Payer leaders are turning their attention to health equity, prior authorization, AI and more as 2024 approaches.
These 23 industry leaders explain their top priority for 2024. The executives 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. 9-10, 2023, at the Swissotel in Chicago.
If you work at a health plan and would like to join as a speaker in April, contact Randi Haseman at rhaseman@beckershealthcare.com.
The following are answers from our speakers at the events.
Question: What's your top priority for 2024?
Don Antonucci. Chief Executive Officer of Providence Health Plan (Portland, Ore.): In 2024 Providence Health Plan will continue to focus on accessibility, affordability and overall member experience. Value-based care arrangements remain a top strategic priority for us. By working with our provider partners and shifting focus from volume-driven services to outcomes-based models, we can ensure that members receive the highest standard of care while keeping healthcare costs down.
Arta Bakshandeh, MD. Chief Medical Informatics Officer at Alignment Health (Orange, Calif.): At Alignment Health, my top priority for 2024 is to continue to work closely with our data and clinical care teams to refine our proprietary AI-powered AVA platform to improve member care and elevate member experience. We're pleased with what AVA and our clinical model have accomplished when it comes to health outcomes over the last 10 years, but we've only scratched the surface. We're excited by our potential to deliver even more personalized and precise member care while reducing the administrative burden on our doctors and care teams.
Jessica Chaudhary, MD. Medical Director at Carelon Behavioral Health (Indianapolis): My top priority for 2024 is to see mental health on equal footing as physical health. While there have been improvements in reducing the stigma around mental health, people continue to suffer in silence. There remains a hesitation to discuss candidly issues around mental health in the same way issues around physical health are discussed. We can all help to solve these challenges by encouraging open and honest dialogue and communication, offering compassion and support, and making mental health a priority in school, the workplace, and in our homes and communities.
Mac Davis. Vice President of Digital Product and Data of Belong Health (Philadelphia): For 2024, we are doubling down on our most impactful member interventions and provider coaching and engagement activities. Scaling some of our early successes in AI and workflow embedded models are a huge part of this. This will allow our people to increasingly focus on developing the personal connections that drive behavior change at scale.
Robert Groves, MD. Executive Vice President and Chief Medical Officer of Banner | Aetna: Prior authorization reform tops my list. The reason is clear. Prior authorization is a burdensome and archaic process which is long past due for an overhaul. No one likes it. All segments (payer, provider, patient) acknowledge the problem, and we now have technology that can not only serve to support physician decisions in the moment, at the point of service, but can also cut through the complexity of insurance contracts and guide both provider and patient. We have the technology to eliminate "mother may I" and provide real-time decision support and on-demand peer to peer. We need the will to make it happen. Time is wasting. Let's do this.
Jessica Hohman, MD. President of Cleveland Clinic Accountable Care Organization: Our top priority for 2024 is to optimize our home-based continuum of care for our patients. To do so, we will be focusing on better identifying and personalizing how to engage patient segments of varied risk as well as integrating and growing our home-based suite of post-acute, wraparound and acute services.
Michael Hunn. Chief Executive Officer of CalOptima Health (Orange, Calif.): As a Medicaid public health plan serving nearly 1 million members in Orange County, Calif., the top priority is to serve each individual with dignity and respect by focusing squarely on access to quality networks of care.
Will Johnson. Vice President and General Manager of +Oscar Modular Solutions at Oscar Health (New York City): 2023 was a great year for +Oscar, which is our technology platform driving better engagement, outcomes and business performance for clients across the healthcare ecosystem. We've been specifically focused on externalizing Campaign Builder, +Oscar's engagement and automation platform.
As we look to 2024, we want to continue this momentum by focusing on a few specific goals. We want to: 1) continue delivering for our existing clients, 2) partner with new clients, and 3) launch differentiated features and services to bolster our offering.
We’ve been fortunate to have the opportunity to partner with both leading provider and payer organizations to support their engagement efforts. Next year, our top priority is delivering for those clients and expanding the universe of use cases we address for those clients. In parallel, growth remains a critical focus for us, and we'll be actively engaging new potential partners. We have a robust pipeline of differentiated features and solutions that fit within the Campaign Builder Ecosystem, and we expect these additions will support both "1" and "2" throughout 2024 and beyond.
