
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  And going off of that at an industry
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  level, how would you describe the biggest barriers
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  to effectively serving and engaging members?
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  What opportunities do you see for large scale
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  improvements, and how are you applying all this
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  in your current strategy?
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  So I think some of the biggest barriers
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  really come
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  back to access
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  overall.
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  And the pandemic has taught us not only
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  can we use a myriad way of
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  engaging members digitally
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  through telehealth,
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  but also just your regular brick and mortar.
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  Primary care is central to overall health.
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  And our senior population
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  in Western Pennsylvania
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  and and Alleghany County, which is where Pittsburgh
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  is, Alleghany County has the the 2nd highest
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  aging population behind Miami Dade. So we're number
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  2 with with our seniors growing older.
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  And from a a barriers perspective, what we've
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  seen in this post pandemic
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  world is that
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  things are much more complicated.
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  And as a result, our our physicians
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  who still tend to be very fee for
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  service focused instead of
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  really in value models. They're just trying to
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  deal with, enormous volumes and high utilization. And
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  so that doesn't really lend itself to comprehensive
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  evaluations for our seniors. It really is much
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  more episodic
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  in
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  nature. And when you're
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  It really is much more episodic in nature.
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  And when you're dealing with the kind of
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  complexity and acuity that we're seeing,
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  being episodic
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  versus comprehensive
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  tends to make things more expensive,
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  tends to spread things out across the population.
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  Seniors
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  get frustrated that they're not they're only being
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  seen for maybe their diabetes
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  and not for
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  their asthma or their COPD. They have to
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  come back for a second or third visit.
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  So that creates access issues, which is an
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  unintended consequence overall.
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  So how we're addressing these is really engaging
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  with our physician and provider partners very differently.
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  Having new conversations,
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  not just about risk adjustment and quality,
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  but also
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  about what their goals are.
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  Because most physicians, frankly, have been burned out
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  in this, again, post pandemic world. They're they're
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  being asked to see huge numbers of people
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  and that doesn't lend itself to good quality
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  care either.
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  So
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  by coming together and trying to solve in
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  a more aligned way, these conversations
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  are the ones that are driving
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  changes in process and changes in focus
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  by both the payer and the provider side
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  of the house at UPMC.
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  Let's shift gears just slightly toward health equity.
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  So as health equity becomes increasingly centered in
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  payer strategies,
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  how are you addressing health disparities? And can
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  you share specific examples of measurable successes to
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  date? Sure.
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  So at at again,
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  UPMC,
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  we are a regional health plan. So we
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  are very community focused and community engaged.
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  And one of the things that we've done
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  for years is not just focus on behavioral
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  health or social determinants as a kind of
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  buzzword,
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  But we understand at the community level, at
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  the community hospital level,
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  what's happening
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  in those different neighborhoods.
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  There's
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  rural. There's urban. There's suburban.
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  There's
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  cultural
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  sensitivities that we need to pay attention to
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  and how people choose to access care.
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  So our strategies have been about engaging people
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  where they are.
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  And not just looking at things like
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  like language or or
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  those kinds of barriers. But instead,
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  looking at at going into churches, we have
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  something called our faith and wellness challenge. It's
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  almost like the biggest loser
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  where different churches, mosques, and synagogues compete
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  to get healthier over, you know, a period
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  of time.
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  We engage with our our local groceries
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  to have
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  mobile access to healthier foods going into communities
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  that have food, you know, that we look
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  at the deprivation index
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  and there's food deserts and
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  and a lot of communities. So we try
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  to partner with those groceries to bring
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  literally
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  mobile trucks that bring in healthy foods. And
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  then from a benefit design perspective, we have
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  a healthy foods card that's particularly focused on
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  our special needs plan.
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  So our members can
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  use that card at those those mobile trucks
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  to buy that healthy food. That's just one
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  example. I could go into several.
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  But primarily,
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  we like to focus on the behavioral aspects,
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  on the social aspects, on the community aspects,
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  and make sure that our benefit designs
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  reflect that sense of values
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  for putting
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  people
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  first.
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  Have a hashtag grandma and grandpa centered care.
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  And that means really understanding what the individuals
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  need
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  and making sure that our community focus
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  is central to all that we do from
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  an operations and a member services execution.
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  And as we wrap our conversation here, is
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  there anything else you'd like to share on
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  the podcast today?
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  I would just say that, you know, there's
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  still a a thought that members are,
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  or seniors or persons with disabilities are not
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  as digitally focused
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  as maybe some younger folks.
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  And I would say at UPMC, we've seen
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  that not to be the case. That our
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  seniors engage with our flex card. They engage
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  with us digitally.
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  They're very comfortable doing telehealth visits even in
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  rural communities.
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  But even they struggle with different things. So
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  creating
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  tech guides or or doing things that, you
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  know, again, meets that individual where they are.
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  There's so much fear
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  when it comes to making decisions
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  in the Medicare space that anything that we
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  could do as health plans
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  to better support and engage our members
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  and make things easy for them, have an
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  easy button,
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  that is the way forward.
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  And our seniors really appreciate that and reward
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  us with high retention and satisfaction.
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  Wonderful. Well, Angela, thank you for taking the
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  time to be here today on the Becker's
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  Healthcare Podcast. Again, we are live at the
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  2024 fall payer issues roundtable. Thanks so much.
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  Thank you.