The Payer's Compass: Insider Strategies for Digital Health Partnerships

Speaker A: Hi Sukanya, Nice to see you and thanks so much for taking the time today to join Architect Health's the Front Door newsletter.

Speaker B: I'm so excited to be here. Thank you for having me.

Speaker A: Wonderful. Well, for asynchronous audience, let me share a bit of context. My name is Toam Shah and I'm the co founder and CEO of Architect AH Health. At Archduct Health, we improve cost savings and relieve point solution fatigue for health plans by aggregating, evaluating and managing virtual care solutions. As the front door for digital health, we cut through the noise of point solution so plans knows which one truly adds value. In our newsletter series, we interview healthcare executives and founders on their experiences with healthcare innovation, digital health and preventive care. Our goal is to identify pain points in these spaces and paint visions on how to address them, hopefully inspiring change makers in our industry. Today we are fortunate to have an incredible guest former Oller Wyman alum and helpline executive Sukanya Soderland Sukanya Soderland is Senior Vice President and Chief Strategy Officer for Blue Cross Blue Shield of Massachusetts, the largest private health plan in Massachusetts and one of the largest independent, not for profit Blue Cross Blue Shield plans in the country. Blue Cross's mission is to show up for everyone like they're the only one. The company guides members to the exceptional healthcare they deserve, affordably, equitably and seamlessly, and is consistently rated among the nation's best health plans for member service. Sukanya Ah, in partnership with the company's management team, is responsible for developing strategies that will drive Blue Cross's overall direction and achieve the company's business goals. She also leads data analytics, business performance and process improvement and innovation. Sukunya joined Blue Cross in 2018. Previously she was with Oliver Wyman, where she served as a Senior partner in their health and life sciences practice, co founded the Oliver Wyman Health Innovation center, and was the lead healthcare partner in Oliver Wyman's digital technology, operations and analytics practice. Sukhanya is a frequent speaker in national forums on healthcare transformation. She serves on the Board of the Trustees of Reservations and the Board of Museum Advisors for the Museum of Science. Sekanya holds an MBA from Harvard Business School and graduated magna Cum Laude from Harvard College. Thanks again for being here, Sukanya.

Speaker B: Thank you for having me.

Speaker A: Cool. All ready to get started?

Speaker B: I'm, um, ready.

Speaker A: Let's do it. So Sukanya, both of us started our careers in healthcare consulting at Alper Wyman. Tell us about your journey into healthcare, your work at OW and How that evolved into you leading strategy at one of the largest blues plans in the country?

Speaker B: Well, my journey into healthcare was somewhat serendipitous. Um, I actually started out in high school and actually even before high school more focused on social impact, uh, versus health care. I did the obligatory, as an Indian daughter did the obligatory research assistantship, um, dissecting mice hearts one summer, uh, uh, with a professor, uh, for some NIH work and discovered that was not for me and so hadn't anticipated I would go the pre med route and studied sociology and economics really with the desire to try to help um, make a difference in the world more from an um, intergroup relations standpoint. So I had done a lot of work with an organization called Seeds of Peace which brings youth from the Middle east and other parts of the ah, war torn regions of the world together. And that was really my orientation and focus. And what really got me interested in business was again serendipitous in that I had ah, worked as a volunteer ah, research assistant for a professor at Harvard Business School, Rosabeth Moss Kantor. And she was studying um, the power of public private partnerships and had assigned me to interview leaders in the city of Denver. And as I was interviewing both business and nonprofit leaders in Denver, what I recognized was that the business world had much to offer to the not for profit world. And so that is what sparked my interest in learning more about business. And I figured I um, might pick up some tools and tricks along the way if I did a couple of years, no more what I thought in consulting. And that led me to Oliver Wyman where initially I started off doing anything and everything under the sun, save uh, for health care. So both strategic and operational consulting and anything and everything except for health care. And then about a handful of years in um, I ended up joining the then fledgling health and life sciences practice. It was just a handful of us getting started um, in focusing on health care. And I joined that practice for two reasons. One was uh, because I thought there was an opportunity to meld my interest in social impact with my love of the problem solving and working with clients of consulting. And the second was that the founding partners were people whom I really respected and appreciated working with. And culture is very important to me. And so then one thing led to another as you referenced and you know, I had the great pleasure of being part of the growth of that practice which is now, you know, and has been for years the highest growth, highest margin practice of the business. Um, we did a couple of acquisitions of other firms and then Also um, had the great privilege of working with the late Tom Main on founding the Oliver Wyman Health Innovation center, which was really focused on trying to put our money where our mouth was in terms of the mission of the health and life sciences practice, which was as you know, uh, as an alum, transforming health care through the relentless pursuit of a better way and trying to help close the innovation diffusion gap between what I call as the islands of innovation of all the disruptors uh, out there and the incumbents on the mainland. And so, um, I greatly enjoyed my time there and uh, had fun with the digital techsops and analytics folks as well. Uh, but when the opportunity uh, turned up to join Blue Cross Kushoda, Massachusetts I couldn't turn it down. I wanted to see if I might have um, the ability to have more impact on the field versus on the sidelines. And had great respect for what Blue Cross Blue Shield of Massachusetts has done as a pioneering health plan, um, in the country, both in terms of its impact in Massachusetts and its sort of outsized impact it's played over the years in terms of both access to care as well as um, the advent of value based care payment um, across the country.

