The executives featured in this article are all speaking at the Becker's Payer Issues Roundtable being held at the Hyatt Regency in Chicago from April 3-4, 2023. To learn more about this event, click here.
Editor's note: Responses have been lightly edited for clarity and length.
Question: What are your top strategic priorities for 2023?
Yan Yan, MD, MBA. Director of Strategy Advancement, Clinical Strategy and Analytics at Humana: My team's top strategic priorities for 2023 are to explore how we can best use all of our insurance levers and operations to drive value for all stakeholders, including members and providers, to enable and encourage high-value choices. Also, to collaborate with network providers and member groups to encourage greater adoption of and adherence to evidence-based care to reduce avoidable utilization and improve health outcomes.
Peter McCauley Sr., MD. Medical Officer at Cigna Healthcare: The first priority is to continue to embed health equity in our enterprise culture, systems, policies and practices. The focus is on strengthening our enterprise capabilities by developing a core learning curriculum to build health equity competency across our workforce. Second, to continue to equip customers, clients, providers, and communities to advance health equity.
In 2023, we plan to enhance our current capability to identify and address the customers' social determinants of health needs. We will do this by testing a curated network of locally-contracted, community-based organizations and track referrals through a closed loop data platform. This capability will allow us to assess how rapid support for SDOH may drive better health outcomes, utilization of care and reduced medical spending.
Finally, to continue to serve as a leader in health equity. We aim to leverage our progress from the first two goals to strengthen our position as a leader in health equity and partner of choice, and create health equity content to increase awareness internally and externally of our unique work in the health equity space.
Johanna Vidal-Phelan, MD, MBA, FAAP, Chief Medical Officer of Quality Department at UPMC Insurance Services Division; Clinical Assistant Professor of Pediatrics, University of Pittsburgh School of Medicine: 2023 will be a critical year for health equity. Health disparities are not a new phenomenon. When my medical career began more than 20 years ago, I quickly witnessed the impact of health disparities on the pediatric patients and families I was serving. Back then, although many would agree that disparities were unfair, few were willing to face the daunting challenge of addressing them.
Fast forward to the here and now, and so much has changed in the world, while the issue of health equity remains. Thanks to national organizations such as CMS and NCQA however, everyone is talking about health equity now and how we, as a healthcare industry, need to address disparities. I envision 2023 as the year where we move beyond the efforts of acknowledgement, education and obtaining buy-in, to a time of action and seeing positive results. It is true that the first step in addressing health disparities is to acknowledge them, but now is the time to move forward and take action. I firmly believe that 2023 is going to be a decisive year in the journey to achieving health equity.
Caring for our pediatric population and their families is also an important priority for our team. Because ‘children are not little adults,' addressing the needs of our youngest members requires the knowledge of clinicians who have experienced working with this important population, their families and support networks. We can't serve our pediatric members alone however, and that is why we are so dedicated to strengthening the partnerships we have with our pediatric providers, hospitals and the community.
We strive to continue improving the clinical treatments and quality of care provided to our pediatric members and families. We also acknowledge the challenges many parents and caregivers are facing with misinformation and how, as a healthcare industry leader, we need to remain steadfast in addressing vaccine hesitancy to help protect our children from vaccine-preventable illnesses.
Caroline Carney, MD. President of Behavioral Health and Chief Medical Officer, Magellan Health: My top strategic priorities for 2023 and beyond are really the same as they've always been. It's the tactics that evolve over time. I want to see evidence-based care be the standard in mental health and substance use disorder care. I'd like to see better disease management care in mental health, starting with more universal interventions in first psychotic episodes, early care — especially family-based treatment care for eating disorders, and shedding the idea that an app alone can treat mental illness.
I am very focused on collaborative care given our country's need for access and availability of mental health care. I am also very interested in matching the right level of care and support to a person's needs — not based on marketing or tradition alone. Finally, although this is a huge endeavor, we need to think about holistic systems of care so people don't fall through the cracks in today's discombobulated system. I am excited about the focus on behavioral health and look forward to what is ahead.
Kiki Louis, MD. Interim Chief Medical Officer and Head of Clinical at Oscar Health: My top priority is ensuring that my team is executing against Oscar's strategic company objectives for 2023. It's an exciting time at the company as we have entered the year with strong momentum across the business. We have a clear roadmap for the organization and are laser-focused on executing against that plan. Due to our disciplined execution in 2022, we believe we are better positioned than ever before to hit profitability for our insurance business in 2023.
With that in mind, our teams will be doubling down on the efforts we have in place to hit our medical loss ratio and administrative expense targets. Of note, we will be focusing our tech efforts and resource allocation on projects that aim to drive the most improvements in MLR and administrative efficiencies.
