Latest / Becker’s Payer Issues Podcast / John Byrnes, Chief Operating Officer at Banner|Aetna

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John Byrnes, Chief Operating Officer at Banner|Aetna · Becker’s Payer Issues Podcast

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Hello, everyone. This is Jacob Emerson with the
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Becker's Pay Your Issues podcast. Thrilled today to
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be joined by John Burns, who is the
0:46
chief operating officer at Banner Aetna. John, thank
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you so much for taking the time to
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be with me on the podcast today. Hey,
0:52
Jacob. Thanks for having me. Yeah. Absolutely. And
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before we dive into everything we wanna talk
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with you about, John, can you tell us
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a little bit more about yourself, your background
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in health care, and what it is that
1:02
you're doing today at Banner Aetna?
1:04
Sure. Yeah. Happy to. So as you mentioned,
1:07
I'm the chief operating officer of
1:09
Banner Aetna,
1:11
which is a joint venture health insurance company
1:14
based out of Arizona.
1:16
I stepped into this role in April
1:18
after having spent more than a decade with
1:21
Aetna
1:22
and CVS Health.
1:23
And,
1:24
in in that role, I was,
1:27
really did a number of different functions covering
1:30
government affairs, enterprise strategy, product design,
1:33
and most recently was in clinical network operations
1:36
for about five years for the company,
1:38
focused nationally on all of our our various,
1:42
network operations across care management, utilization management, and
1:45
the like. So, that's where I'm coming from.
1:47
In my current role as the COO of
1:49
Banner Aetna, I'm responsible for leading the development
1:53
and execution of our integrated strategic plan. And
1:56
that's really with a focus on aligning our
1:59
payer and provider capabilities,
2:01
affordability,
2:02
enhance quality, and deliver a seamless member experience
2:06
for our customers.
2:07
And I'm also responsible for oversight of our
2:09
day to day operations, which covers everything from
2:12
medical cost and network performance, clinical quality, service
2:15
operations, and compliance as well.
2:18
Fantastic. So you were at CVS for a
2:20
long time. Now you're back at Banner Aetna,
2:23
which, of course, you you helped launch.
2:25
And you're returning to the company
2:28
during a time for the industry where there's
2:30
a lot of pressure on the traditional insurance
2:32
model,
2:33
and that really it seems to be across
2:35
every market at this point. So talk to
2:38
us. What's your perspective on all of this?
2:40
What's your vision for scaling the impact,
2:44
of Banner Aetna, and what does success look
2:46
like right now, in terms of operations
2:49
and clinical outcomes,
2:51
given the state of the industry?
2:53
Absolutely.
2:54
You know, I'm I'm really excited to come
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back
2:57
and work with this business. I think,
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you know, from the beginning, Banner Aetna was
3:02
built on a clear and compelling vision, which
3:05
was
3:06
to reimagine the healthcare experience
3:08
around the needs of the individual.
3:10
And the founding principles that we crafted when
3:14
this business was stood up were really designed
3:16
to move beyond
3:17
transactional health care by delivering
3:20
personalized, seamless, and affordable experiences
3:23
that empower members to really achieve their best
3:26
health.
3:27
And at the heart of that strategy is
3:28
a belief that
3:30
success comes from tightly integrating
3:32
the payer and provider capabilities
3:35
to deliver those results.
3:36
And that's not just in theory, but really
3:38
in practice. And I think that this approach
3:41
and the business that has been stood up
3:43
is really uniquely suited to
3:45
Arizona's diverse and dynamic market.
3:48
When we think about what that means for
3:50
our operational success to date and where we
3:53
go from here, we're really focused on four
3:56
primary levers operationally to drive efficiency, engagement, and
4:00
value for our customers.
4:02
And that covers everything from things like real
4:04
time data integration. So how do we strengthen
4:07
the data and workflow between between the health
4:09
plan and the care delivery teams
4:11
to improve decision making, reduce administrative friction, and
4:14
enable more effective,
4:16
care management?
4:18
It also covers things like virtual care expansion.
4:20
So with our consumer expectations
4:23
and seeing how those are shifting in the
4:24
market,
4:25
we wanna scale seamless
4:27
and digitally enabled care options that are fully
4:30
integrated into the member care journey so that
4:33
members can access care virtually,
4:36
or in person depending on their needs, where
4:38
they are geographically located and so forth.
4:41
And really helping by doing that helping reduce
4:44
inpatient utilization
4:45
and enhance that access, especially in rural and
4:48
underserved communities.
