Future leaders in the health insurance industry should stay curious, keep an eye toward the future and put members first, executives say.
Becker's asked leaders from across the payer space their best advice for the next generation of leaders in the industry.
The executives featured in this article are all speaking at the Becker's Payer Issues Roundtable, which will take place Nov. 9-10 at the Swissotel in Chicago.
To learn more about this event, click here.
If you would like to join as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.
Question: What is one piece of advice you would give future leaders in the payer industry?
Don Antonucci. President and CEO of Providence Health Plan (Portland, Ore.): My advice to future leaders in the payer industry is to foster and maintain an insatiable curiosity. Embrace the transformative power of technology in healthcare, channel your curiosity into enhancing member and patient experiences, support and enable healthcare providers, and relentlessly seek meaningful solutions to promote healthcare equity for all.
Matt Bennett. Senior Vice President of Care Delivery at Evernorth (St. Louis): Healthcare is undergoing a massive transformation, and now is the time for stakeholders across the industry to come together and transform how care is accessed and delivered. Having had the personal fortune to work for both payers and providers during my career, I would highly encourage leaders to experience the different dimensions of healthcare. By forging stronger partnerships, leveraging the power of our combined data, and leaning together into value-based care, we can create a far better patient experience that significantly improves health and value.
Neel Butala, MD. Assistant Professor of Medicine-Cardiology at the University of Colorado School of Medicine (Aurora); Chief Medical Officer of HiLabs: Future leaders in the payer industry must invest some time to become familiar with the latest advances in big data and AI, which are poised to transform payer operations and member experiences in coming years. Understanding the basics of the technology underlying the latest machine learning algorithms, large language models and big data processing workflows will enable them to "speak the language" of AI. This knowledge will enable them to choose the most appropriate AI solutions for payer pain points in the future and avoid common AI pitfalls — such as poor-quality input data, minimal configurability and high false positive rates — that can lead to adverse business and member outcomes.
Caroline Carney, MD. President of Behavioral Health and Chief Medical Officer at Magellan Health (Maryland Heights, Mo.): The advice I would give the future leaders in the payer industry is two-fold: 1) always listen to your frontline staff — they know what really is and isn't working and what we need to solve for; and 2) to keep an open mind and be willing to partner with regulators, agencies, vendors and others — getting to the right outcome for those who we serve is the best goal, and in order to get there we need to think of working across the board.
Lyn Carter. Director of Employer Health Solutions at Trinity Health (Livonia, Mich.): Data integrity is critical. Conduct frequent audits, ask tough questions, and make no assumptions. Quality programs, risk adjustment, utilization patterns and claims data are all critical components to a successful plan, and accurate data is the foundation. In the era of shiny AI products and complex payment models, it's more important than ever that our basic skills, like data integrity and security, are executed flawlessly.
Ceci Connolly. President and CEO at Alliance of Community Health Plans (Washington, D.C.): The leaders of tomorrow need to be prepared to ditch the status quo. From the shift to value-based care and the surge in artificial intelligence models poised to relieve the burden felt by clinicians and consumers alike, the way that we deliver and cover care has changed. Leaders need to welcome these changes and be decisive, with a North Star guiding their vision on how to continue to adapt to provide the best possible care and coverage for consumers.
Onyinyechi Daniel, PhD. Vice President of Data and Analytics Strategy at Highmark Health (Pittsburgh): Future leaders in the health insurance industry will need to be resilient and adaptable. Resilience in the face of some of our most pressing challenges — equitable, high-quality healthcare for all, at an affordable cost and with a great clinician and patient experience. Leaders will also need to have the ability to quickly adapt to the rapid changes and advances in the use of technology such as AI and machine learning in healthcare. Finally, it will be essential for future health insurance leaders to lean into strategic collaborations and partnerships with other payers, technology vendors, trade organizations, academic institutions and, most importantly, providers. Alignment of objectives is critical, given the multidimensional factors that determine health and well-being.
Mac Davis. Vice President of Digital Product and Data of Belong Health (Philadelphia): Payers rightfully have a culture of caution that prioritizes member safety, compliance and fiscal responsibility. But that culture has over-indexed the value we place on staff that say "no" or consistently find the reason "we can't because. …" At Belong Health, one of our key cultural values is to "find the yes, before saying no." A way to put that into practice is by focusing on saying, "Yes, if …" rather than "No." The phrase "Yes, if …" allows you to look for solutions that account for barriers, real or not, without losing focus on the actionable goal.
Rushil Desai. CEO of Aetna Better Health of Illinois (Chicago): As a healthcare leader, I'm focused on improving the healthcare system, and value-based care is key in this constantly evolving environment. My advice to leaders is to strive daily to serve members and providers by leveraging technology and clinical innovation to prioritize towards population health outcomes, improve quality and decrease cost through alternative payment models. Our health plan has one of the largest value-based care footprints in Illinois, forging strong provider partnerships to address health inequities and allowing for longitudinal healthcare experience, together. At the core is member centricity to simplify and improve the healthcare experience for greater engagement, adherence and outcomes.
