Payer Perspectives from Health Evolution Summit 2021

The backdrop for payers coming through the COVID-19 pandemic balances the realities of continued enrollment growth in managed Medicare and Medicaid, and an acceleration of emerging capabilities like virtual  health and home-based care. Recently, Dawn Owens, CEO of TripleTree Holdings, moderated the Payer Insights panel at Health Evolution Summit 2021, where payer CEOs shared their perspectives on the new drivers of competitive advantage and consumer engagement, their posture toward digital, primary care, and traditional provider systems, and more.

We’re pleased to share a recap of this discussion written by Gabriel Perna, Senior Manager, Digital Content at Health Evolution, which is also available on the Health Evolution website. 

Payer execs on COVID’s impact on membership engagement, organizational priorities and more

For David Holmberg, CEO of Highmark Health, the large integrated health system based in Pennsylvania, the impact of COVID was apparent early on. In February of 2020, he received an early morning call from Cynthia Hundorfean, CEO of Alleghany Health Network. 

“[Hundorfean] called me on a Sunday and said, ‘I need you to come into the office, we’ve got a meeting going on.’ I walked into that meeting in my running clothes. There were 20 doctors and clinicians, and they laid out what they believed was the worst-case scenario. And my ask that day was to call the governor, pull the fire alarm, and say, ‘This is really exploding.’ It was all on the basis of data,” said Holmberg during a discussion at the 2021 Health Evolution Summit, Payer Insights. 

From that moment on, Holmberg said, Highmark relied on real-time data to keep track of what was happening from patients and members. He says the company created a Naval aircraft-like command center with multiple screens and data points that tracked real-time cases, admissions into the hospital, death, success stories and much more. Having this data allowed Highmark to focus their efforts in engaging members, and double down on the things that had a high return, both economically and from a purpose standpoint.  

Holmberg was joined by Dawn Owens, CEO of Triple Tree Holdings, Felicia Norwood, EVP and President of the government business division from Anthem, and Paul Tufano, Chairman and CEO of AmeriHealth Caritas. The four leaders discussed how COVID has had an impact on their health plan’s membership engagement and re-emphasized organizational priorities around culture, resiliency and value-based care.  

Membership engagement during COVID  

AmeriHealth has similarly leveraged data and analytics to track members during the COVID crisis, said Tufano. They used this data to find the COVID hotspots that were impacting high-risk members of the Medical Assistance (Medicaid) managed care health plan. And then Tufano said it was a matter of prioritizing outreach for those members. Beyond this one-on-one engagement, Tufano said the company reached out to local community organizations to increase vaccine uptake and promote other critical public health measures. 

“At times, we turned our wellness and opportunity centers, which we have in our markets, into vaccination centers, and engaged with our members and community leaders to talk about the importance of vaccination,” Tufano said. “And I think the one thing for all of us in this part of the health care industry to really underscore is the importance of us doing more for those of our neighbors, our fellow Americans who have challenges that became more acute during the pandemic.” 

He said that the pandemic created a closer relationship between the company and its Medicaid members, which in turn has made the organization recommit to addressing the social determinants of health. “We need to be focused on the life outcomes of our members in the Medicaid space,” Tufano said. The company also prioritized mental health services and whole-person care for these underserved populations, he said.   

At Anthem, Norwood said the company’s 80,000 associates spent countless hours calling millions of members to see how they were doing and if they had access to the fundamental essential things you need to get through every, single day. Like AmeriHealth, they also partnered with community organizations to increase membership engagement during COVID. Norwood said that it’s imperative this collaboration continues after the pandemic ends.  

“I think the engagement we’ve had with community-based partners during this time is something that absolutely should continue. That is the only way we’re going to be able to reach our members. It’s really what it means to be committed, connected, and invested in the communities that we serve,” Norwood said at the Summit.  

Culture matters and continues to matter 

Norwood credits the culture of the organization, led by the vision of CEO Gail Boudreaux, for ensuring the company stayed aligned in trying to engage its members and achieve other important goals. 

“We had culture conversations. We communicated often with associates. We gave our leaders the tools to lead, trying to help them understand why culture mattered,” Norwood said. This was especially important when workers had to go remote, she noted. “It was the north star. It was what mattered in terms of being able to make sure we had alignment across the organization during this time, with turbo charge, communication and collaboration. And giving the tools to managers to lead remotely, which was something that they really haven’t had to do before.” 

To Norwood’s point, the executives said that the pandemic showed the importance of collaboration and organizational alignment. “This moment in time has crystallized that importance and how foundational it is to the success of high-performing organizations seeking to serve important populations,” Owens said.  

This was the case at Highmark. The organization carved off teams to work on critical projects and “play the chess game,” Holmberg said, meaning they leveraged different skillsets. “They were different people from different organizations, and throughout the enterprise, and they had a role. And then, we had to make sure that everything aligned,” Holmberg said.  

Tufano added that the switch to remote work for the company’s employees worked because of its organizational commitment to resilience and ingenuity. It was a slightly less jarring transition because at the beginning of 2020 the executive team strategized around what a remote workforce would look like. After that tactical outlook, AmeriHealth began the transition to remote before everyone else started to do it in March. That led to a larger cultural acceptance where people within the company became willing to take on more risky projects, Tufano said.  

“I think we have to really reflect on the resilience, and what we were able to accomplish that maybe many of us didn’t think was possible,” Tufano said. Another important cultural priority at AmeriHealth was increased communication across the organization, he noted. “I came to appreciate the importance of being visible even more than I was before, of talking with associates, doing virtual town hall meetings, answering people’s questions, and asking the management team to spread out and do that as well.”  

Value-based care remains a priority  

The organizations are coming out of the pandemic with an increased commitment to value-based care. As a large insurer and a health system, Highmark has a significant investment, to the tune of $6-$7 billion in revenue, in risk-based contracts, along with more than one million members on the insurance side. The commitment to value at Highmark comes in the form of its “Living Health” initiative, Holmberg said, which has become laboratory to leverage technology and test value-based outcome models.  

“We’re able to take full risk and that’s what we are, with millions of patients, and learn and figure out what works from a value-based outcome standpoint. It has to improve quality and safety outcomes and reduce friction. And if it does those things, it will also impact affordability,” Holmberg said. “Fee for service is a problem. I mean, it was a problem before COVID, and it certainly was a problem during COVID.” 

Norwood at Anthem said the company is focused on value-based payment arrangements for its Medicare Advantage business, which has become increasingly popular she noted. They have also seen increased receptivity from providers about making the transition to value, particularly with its partners on the Medicaid side, which has seen a huge influx of members from the pandemic. But there’s a lot to work from a model structure standpoint, she noted.  

“I think there’s the opportunity to rethink what some of those value-based care arrangements look like. A lot of discussions come back to the fact that when you you’ve seen one value-based arrangement, you’ve seen one, particularly when you think across the state landscape in which we do business. There’s a lot of work to be done there, primarily with respect to Medicare and true risk arrangements and where we’re going. But it’s a great opportunity,” Norwood said.  

Tufano said value and affordability remain a priority for AmeriHealth, and within the scope of the pandemic, it’s shown that the company is heading down the right path.  

“We as a company have seen why our long commitment to value-based care makes a lot of sense. And we think coming out of the pandemic, we see more and more interest from providers in having value-based relationships. We feel pretty good about that,” Tufano said.