Payers are planning to grow their value-based models, improve health equity, implement new technology and more in the coming years.
The 21 leaders featured in this article, part of an ongoing series, are all speaking at Becker's 2024 payer roundtables. This includes our spring Payer Issues Roundtable, which is set for April 8-9, 2024, at the Hyatt Regency in Chicago. Some executives will also speak at our fall Payer Issues Roundtable, which is set for Nov. 4-6, 2024, at the Hyatt Regency in Chicago.
If you work at a health plan and would like to join as a speaker in April or November, contact Randi Haseman at rhaseman@beckershealthcare.com
Question: What does growth look like for your organization over the next 12 to 24 months?
Faris Ahmad, MD. Medical Director, Clinical Partnerships at Blue Cross Blue Shield of Michigan (Detroit): Growth over the next 12 to 24 months will involve a combination of strategic planning, innovation, and responsiveness to market dynamics. Such as:
- Population health — Developing/expanding our programs to address chronic disease management and preventive care.
- Value-based care models — Advancing value-based care models that focus on outcomes rather than volume, fostering collaboration between the payer, providers and patients.
- Investment in technology — User-friendly online platforms, mobile app and telehealth services, as well as advancing our data analytics when evaluating quality metrics and outcomes.
- Customer experience — Improve communication, personalize services, and simplify our claims and enrollment processes.
- Innovative partnerships — Collaborate with providers, vendors, technology startups, and other stakeholders to enhance our ability to deliver comprehensive healthcare solutions.
Abdou Bah. Senior Vice President of Medical Management and Chief Health Equity Officer of EmblemHealth (New York City): EmblemHealth currently serves over 3 million people in the New York tri-state area. In addition to increasing membership in our existing customers, we are uniquely positioned to support New York City's growing health insurance needs. Our local presence, infrastructure, and focus on quality, as evidenced by our NCQA Health Equity Accreditation, allow us to effectively partner with the city and federal government to provide access to affordable, high-quality healthcare for all.
Neel Butala, MD. Chief Medical Officer of HiLabs and Assistant Professor at the University of Colorado (Aurora): HiLabs has had a 75% year-on-year growth in revenue and headcount since 2021, and we are on track to do the same or better this year. Growth is driven by growing demand for our services, including payers coming to us to co-create novel applications of AI in healthcare data.The burgeoning demand clearly indicates that health plans are embracing AI and seeking partners with healthcare domain knowledge to drive innovation to improve the healthcare experience. We're most excited about our growth in the clinical application of our AI model, including FHIR and other interoperability applications. More and more stakeholders in healthcare are recognizing that clean, quality data is a crucial input to realize AI's potential for predictive, unbiased medicine, and we expect that trend to continue into 2024.
Jessica Chaudhary, MD. Medical Director at Carelon Behavioral Health (Indianapolis): There are numerous opportunities for growth for our organization. These include expanding care for an aging population by expanding Medicare Advantage and offering greater access to in-home services. There will be a greater emphasis on managing chronic and serious disease outside of an acute care setting. There is further opportunity for expansion in the areas of mental health and pharmacy services. The engine of our growth, Carelon, will continue to focus on delivering whole health solutions, especially for the seriously ill and most vulnerable populations.
Manu Chaudhry, DDS. President of Capitol Dental Care (Salem, Ore.): Capitol Dental Care, a dental care organization in Oregon, constantly and continually seeks to elevate humanity. Several key initiatives over the next 12-24 months include:
- Advancing reverse dental-medical integration including Ha1c testing, vaccine administration, health information exchange, and value-based purchasing.
- Melding social determinants of health with dental services through community information exchange.
- Measuring and improving population/community/individual health.
- Continuing to identify root causes of health inequities, pilot programs to mitigate them, and scale/sustain these innovations.
Po Chou. CEO of EVMS Medical Group (Norfolk, Va.): Growth for our organization in the next 12 to 24 months consists of 30% to 50% growth and diversification of revenues, further collaboration with our partners, and seed planting in future strategies and deployments.