Speaker A: Fantastic. And what an interesting journey to get from the work that you were doing in social impact all the way now to leading uh, uh, plans, um, strategy.

Speaker B: Um, yeah and my husband is ah, my Focus group of 1 I like to say. He's um, he's a physician, he's a nephrologist locally. So he keeps me very well grounded uh, on what's happening really on the front lines which is really where um, you know, it matters most. And so it's been very helpful to get that lens of what patients, um, patients are experiencing and what providers are experiencing. And as we all know healthcare um, is experiencing a lot of challenges right now. So I bear that with great, uh, humility and a sense of responsibility.

Speaker A: That's amazing. Transitioning slightly and kind of diving a little bit into your work, um, how has your view of digital health, like telehealth apps and virtual first care, changed over time, pre pandemic versus post pandemic. And uh, looking at your crystal ball, what does the future hold in store?

Speaker B: Well pre pandemic it was sort of fun, shiny objects that were a bit more on the fringe, uh, really interesting stuff but more of a novelty. And with the advent of COVID and the pandemic, digital health really became a lifeline uh, for many folks in many respects and came to the forefront. And now I would say it's sort of table stakes and there's an expectation that um, folks will be able to access health related needs in a digital manner. And the range there is very wide and broad as we know. Um, I think as I look to the future I anticipate that we will see further adoption and I would say integration of digital health into the traditional health care system and into I m might call it the non traditional more alternative health care system. And that's really a function of both the severe supply demand challenges that we face today which um, we're all quite aware of in terms of massive access challenges, um, spiraling costs, the uh, rising disease burden that the population is experiencing and as well as the advent of technology and advanced computing power and AI et cetera that might be able to help plug some of those gaps. And so what I'm anticipating moving forward is that we'll see more hybrid convergence of traditional care models with digital health models partly just out of necessity with admin cost challenges and um, supply shortages of staff, um and then frankly as I look at the younger generations I think their expectations are quite different. And so uh, the surveys have suggested that Generation Z as an example looks more to TikTok or their mother first for referrals uh as it relates to healthcare versus their primary care physician et cetera. And so I think we'll see um, a greater um, recognition and comfort with digital health that will get integrated in and then quickly. I'd say that I think we'll also see there could be more of a vector around the merging of digital health related solutions towards more of the curative therapies that are entering into the marketplace and that are growing uh, with the ability to take what's really tremendously sophisticated technology that's emerging now in terms of being able to cure certain conditions and diseases and being able to match them to the right people in the right way at the right time. And then I also think we'll see uh, digital health potentially facilitating a um, growing movement towards alternative care, uh, holistic care. Um, the Oliver Weinman forums, um, analysis worldwide of thousands of people suggest that upwards of 15% of the population are what they call explorers who are interested in alternative modalities to manage their health related conditions. And I foresee digital health playing a role there.

Speaker A: That's very, very interesting and I think several guests on our show have kind of mentioned similar um, predictions as in the pandemic was almost a proof of concept for some digital technologies. And now the baseline is the threshold is much higher um that we've proven it out, um, we found some solutions that do work and work effectively. Now there's a huge roadmap for the future about where these things can now develop and grow to continue to improve outcomes, um, and lower costs. Um, something specific and relevant to Blue Cross Massachusetts is the partnerships with OSHI Health and Virta Health that were announced. How does Digital Health fit into Blue Cross Massachusetts long term mission and transformation? Were there any challenges you face when determining the Digital Health strategy?