4:50
Another thing we're looking at operationally is with
4:53
the advent of AI and how much that
4:55
has has started to really mature over the
4:57
last,
4:58
eighteen to twenty four months is looking at
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how we can leverage
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some of those AI capabilities
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to better drive predictive analytics,
5:07
help integrate some of those,
5:09
AI capabilities into the operations, and really in
5:12
doing that, driving better outcomes as well as
5:15
enabling and empowering clinicians
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to deliver the best care possible.
5:20
And then I would say operationally,
5:22
the last thing and the fourth lever is
5:24
really around
5:26
how we think about this from an employer
5:27
centric standpoint.
5:29
So we obviously have a lot of self
5:31
funded
5:32
employers of varying sizes across the state
5:35
and really thinking about how do we empower
5:38
and enable them
5:39
to manage
5:41
the rising cost of health care for their
5:43
workforce
5:44
while at the same time empowering
5:46
and helping to improve the health of those
5:48
members.
5:49
And really the success tied to that is
5:52
are we able to,
5:54
help support enrollment growth, drive administrative efficiency,
5:57
and ultimately help the employer to have some
6:00
long term retention
6:01
with their employee base.
6:03
So that's operationally how we think about kind
6:05
of where we go from here. I would
6:06
say from a clinical standpoint,
6:09
we will continue to demonstrate that the integrated
6:12
care of this joint venture
6:14
can outperform the traditional models and fee for
6:17
service,
6:18
and that really results in better health outcomes
6:20
at lower costs.
6:21
So for this, we're focused on a few
6:24
different critical pieces of it clinically.
6:26
One is around chronic condition management. You know,
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we've already seen some really great outcomes in
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diabetes reversal through our partnership with Virta Health,
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both on the A1C reduction side as well
6:37
as,
6:38
a substantial reduction in diabetes medication,
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and then just overall weight loss. And I
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think
6:45
that has been a real,
6:47
use case and some of the demonstrated proof
6:49
points around that that has given us,
6:52
an opportunity to build from as we think
6:54
about the momentum and looking at other conditions
6:56
like kidney cardiovascular disease, and how we better
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support and and help members manage those conditions,
7:03
with with this arrangement.
7:05
I think preventative care and early intervention
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is another one where we're really focused clinically
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on how do we increase screening rates and
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timely interventions
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for members, making sure they're getting in to
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see a primary care provider, making sure that
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they are, avoiding
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unnecessary hospitalizations
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and really take advantage
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of the full suite of services that are
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available to them. And then when we think
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about hospital utilization,
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we're also looking at it from the standpoint
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of
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when a member goes into those care settings,
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how do we make sure that we're wrapping
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around them with the right level of care
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and support? So everything from proactive care coordination,
7:44
to post discharge follow-up.
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How do we make sure that we reduce
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those unnecessary ER visits and that when a
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member leaves a care setting, they're equipped with
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the right level of education, the right level
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of care support, and follow on care to
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be able to avoid an unnecessary readmission.
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And that's particularly true for for high risk
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populations.
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Absolutely. And, you know, John, we've heard from
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several banner Aetna leaders in the past.
8:11
I'll always point into your your value based
8:13
integrated model as a key differentiator
8:15
in the market. So
8:17
talk to us about why you think Arizona
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is such a uniquely strong market for the
8:22
type of transformation you just described, and can
8:24
you expand a bit for us about how
8:26
you're leveraging
8:27
those local dynamics to push this model even
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further?
8:31
Yeah. Absolutely.
8:32
I I mean, if you look at Arizona,
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it it really represents
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a uniquely fertile environment for value based integrated
8:40
care. And I think Banner Aetna is purpose
8:43
built to lead that transformation.
8:46
It's obviously not the only player in this
8:48
space, but the way it has been configured
8:50
and just the opportunity of these two large
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organizations
8:55
is in a lot of ways unparalleled.
8:57
But if you look at the state's
8:59
health system landscape broadly, it's highly consolidated
9:03
among a handful of hospital systems,
9:05
Banner being one of those. But then you
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have HonorHealth, Mayo,
9:08
Abrazo and others.
9:10
I think this concentration
9:11
of
9:13
system of health systems in the market
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and with Banner alone commanding nearly 50% of
9:19
inpatient volume, within Maricopa County, it really creates
9:22
a perfect scale for the integration
9:25
and data sharing around these aligned incentive models
9:29
and what we're going after.
9:30
The other piece of it, if you think
9:32
about the uniqueness of Arizona, is
9:34
the demographics
9:36
of the state, relative to the population.
9:38
And, you know, Arizona has 49%,
9:42
roughly of its residents that identify as Black,
9:45
Hispanic, Asian or Native American.