From a virtual care perspective, we have made impressive strides in our ability to provide high-quality care, while bending the cost curve and delivering a seamless experience for our members. We recognize the power of these plans to support the health of members who may otherwise not seek care and look forward to deepening this impact in 2023.
Robert Groves, MD. Executive Vice President and Chief Medical Officer, Banner | Aetna: Digital automation, patient engagement, and prior authorization reform.
Susan Beaton. Vice President, Health Plan Strategy, Wellframe (Boston): We're seeing health plans reinvest in their digital ecosystems to make sure they're capturing and creating the most value for their organizations and their members. They're also using digital tools to continue breaking down internal data silos and improving cross-functional relationships to deliver more cohesive member experiences. Plans are also starting to work more closely with providers to help advance public health initiatives and address health equity issues and barriers for Medicaid members.
Harshita Sahu. Director Of Analytics and Data Products, BCBS Massachusetts: Our top priority for 2023 is to enhance our patient journey by directing them to affordable care options including virtual primary care, mental health and other specialty support. Data analytics is central to achieving this goal and modernizing the healthcare payer landscape.
Heather Trafton. President and Chief Executive Officer, Mass Advantage: Continuing to build a high performing provider network resulting in lower medical loss ratio and increased patient satisfaction, as well as becoming a market leading provider affiliated health plan in Massachusetts. The long term result will be providing high value healthcare to members through a differentiated product offering via vertical integration.
Gregory LeGrow. Executive Director of Payer Product Market Strategy at athenahealth: athenahealth's vision is to create a thriving ecosystem that delivers accessible, high-quality and sustainable healthcare for all. To deliver on our vision in 2023, we are focused on helping healthcare providers make the leap from ‘volume to value' by supporting their efforts to deliver high-quality care and optimize their financial reimbursements.
By integrating payer member data into the athenahealth EHR at the moment of care our healthcare providers can better identify and address patient care and diagnosis gaps, leading to cost-effective, high-quality value-based care outcomes. We are also working with payers to help their members identify possible referral partners based on patient priorities such as being in-network and conveniently located.
Ceci Connolly. CEO at Alliance of Community Health Plans: This year, ACHP is gearing up to deliver our vision for a next generation Medicare Advantage program. MA has quickly become the choice of America's seniors and is an area in which ACHP members outperform the rest of the industry. We are thrilled to share our insights into how we can work together to continue improving this high-value program.
As we all know, Medicaid redeterminations are on the horizon and will likely be a perilous process, bringing significant uncertainty for millions of working Americans. ACHP, with its member companies in 37 states and the District of Columbia, is committed to doing everything we can to ensure that those who will lose Medicaid coverage can seamlessly move into another plan and retain access to equitable, affordable, high-quality care.
We have quite a few other things up our sleeves – continuing to lead the industry in the push toward value-based care, driving affordability for consumers and working with our member companies to address community needs through our Chronic Disease Pledge, which we are excited to roll out later this year.
Kristin Rodriguez. COO at Health Plan Alliance: In 2023, the Alliance is focused on supporting the provider-sponsored, regional and independent health plans within our membership in three critical areas. The first is operational efficiency as a strategic imperative, with particular emphasis on leveraging artificial intelligence and machine learning. Next up is the health plan consumer experience, especially for our provider-sponsored health plan members that want to partner with their provider owners to transform care pathways for aligned lives. Our final area of focus is value-based care and supporting advanced payment model design and execution; practice transformation is a critical piece of the formula for success.
Tim Kelly. Chief Commercial Officer at Carrot Fertility: As the leading global fertility care platform for women+, one of our top strategic priorities for the year is to continue expanding both the depth and breadth of our products, services and access to care. We've rolled out several additional products to support our members globally, and in the last year, we've launched Carrot Plans, personalized guides with thousands of possible combinations of options, each tailored to an individual Carrot member's specific needs, goals and health concerns. This year, we're continuing to focus on how we can best support our members on their lifelong fertility healthcare journeys and ensure they receive complete and comprehensive support.
Manu Chaudhry, DDS. President of Capitol Dental Care: 2023 strategic priorities include investing in provider-friendly technologies and services in order to reduce administrative burden, continuing growth and integration associated with movement towards value-based care, integrating social determinants of health concepts, and participating in measure development with the Dental Quality Alliance and CMS — especially with adult oral health.
In the long term, we aim for data sharing of all claims across all payers. This will include collaborating with all payers to best understand care coordination across medical, behavioral, and dental health platforms and social health organizations, in addition to discussing which dental services are appropriate from a public health approach and workforce diversity in comparison with commercial payers.
Sharon Williams. Vice President of Payer Relations and Managed Care at City of Hope Atlanta: City of Hope's top strategic priorities for 2023 are to accelerate growth and democratize high quality academic care, to strengthen workforce – clinical and nonclinical – through recruitment, to reduce expenses, and to continue our commitment to safety and quality to provide patient-centric care.