Tenbit Emiru, MD, PhD. Executive Vice President and Chief Medical Officer of UCare (Minneapolis): Future leaders in the payer industry should be consumer focused. It will be imperative that they understand the consumers, how they like to be engaged with their health, their needs and preferences. What it means to be healthy can vary among individuals and therefore, what consumers will need to be healthy has to be customized to individuals. Future leaders need to be adaptable to ensure that their value proposition focuses on providing services that are personalized. Aided by technology, we have been accustomed to interacting with other industries and receiving what we want almost instantly with a simple click. Similarly, people want to interact with the healthcare industry when they want it, how they want it. Instead of consumers coming to medical institutions to access care, most care will be delivered wherever consumers choose to receive it. Future leaders in healthcare should put the consumers at the center of the industry and constantly shift their products and services to meet that need.
Wilson Gabbard. Vice President of Quality and Condition Management at Advocate Health Care (Downers Grove, Ill.): Although I have the unique position of sitting in the "payvider" space, my favorite part of working in healthcare is the endless opportunity to solve complex problems. From working with our patients, to working with our care teams, to working with our payer partners, there is a never ending supply of complex problems to solve. The most rewarding part however, is when you are able to align win-win opportunities for each of these stakeholder groups in ways that meaningfully impact health outcomes and that could be no more common than in value-based care. I hope that future leaders see the opportunity and strength in collaboration.
Robert Groves, MD. President and Chief Medical Officer of Banner|Aetna (Phoenix): My one piece of advice for future leaders in the payer industry is simple. Foster trust. This requires transparency, accessibility, simplicity and integrity. The data are already out in the ecosystem. If your network underperforms, if your PBM hides sources of profit, if your processes are unfair, eventually everyone will know. It is not a question of "if" your practices will be exposed, but rather "when" and "how" exposure happens. Anything you do and/or say will be scrutinized. It is always better to address your flaws, to expose them and commit to changing than to have someone else expose them. When information becomes public knowledge, can you stand behind your decisions as a leader? Is your leadership trustworthy? Ask yourself that one question in every circumstance.
Mike Hill. CEO of Total Control Health Plans (Holland, Mich.): Payers are ground zero for improving a plan participant's healthcare outcomes and overall healthcare experience. Traditional health insurance has evolved into a bureaucratic mess focused more on defending one's turf and pointing fingers than the actual objective, which is helping plan participants get as healthy as possible, as quickly as possible, without going broke. A payer who is willing to build solutions that connect those who want to pay for high quality care with those who want to deliver it, in an efficient and transparent way, have the opportunity to disrupt a stale industry and change the trajectory of healthcare in the United States in a very meaningful way.
Dennis Hillen. Senior Vice President and Market Leader of Oscar Health (New York City): I would advise future leaders of the industry to lead with empathy. Consumers often encounter the healthcare system only when at their family's most vulnerable moments. The system needs to be easy, intuitive and should make the path to low-cost, high-quality outcomes the path of least (or no) resistance. At Oscar, we invest heavily in our member experience, seeking to engage our members early, often, and especially when facing the challenges that prevent them from living their lives.
Alex Li, MD. Chief Health Equity Officer at L.A. Care (Los Angeles): My rallying cry for my colleagues would be Affordable healthcare for all! Healthcare affordability is a major concern for many Americans and especially those with chronic health challenges and people with limited economic means. While it is true that Americans enjoy access to advanced medical services, however, indicators like life expectancy, maternal child health and others show that the U.S. spends more and gets less or worse outcomes relative to our peers. A few things that I recommend that we focus on include, an increase focus and investment to our primary care providers with more value based care and payments focused on preventive health services delivered to their assigned patients and to utilize our data to identify under resourced communities. Only through a more coordinated and focus effort, can we help address some of the risking cost with healthcare and get better health outcomes for those that we serve.
Brian Li. System Director, Community Health Strategic Initiatives at CommonSpirit Health (Chicago): Embrace a holistic approach to healthcare. Incorporate social determinants of health (SDOH) / non-medical drivers of health into your strategy. Recognize that health outcomes are not solely determined by medical interventions, but influenced by social and environmental factors. Addressing SDOH is not only a moral imperative but also a strategic advantage for payers.
To lead effectively in the payer industry, here are a few areas to think about:
1) Invest in data analytics to identify SDOH factors affecting your members.
2) Foster strong relationships with community organizations, healthcare providers and social service organizations.
3) Tailor interventions to the community — have interventions community led and community driven.
4) Prioritize preventive care and early intervention.
5) Continuously evaluate and assess the impact of your SDOH initiatives and adjust strategies as needed.
6) Advocate for policy changes and investments that address root causes of SDOH.
By improving the overall health and well-being of your members through a holistic approach, you can achieve better outcomes, reduce costs, and promote health equity in the community.