9:47
And with that comes the need for culturally
9:50
tailored and personalized care that is accessible across
9:54
the state.
9:55
And so when we think about that relative
9:57
to our business, you know, Banner Aetna was
10:00
physically designed to take advantage of these dynamics,
10:03
as a joint venture
10:04
between the national scale of Aetna as a
10:08
health plan
10:09
and then Arizona's,
10:11
health system with Banner
10:13
and the breadth and depth of that system.
10:15
We're not simply coordinating care. We're really integrating
10:18
it. So this model breaks down the traditional
10:21
barriers between the payer and provider
10:24
to deliver that more connected accountable experience across
10:27
the continuum.
10:28
This means that we can act faster on
10:30
the insight insights that we have for our
10:32
members,
10:33
to more effectively align those incentives to meet
10:36
members where they are. And whether that's through
10:38
things like digital navigation tools for members,
10:41
and our work with ninety eight point six
10:43
and and virtual care, whether that's some condition
10:46
specific programs like Virta Health and the partnership
10:49
we have there, or whether that's community based
10:51
programs that we offer through our Get Active
10:53
program or the banner at the kitchen,
10:56
and then even personalized care management through the
10:58
the banner,
11:00
the banner care team. You know, we have
11:02
a suite of services
11:05
and ways of engaging and tailoring those offerings
11:07
for members that really meets them where they
11:09
are and and the unique needs that they
11:11
have.
11:12
And then I would say with that,
11:14
the unique advantage that Banner Aetna has in
11:16
Arizona, if you look at things like the
11:18
performance network that we offer, is the cost
11:21
savings associated with that for commercial plan sponsors
11:24
and the broad access that's provided across key
11:27
Arizona counties, which really reaches the majority of
11:30
the state's population,
11:32
with those banner facilities,
11:34
it is really unparalleled.
11:35
And I think that combination of
11:38
local access to care
11:40
combined with the national scale and track record
11:44
of,
11:45
a national payer like Aetna,
11:47
really comes through in in the results that
11:49
we've seen where, you know, we have three
11:51
times higher than industry average member engagement, and
11:54
we're positioned to lead the market in really
11:56
delivering that integrated and value based care.
12:00
The last thing I'll say on this is,
12:02
you know, we wanna push this model further,
12:03
and that really means we wanna embed those
12:06
value based principles
12:08
into every facet of our operations, whether that's
12:10
clinical programs, member experience, or even employer engagement.
12:14
It's really
12:15
around
12:16
making sure that we're able to quickly adapt
12:19
to
12:20
Arizona specific needs and address
12:23
gaps in care for rural populations, be able
12:25
to tailor solutions for those diverse communities,
12:28
and then really partner with employers to improve
12:31
the health of of their employees.
12:33
So in a nutshell,
12:35
we're not trying to rep retrofit value based
12:38
care into a legacy system. We were built
12:40
for it, and I think Arizona is the
12:42
ideal market for this type of model.
12:45
Absolutely. Well, I appreciate you breaking down those
12:47
local dynamics for us. That all makes a
12:48
lot of sense.
12:50
And beyond improving outcomes and and lowering costs
12:53
for your for your patients and your members,
12:55
Sean, you touched earlier on elevating that member
12:58
experience. We've heard from leadership at the company
13:00
in the past about things like frictionless billing.
13:04
So so what's your perspective? What what does
13:06
this look like in practice,
13:08
from for Banner Aetna, and how do you
13:10
balance human centered care with that push for
13:13
operational efficiency?
13:15
Yeah. That's a great question.
13:17
You know, it's funny. I think in a
13:19
lot of ways when we talk about these
13:21
different concepts, whether it's health outcomes,
13:24
costs, medical cost management, or member experience,
13:27
they're often talked about as competing goals. And
13:31
I think the way we view it as
13:33
they are
13:35
interdependent goals to one another.
13:37
Our model is not built to only lower
13:40
medical costs or only improve health outcomes or
13:42
only elevate the member experience.
13:44
It's really built around
13:46
those
13:47
three principles
13:48
being of equal weight
13:50
and of equal importance.
13:52
And
13:53
by integrating
13:55
Banner's patient centric clinical care with Aetna's deep
13:59
operational rigor and digital capabilities,
14:01
we're able to really
14:03
deliver against those three imperatives.
