Payer executives shifted their focus to population health and implemented new strategies in 2024.
The five executives featured in this article are speaking at Becker's Spring Payer Issues Roundtable. The spring roundtable will take place April 28-29, 2025 at the Hyatt Regency 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.
Note: Responses have been lightly edited for length and clarity.
Question: What was the best change you made in 2024?
Michael Hunn. CEO of CalOptima Health (Orange, Calif.): In Orange County, California, CalOptima Health provides Medicaid health insurance to one third of the 3.1 million population. In 2024 we focused our significant resources outward, meeting our members where they are! On the streets with a street medicine program, in neighborhoods by helping to fund 1,220 housing units, in their homes by providing in-home supports and medically tailored meals, and in schools by providing mental health well spaces — just to mention a few of our initiatives. The best is meeting our members where they are!
Sachin Jain, MD. President and CEO of SCAN Group (Long Beach, Calif.): SCAN's victory in our Medicare Stars litigation prompted industry-wide star ratings recalculations. These recalculations applied to over 60 plans and drove $1.4 billion in bonus payments to the industry — leading to better Medicare Advantage benefits for over 1 million beneficiaries.
Phillip Randall. Director, Population Health & Community Programs at Banner|Aetna (Phoenix): A fantastic change Banner|Aetna made in 2024 was to expand our population health programming to include more in-person experiential learning and peer support. At their core, our population health programs are intended to empower high or rising-risk members to make real, lasting lifestyle modifications that lead to better health. However, making lifestyle changes isn't easy. And because each person is different, there is no one-size-fits-all solution. That's why our wraparound support combines the power of virtual and digital tools with meaningful face-to-face interactions, ensuring members receive the help they need — when and how they need it.
Brian Smolich, PharmD. Vice President of Quality and Managed Care Operations at Health Alliance Medical Plans (Champaign, Ill.): Removing a brand biologic agent from formulary and successfully converting members to a lower cost biosimilar without impacting member's clinical care.
Chandni Sud-Thavakumar, EdD. Vice President, Performance Operations at Mass Advantage (Worcester, Mass.): In 2024, the best change we made was to implement ways to proactively identify barriers for our members or areas of concern when it came to leveraging their full benefits to improve their health. Not only did this help us better predict where our product design needs to change, but it also helped improve retention and experience. In addition, investing in better reporting and synergy of workflows across the business to focus on the right leading indicators and KPIs allowing us to improve performance concurrently as our members seek care.