Erin Drinkwater. Chief of Government Relations and Strategic Partnerships at MetroPlusHealth (New York City): MetroPlusHealth had an outstanding 2023, closing the year with a peak membership of 760,000 serving nearly 1 in 5 New Yorkers enrolled in the Essential Plan, Medicaid or Child Health Plus. As we look ahead, our priority goal is to double down on our standing as a provider-owned plan, owned by [NYC Health + Hospitals], the largest municipal hospital system in the country. From a policy perspective, our aim is to increase awareness among elected officials and other decision-makers at all levels of government in discussions related to healthcare delivery and member outcomes. We will also continue to expand on our work in the diverse communities and neighborhoods of New York City, creating opportunities for meaningful engagement to serve New Yorkers across the five boroughs.
Jason Feuerman. President and Chief Executive Officer of LTC ACO (Kennett Square, Pa.): 2024 presents new opportunities for us to care for beneficiaries, enhance quality outcomes and reduce costs. Last year, we introduced predictive analytics models for hospitalization risk, end-of-life care, and medication management, with 2023 preliminary results due by Q1's end. Looking ahead, we plan to extend our care beyond nursing homes, emphasizing precise ICD-10 code capturing for accurate risk representation in our 2025 contract period. We remain very bullish and enthusiastic about our continued ability to grow, improve quality and create healthcare efficiencies. Our provider partners are incredibly dedicated and committed to this high-needs population, and we will continue to support them through data and predictive analytics powered through artificial intelligence to achieve our fully aligned objectives.
Gen Gillespie. Co-Founder and Chief Revenue Officer of Belong Health (Philadelphia): We'll be hitting the third anniversary of Belong Health in March, and as a start-up our growth looks different than a mature health plan or cost-of-care risk management company. Over the next 12 to 24 months we are accelerating growth of providers and beneficiaries in our ACO REACH model. We also continue to refine and evolve our partnership model and are doubling-down on our MA/D-SNP, with some partners looking to launch those products in risk partnerships with Belong and others looking to Belong to help them improve the cost and quality outcomes of their existing lines of Medicare business. Finally, we are expanding our care delivery capabilities with our partners via deployment of our Belong Medical Group. Through all of this, we're taking innovative steps to better manage long-term program and plan performance to deliver high-value care and outcomes. We strongly believe in community-based care and therefore have a preference to go deep in the communities we serve on behalf of our partners to generate the collaboration and outcomes health plans, providers and beneficiaries want to see.
Joe Glinka. Director of HealthChoices at Highmark Wholecare (Pittsburgh): Medicaid redetermination processes will have a dampening effect on net enrollment growth for the foreseeable future. Once the impact of the unwinding process concludes, growth should become more visible.
In a broader context regarding growth, we are continuously assessing opportunity, relevance and sustainability of expanding service offerings within our current markets to assist plan members, providers and community-based partners. In this regard, redetermination has served as a stimulus to help drive positive momentum that will extend beyond redetermination and become business as usual.
Robert Groves, MD. Executive Vice President and Chief Medical Officer of Banner | Aetna (Phoenix): Our Banner | Aetna CFO, Dan Keller, says it best. "2023 was a strong year of membership growth for Banner | Aetna. We expect to continue that growth in 2024 driven primarily by the individual and small group segments as we are well positioned from a price perspective."
Michael Hunn. CEO of CalOptima Health (Orange, Calif.): Growth for our Medicaid health plan here in Orange County, Calif., with nearly 1,000,000 members out of a population of 3.2 million, will principally consist of newly eligible individuals, regardless of immigration status, ages 26 to 49 that can now apply for full-scope Medicaid services (called Medi-Cal in California). Growth for our insured rolls is NOT good news because it means that more individuals or families are becoming low income or living below the federal poverty level. Our critical focus will be to ensure a medical home for each individual and support of our safety net providers to ensure network adequacy for care.