14:06
So for, you know, commercial plan sponsors, this
14:09
means that we're creating a healthcare experience that
14:12
helps their employees
14:14
stay healthy,
14:15
be productive, and be supported,
14:17
in their health care journey, but it also
14:20
gives those employers better control over cost and
14:22
outcomes. So it's both meeting the member where
14:24
they are and making sure that we're caring
14:26
for them and and the various health needs
14:28
that they have, but then also
14:30
equally able to demonstrate the rigor and operational
14:33
excellence needed,
14:34
to be able to manage a a health
14:36
plan at scale for for an employer of
14:38
any size.
14:40
I think from a member experience standpoint,
14:42
when we think about that and your question
14:44
around frictionless billing
14:46
in particular,
14:47
you know, we want to take off those
14:50
points of friction where they exist. And when
14:53
this business was set up, a lot of
14:54
what we looked at was what are those
14:56
critical pain points that a member experiences when
14:59
they go into,
15:01
get care, when they have that health care
15:03
journey experience?
15:05
And when we look at that and and
15:07
tackling things like, frictionless billing and how we
15:09
can simplify that, we we look at it
15:11
across the whole ecosystem. So we want to
15:15
simplify how members are able to access care.
15:17
We want them to understand their health care
15:19
benefit simply, and we want them to be
15:21
able to navigate the system
15:22
in a way where there aren't barriers to
15:25
care and there aren't barriers to understanding that
15:27
the care that they're getting, or paying for
15:29
that care. And we've invested in a lot
15:32
of a lot of the solutions around that.
15:34
So things like proactive care advocacy, providing digital
15:37
front doors, providing more of an integrated customer
15:39
service model that's powered by real time data,
15:42
and then shared accountability between our payer and
15:45
and provider teams.
15:47
I think what makes,
15:48
again, this arrangement unique is the ability to
15:52
combine
15:53
the empathy with the efficiency.
15:55
The empathy and understanding for the customer, whether
15:58
that's a plan sponsor or the member, as
16:00
well as the efficiency of being able to,
16:03
deliver those business results in a way that's
16:06
really gonna be meaningfully valuable to that customer.
16:10
You know, Banner brings a long standing commitment
16:12
to that relationship based community anchored care. So
16:15
it's rooted in trust. They have the local
16:17
presence, the deep clinical expertise,
16:20
things like same day appointments, providing culturally tailored
16:23
behavioral health programs,
16:25
having embedded care teams in primary care settings.
16:28
The emphasis is always on meeting the member
16:30
where they are and then treating the whole
16:32
person as part of that. And then conversely,
16:34
Aetna,
16:35
as the payer, brings the operational backbone to
16:37
make that scalable.
16:38
So from things like precision analytics and coordinated
16:41
care management
16:42
to streamline digital tools that reduce administrative burden
16:46
for the member and provider. You know, we
16:48
don't view operational efficiency as a trade off
16:50
to human centered care. Instead, we see it
16:52
as the engine that enables it. And when
16:54
processes are efficient and data flows seamlessly,
16:58
clinicians can spend more time with patients and
17:00
members, and, ultimately, the experience is more personalized,
17:03
timely, and effective.
17:06
Absolutely. Well, Ben Aretna is very clearly on
17:09
the forefront of that value based integrated care
17:12
model, John. So we really appreciate you sharing
17:14
your insights on where the company will continue
17:16
to go under your leadership.
17:19
But before we go today, are there any
17:21
final thoughts you wanna share with us, share
17:23
with our listeners, our health care leaders all
17:25
over the country? Any final bits of advice
17:27
you'd wanna share with them?
17:29
The only thing I would say is that,
17:31
you know, I'm incredibly energized
17:33
to step into this role,
17:34
coming up on four months now, and
17:37
I think this is a really
17:38
defining moment,
17:40
not just for value based care, but the
17:42
the health care industry broadly when you look
17:44
at market dynamics, what's going on, you know,
17:46
in the regulatory environment and otherwise.
17:49
I think it's a an exciting time. There's
17:51
a lot of challenges, and the challenges are
17:53
real,
17:54
but so is the opportunity.
17:55
And, you know, I firmly believe in the
17:58
model of this business,
18:00
and what can be delivered
18:02
ultimately in in bringing value to customers and
18:05
members and making health care simpler. And I'm
18:07
confident that we
18:09
can and and will continue to build something
18:11
that really is unique,
18:13
in Arizona. I'm excited for the future of
18:15
where this will go.
18:17
Fantastic. Well, John, thank you so much for
18:20
taking the time to sit down with us
18:21
and for sharing your thoughts with our listeners.
18:23
We really appreciate it. Thanks, Jacob. I appreciate
18:26
it. And to our listeners, if you'd like
18:28
to listen to more podcasts from Becker's Healthcare,
18:30
you can visit beckershospitalreview.com.