Speaker B: Well, as you referenced, our mission is uh, showing up for everyone like they're the only one. And in order to put that mission into action, our vision really um, is predicated on building trust with our members to be able to guide them and navigate them to the right care, right place, right time, at the right price. And in order to do that, we need to know our members, really understand who they are on a multidimensional level. Um, recognize what their needs are, understand what are the moments that matter for them where we can cut through some of the clutter. Because at this point attention is hard to capture for anyone, um, across the board. Um, and then how do we earn their trust so that we can help guide them, where appropriate, to the right set of options for care when they need them? And how do we make available, um, the broad and relevant set of options that are high quality, high value, that meet their needs, um, appropriately? And how do we know our providers well enough? And how are we able to apply the right kinds of measures and metrics to be able to provide that seal of approval, if you will, that gives our members peace of mind. And uh, so that's really what our vision is and what we've been working towards. And there are certainly challenges on that front, no question. I think probably one of the biggest challenges that we face that frankly the entire industry faces is around driving engagement and adoption. And part of that is uh, really finding the right opportunities to reach out to people and uh, cut through the clutter, if you will. And so we're trying to identify what are the moments that matter. Is it when someone, um, when someone doesn't have a PCP or their PCP has retired? Is it when someone gets diagnosed with a chronic condition or when they've lost their job or they've had a birth of a baby, you know, what are the right moments where we're able to build goodwill and, and um, offer value to our members and build trust and then uh, establish a longer term relationship with them along the way?

Speaker A: Fantastic. And um, a lot of what you're mentioning is kind of things that we're focusing on, um, as we're building in the digital health ecosystem as well. I love the point about providing the right care at the right time, but also the right price because that's so important. Um, you, you also mentioned um, the concept of this clutter. So let's dive deeper into that. The concept of point solution fatigue has been voiced consistently across payers, providers and even patients. What approach has Massachusetts, um been taking to address that?

Speaker B: Well you have point solution fatigue is absolutely ubiquitous at this stage, both in healthcare and I guess overall across the different elements of our lives right now. Um, partly I think, because there's no dearth of challenges, uh, in health care and no dearth of creative entrepreneurs who are trying to help solve for those challenges. And capital markets have been plentiful in the past and so we now have a solution for almost anything and everything it seems. And yet they are these islands of innovation like I referenced before, even islets of innovation like little bitty things. And so um, it is hard to drive the adoption, the engagement and integration into uh, care protocols and um, people's overall management of their conditions appropriately because it's just a dizzying array of solutions. What uh, Blue Cross has aimed to do is what many uh, health plans I think have also pursued as an approach, uh, which was initially to say how do we curate best of breed solutions? How do we identify who is most efficacious and has the right um, body of evidence to support their results and can integrate seamlessly and so on and so forth. And so we have done that and that is valued by many of our customers and members. And at the same time we have customers, particularly really large group customers, who prefer to identify um, innovators and vendors whom they would like to work and partner with. Oftentimes they establish these relationships on their own or counseled by brokers or benefits consultants as to whom they ought to be working with. And so we obviously want to make sure we are um, accommodating that and integrating appropriately there. And so one of the things that we're focused on, and I think much of the industry, um, is increasingly trying to understand and focus on, is how do we create the right air traffic controller, if you will? What is the almost like meta analytics engine that sits across, horizontally across all these various vertically oriented point solutions that may be optimizing for diabetes or for musculoskeletal or whatever the case may be, but aren't necessarily looking across the consumer or the member's journey and recognizing and Understanding what, where and how to optimize uh, appropriately. And so that is I think um, where we'll see the industry moving more and more towards. And you know, everyone likes to talk about having a platform and being a platform. I think that's the kind of platform industry wide where we are very much tailored to the needs and preferences and uh, specific characteristics of different members and their care teams to be able to best optimize outcomes.

Speaker A: I completely hear you. And we talk to customers, um, and organizations all the time about um, it's almost like Russian stacking dolls where you have the carrier, you have the tpa, you have an aso, you have uh, the self funded employer, a commercial employer, and everyone is getting inundated with emails from vendors, uh, and some of the point eligibility just comes into the communication and the clutter in your inbox when it comes to, well how do I even figure out which of these solutions are valuable, which ones my carriers have access to, which ones, you know, other kind of ecosystem, um, partners have access to. And then how do we kind of consolidate efforts? One for obviously the procurement and contracting piece of it, but also when it comes to what I show to my employees and members. And um, there has to be, like you said, something that sits across all these different pieces and combines and plays with them and integrates with them in a seamless, um, cooperative fashion. Um, something I think our audience would love to know is what are the most important criteria Blue Cross Massachusetts has when deciding to work with these third party solutions and vendors, especially those digital health solutions providing care delivery? Um, what are some prerequisites that you'd suggest to any companies planning on selling to plants today?