Gregg Kimmer. President and CEO of Atrio Health Plans (Salem, Ore.): My primary priority in 2024 is to continue Atrio's focus on addressing customer service with the best "hands on" experience possible from a Medicare Advantage carrier. Regardless of all the other things we focus on, if we don't properly onboard and take care of our members, nothing else matters. It's important to remember they "choose" to be with us, and that it's a privilege to serve them.
Brian Li. System Director of Community Health Strategic Initiatives at CommonSpirit Health (Chicago): My top priority for 2024 is to involve communities affected by health disparities in the planning and decision-making processes of our initiatives. Their insights and needs should guide the design of both short-term and long-term strategies. This ensures that our initiatives are culturally sensitive and relevant.
Alex Li, MD. Chief Health Equity Officer of L.A. Care (Los Angeles): As the new chief health equity officer for L.A. Care, which is the largest public health plan in the country, our top three health equity priorities are:
- Addressing maternal and child health with a focus on vaccine catch-up for those young children that missed their vaccine series and improving Black maternal and infant health outcomes.
- Improving physical and mental resiliency and creating a safe environment for school-aged youths and ensuring that the school is a safe and healthy environment for them to learn and grow.
- Addressing the key social and healthcare service needs of our unhoused population in Los Angeles County.
Rob Low. Divisional Senior Vice President of Corporate Strategy Data and Analytics at Health Care Service Corporation (Chicago): Our top priority for 2024 is to scale our deployment of artificial intelligence to improve the member experience. In healthcare, AI has the potential to drive transformational impact across many areas, including driving better health outcomes, strengthening partnership and alignment with providers to support the patient experience.
In 2024 our focus is specifically to roll out a suite of intelligent solutions that promote member engagement and retention. We will expand the use of AI: to perform intelligent customer service call analysis; to prioritize members for outreach; and to anticipate unique preferences, identify healthcare needs, and deliver personalized, timely insights to keep members healthy.
Hilary Marden-Resnik. President and CEO of UCare (Minneapolis): One of our top priorities for 2024 is to continue to move the dial in addressing health disparities in a meaningful, measurable and sustainable way for some of the most vulnerable members of our community. This means looking beyond traditional healthcare access and delivery to critical social drivers of health that impact our members where they live, work and learn. Our extraordinary team will continue to leverage the power of our community partnerships to make a real difference for our members and their communities.
Mamata Majmundar, MD. Chief Medical Officer of Evry Health (Dallas): My priorities revolve around early identification, effectively engaging members and providers, which can lead to better outcomes and lower costs. Three main areas are around prevention, data collection and building collaborative relationships. This involves enhancing preventive healthcare efforts to increase utilization of screenings such as diabetes and hypertension, colonoscopies, mammograms, and immunizations to capture deficiencies that occurred during the pandemic. Simultaneously, bolstering data collection processes for early identification to drive people toward the right resources to empower them to engage in their care as well as actively nurturing collaborative relationships to strengthen our value-based partnerships moving toward at-risk models, aligning incentives, and focusing on quality. These efforts can deepen engagement, improve access, and create high quality care.
Doug Nemecek, MD. Chief Medical Officer of Behavioral Health at Evernorth Health Services (St. Louis): My top priority is to improve access to high-quality behavioral healthcare for all patients. One way we'll do this is by deepening our partnerships with providers and advancing our new, innovative measurement-based care program for behavioral health that focuses on improved outcomes. Through this program, we will collaborate with providers to drive interventions that will benefit patients, clients and mental health professionals alike.
J. Nwando Olayiwola, MD. Chief Health Equity Officer of Humana (Louisville, Ky.): Humana continues our focus on integration of health equity across our business in support of our members and patients. We are committed to three strategic health equity priorities where disparities among our membership exist: improving disparities in access to care and quality of care and addressing barriers to healthy living through supporting our members and patients in improving unmet social needs. We look forward to leveraging our strategy toward health equity with intention.