Hilary Marden-Resnik. President and CEO of UCare (Minneapolis): Whether you are leading a payer organization, a provider organization, or any other organization — my advice is simple: As a leader, your most important role is to create and foster an environment in which your employees don't just understand the mission . . . rather, they are passionate about the mission and proud of how they carry out the mission to improve lives. This passion and pride are the difference-makers that lead to success in every other area of the business.
Ed McFadden. Assistant Professor of Health Care Administration at Trevecca Nazarene University (Nashville, Tenn.): Payers should focus on the member experience, especially in the administrative areas where direct member interaction occurs. How do you make it easy for the member and the payer agents to do the right thing? Find out early what members' communication preferences are, address the regulatory requirements (consents, etc.), and use the preferred communication channel consistently. It is also essential to recognize some communication approaches are more effective for certain types of requests for all members. Confirming receipt of uploaded, mailed, or faxed documents should be seamless. Look beyond the historic payment "rules" built into the legacy systems and give the claims processors and customer service agents a level of authority to eliminate resubmissions that detract from the member experience and cost the plan more in labor than any disputed amount.
Beejadi Mukunda, MD. Vice President and Ohio Market Chief Medical Officer of CareSource (Dayton): Be member-focused and be innovative. Broad-based strategies that involve providers are more likely to be successful than individual outreaches by the plan. Artificial intelligence is likely to change the landscape in healthcare — be at the forefront of change and innovation!
Krystal Revai Sodaitis, MD. Associate Chief Medical Officer of Health Alliance Medical Plans (Champaign, Ill.): I would tell future leaders that while it's important to stay focused on serving your members, do not lose focus on the physicians and other providers that serve those members. Value-based payments are often hidden within larger payment structures that are not directly seen by the care providers. This delays gratification and may dilute motivation to complete value based payment related tasks. Develop programs collaboratively that positively impact or incentivize the direct care providers, not just the system as a whole.
Ashish Shah. CEO of Dina (Chicago): We're encouraged by health plans that are leveraging supplemental benefits as an integral part of their value-based care strategies and programs, and we hope more health plan leaders will do the same. For example, we're seeing plans take advantage of preventative interventions, including home safety evaluations and home modifications, healthy meal programs post-hospitalization, ADL support through homemaker and home health aide services, and transportation for both medical and non-medical appointments. With strategic investment and utilization tracking, there is growing evidence of immediate and significant financial benefit for the plan, improved quality of care for members and an improvement in overall health plan satisfaction.
Jack Shoemaker. Business Operations Delivery Lead at Medical Home Network (Chicago): Think big. Start small. Act fast.
Praveen Thadani. President of Priority Health (Grand Rapids, Mich.): Payers play an important role in enhancing access, ease, quality, equity and ultimately affordability. Hold yourself to a high standard to enhance member health, well-being and community health. Relentlessly partner with providers to accentuate and enhance this focus on simplification toward better health outcomes. Make your members a part of the solution by engaging them. Be steadfast and remember, your responsibility is to improve health, and provision of coverage is a part of that responsibility.
Johanna Vidal-Phelan, MD. Chief Medical Officer, Quality and Pediatrics, UPMC Insurance Services Division and Clinical Assistant Professor of Pediatrics at UPMC Children's Hospital (Pittsburgh): My one piece of advice to future leaders in the payer industry is that to be a great leader, you need to understand the healthcare industry as a whole, not only the perspectives of the payer world. As a payer you are an important part of the healthcare industry and it is imperative to understand the needs of your customers, to engage with your providers, and to proactively study, anticipate and respond to the competing landscape. The various aspects of healthcare are all connected and, to excel in the payer world, you must understand the needs of the population your organization serves. You must remain aware of and be prepared to address the barriers to care and access to service limitations experienced by your members. You must also clearly comprehend and remain connected with the provider experience where clinical services are being delivered. This delicate and fragile co-existence of care continues to be redefined and changes frequently. There is no status quo in the healthcare industry. Flexibility, curiosity and innovation are key to the success of a future leader in healthcare.
Howard Weiss. Vice President of Public Policy and Government Engagement of EmblemHealth (New York City): Listen to your MDs as much as your MBAs. As divided as our country's politics are, Democrats and Republicans agree that consumers need to better understand healthcare pricing and utilization management programs. This means policymakers are likely to demand changes to ensure payer and provider financial incentives reward outcomes. Cost control will continue to be important. However, policymakers may require savings as much from providers and drug companies as from payers, whose primary role will be to coordinate behavioral and medical services to improve outcomes in cost-effective ways. These developments could put even more pressure on payers' clinical staff to create programs that achieve these results.
Chanin Wendling. Senior Director of Clinical Operations at Contigo Health (Charlotte, N.C.): All of us in the industry, from payers to providers to pharmaceutical companies to the government, need to embed driving real change and value to healthcare in what we do. We need to let go of legacy thinking and legacy ways of doing things. We need to take a deep look internally and be bold in asking whether a process, a policy, a workflow is enabling improving outcomes at the lowest cost and simplifying the healthcare experience for employers and members. If it's not, we need to be leaders and change it or get rid of it, even if others in the industry are not yet ready to take that step.