Sheri Johnson. Vice President of Member Billing and Enrollment at UCare (Minneapolis): As the leader of membership billing and enrollment at UCare, I'm looking at how we need to grow/change operational processes to support organizational growth. Growth for us is all about leveraging new and existing technologies to improve efficiencies, shorten timelines, and meet member needs and preferences. Robotic process automation and AI are exciting technologies that we want to understand and implement as part of our operational growth strategy.
Hossam Mahmoud, MD. Regional Chief Medical Officer of Carelon Behavioral Health (Boston): Over the next 12 to 24 months, Carelon Behavioral Health is implementing and expanding programs focused on enhanced support and services for three key populations: members with severe mental illness, members with substance use disorders, as well as children, young adult, and family services. While the eligibility for these programs starts with behavioral health, the expanded programs take on an integrated, holistic approach and incorporate health-related social needs to ensure whole-person support.
Heather O'Toole, MD. Chief Medical Officer of Select Health (Murray, Utah): Select Health has seen remarkable growth over the course of its 40 years of service, and we have no intention of slowing down. Our optimistic growth projections for the next two years are built on the foundation of our core markets in Utah, Idaho and Nevada, while also capitalizing on our successful entry into Colorado. We are confident that our growth strategies will be enduring, promoting retention and leveraging unique partnerships through innovative value-based care arrangements.
Payam Parvinchiha, MD. Interim Chief Medical Officer of SCAN Health Plan (Long Beach, Calif.): It is an exciting time at SCAN. The next stage of SCAN's growth will focus on delivering a differentiated experience for our members. In addition to serving as a leader in designing personalized products and services, SCAN will deliver a clinical-focused model that complements the work of our partner medical groups in each region.
Jack Shoemaker. Business Operations Delivery Lead at Medical Home Network (Chicago): We see growth and opportunity with value-based contracts that focus on overall health outcomes rather than price alone.
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): Growth for our healthcare delivery organization will be focused primarily on two things: people and value-based care. We have to take care of our people because they are the ones who take care of our members. Without a concrete focus on people, career pathing, succession planning and overall professional development, we will not be creating or keeping the workforce we need to remain successful. Without a focus on value-based care strength, we will continue as a country to pay more and more for healthcare without demonstrable, quantifiable improvements in quality care. Both of these areas are critical for our continued growth and progress forward.
Chris Wasel. President of Marketing and Strategic Partnerships at Vantage Healthcare (Canton, Mass.): At Vantage Healthcare over the next 12 to 24 months, we expect to maintain our double-digit growth by continuing to offer a provider-friendly environment supported by enhanced technology tools delivering a more efficient and effective service. This approach will help us to preserve our ability to attract providers interested in working in post-acute care and senior living settings. Our clients experience improved outcomes by Vantage delivering with experienced, talented providers supported by innovative systems and attracting prospective client interest. Our experience and confidence operating under value-based care models continues to grow offering further opportunity for growth … We are optimistic about the next 12 to 24 months.
Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): Atrio Health Plans expanded into new counties in Oregon and Nevada in 2024. Most of our members reside in rural areas of those states, but we now have members in Reno, Nev., and Portland, Ore., as we seek to broaden our footprint into the urban markets. The key to successful growth for us is to keep the members' needs central to the decisions we make — most of our members have access to an Atrio service center, where they can speak with plan representatives about any issues or concerns. That isn't something that most of the larger and multistate plans are able to offer, and it sets Atrio apart favorably. Establishing collaborative relationships with the brokers and providers in those communities will help drive growth in 2025; if those professionals feel favorably about the plan, then they will be more likely to recommend us to the members they interact with.
Troy Williams. Vice President of Hospital Partnerships at First Choice Health Network (Seattle): First Choice Health will be in a transitionary growth phase during the next 12 months. We are implementing significant infrastructure upgrades that will position us well for new markets, and to accommodate growth from 2022 and 2023. The next 24 months will see the growth cycle accelerate, utilizing our new capabilities and processes and positioning our company well for 2025, anticipated to be our largest growth phase in over a decade.