Kimberly Reich. Privacy and Compliance Officer at Lake County Physicians' Association (Gurnee, Ill.): My top priority for LCPA for 2024 is Medicare and Medicaid enrollment. LCPA wants to understand how to build a five-star Advantage plan for Medicare enrollees as well as working to expand our provider network. We want to become a provider for Medicaid members within Lake County. Health equity remains a top priority after Medicare and Medicaid enrollment.
Ashish Shah. CEO of Dina (Chicago): The market no longer needs convincing on the importance of home-based care and benefits. We see this reflected in both the number of health plans (Medicare Advantage, D-SNPs, C-SNPs, I-SNPs, MLTSS, etc.) offering these benefits, as well as member sentiment/desire to access care at home.
Our top priority in 2024 is to support our clients on their quest to improve access to these benefits/services, better coordinate multiple services when necessary, and comply with emerging reporting requirements from states and CMS on the utilization and outcomes as a result of these benefits.
John Snyder. President and CEO of Sanford Health Plan (Sioux Falls, S.D.): Member engagement will be a top priority for us in 2024. Last year we implemented a preventive care virtual visits program for our membership that has proven to be an incredibly important touchpoint for identifying where our members are encountering barriers to care and then collaborating with them on how to re-engage. Sometimes the issue is as simple as the member doesn't connect with their primary care provider — or that they don't know specialist care is available for them. The nurse practitioner team that does these visits also identifies needs that likely would have gone unseen or unnoticed in a more standard clinical setting. Part of our ongoing focus on member engagement will involve innovating to address the social determinants of health that most impact members in our rural footprint as we continue to facilitate open communication with our members.
Howard Weiss. Vice President of Public Policy and Government Engagement at EmblemHealth (New York City): My No. 1 priority for 2024 is to help policymakers and regulators understand what is happening not only at my company but across the payer community. Policymakers are demanding more of payers than ever before. Our community is expected to provide high-quality, affordable, hassle-free coverage while reducing inequities and increasing transparency in everything we do. Health plans are making considerable strides in these areas. For example, at EmblemHealth, we recently reduced the number of services subject to prior authorization, received federal grants to showcase how we address the unique mental health concerns of Asian and Black Americans, and were recognized by the National Committee on Quality Assurance for our work to improve health equity. Understanding what is happening here and with other payers is crucial to developing greater trust with policymakers and ensuring we continue to be heard as they consider changes to the healthcare system.
Chanin Wendling. Senior Director of Clinical Operations at Contigo Health (Charlotte, N.C.): At Contigo Health, we pride ourselves on building direct-to-provider and direct-to-employer health plan benefit solutions that allow our clients to increase access to high-quality care, control costs, and get people back to living their healthiest lives faster. In 2024, we are focused on enhancing our products to better meet the needs of our clients so they can achieve those goals. Enhancements include focusing on high impact care needs such as substance abuse and mental health, and better reporting and analytics so we can help our clients make adjustments to better care for their members.
Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): At Atrio, our top priority for 2024 is to better manage our growth. We are occupying a larger footprint in the Pacific Northwest market and need to develop new strategies that help us understand the needs of our new members and the communities in which they live. Some may need additional medication assistance; for others, transportation may be a greater need. Being able to quickly identify and respond to the needs of our members will be of primary importance.
Michelle Zettergren. President of Labor and Public Sector and Chief Sales and Marketing Officer at Brighton Health Plan Solutions (New York City): One of our top priorities for 2024 is enabling our self-funded clients and their members easy access to high-quality, cost-effective care that aligns with the plan sponsor's healthcare strategy. In today's market, plan sponsors are focused on quality outcomes and are seeking new ways to achieve cost-effective results for their members. Our 2024 strategic investments will focus on continued technological advancements that support member navigation and data transparency, custom provider contracting that aligns incentives and rewards for quality care, expanded medical concierge services for members, including the most vulnerable, and collaborating with strategic partners that share our vision of improving healthcare for the diverse populations we serve.