Speaker B: Sure. So the four primary criteria are around strategic fit, operational fit, economic fit or financial return and risk. And in terms of strategic fit, it's really about how does a particular solution stack up against our four outcome pillars, which are affordability, which is a function of both cost of care and administrative cost. Administrative cost of course being uh, smaller part of the equation, about 10% of the equation. For us it's about quality outcomes, it's about the experience and equity. And at any given point across various lines of business, as you can imagine, um, one or more of those dimensions may play in more heavily than another. But that is first and foremost. The second is around operational, um, fit or feasibility. And, and so this is really understanding um, what are the odds of success of implementation. Is there going to be a significant pull on our IT resources to integrate the solution? Is there going to be a significant pull on our precious few uh, dozen subject matter experts that get called upon for it seems almost every major strategic initiative in the company at a given point in time and so forth. The third is around the financial fit and that's really about the ROI that our actuaries obviously will want to verify. And we also are being uh, quite mindful of not just what the um, upfront cost is for implementation of a particular solution, but what the ongoing cost is. And part of that is a function of the underlying profile of IT infrastructure related costs. So beyond what a vendor might be doing, a digital health vendor might be doing, that's been shifting as you might imagine as more and more of our solutions are put into the cloud and we're working with vendors from a uh, software as a service perspective. They're just built in escalators of what the cost profile will look like moving forward. And so we're m mindful of that as we're trying to manage our overall cost and capital portfolio. And then finally it's about risk and so data governance, data security, uh, ensuring that offender is hitrust, um certified and so forth. It is really important and critical for us. Uh, everyone's aware of the um, elevated nature of concern around all the data security and cyber risk related breaches that have been happening at a more frequent pace. And we're also looking for proof points for um, prior experience base that a uh, vendor may bring to bear that demonstrates that, that they have a successful track record of implementation. In terms of prerequisites, what I would say is it's very helpful when um vendors come to the table having understood what our underlying priorities are such that they can really find a way to tailor their value proposition to are key priorities. You know, it's hard to have um, a movement without some momentum and it's much easier to have momentum when you have a moving train. And so how do you hook onto an existing moving train within the company? Um, you know, I talk about it as two first three, first four first. You know, what are the things where the organization has already designated a particular area of focus, a key priority, has already um, identified KPIs that folks are accountable for delivering on, has already allocated IT resources, subject matter, expert resources, etc. Then the odds of success are going to be higher. So that's one prerequisite. The second prerequisite I would say is what I would classify as just good sales pitch hygiene. Right. Uh, and I've seen players improve on this over the years in so far as being very explicit about what Are the problems you're trying to solve, how does it hook into the overall priorities of the business? Uh, you know, what are the menu of those? If you don't know, uh, upfront, ex ante, um, what are the specific use cases? What is the demonstrated um, set of results, the proof points, the underlying assumptions behind whatever is um demonstrated as the roi? Who is the comparison set from a competitor standpoint? Interestingly very few players tend to offer that up but we're oftentimes trying to find a way to place how are you different from such and such versus such and such that just preemptively offer what that may be, tell us what it would take to work with you, what the lift would look like, how you're going to try to make it easier on us, um, from an integration standpoint, et cetera, how, how you make money, what you're looking for from us, so on and so forth, the basics that sound fairly basic but um, having been pitched by, I couldn't even venture maybe thousands of companies at this point. Uh, I find that there's a lot of variability on that front. And as you know the decisions to move forward with a vendor are seldom single threaded and held just by one business owner. And so therefore there are groups of um, individuals involved in the decision making process which can add to the length of time uh for contracting, et cetera. And so if you miss um, getting to some of the key points up front, you might not get a second shot or your second shot may be months in the making by the time meetings are scheduled with everybody's calendars aligned. And of course that decision making time frame does not align with the cash burn cycle of most digital health vendors. And so um, tightening that up can be helpful.

Speaker A: Very helpful. I mean this should just be a playbook I think at this point. Um, that's very, very interesting and something that you mentioned um, in that was touching on the price piece of it and uh, I'm m starting to notice a lot of vendors are starting to be more focused towards KPI based pricing, outcomes based pricing. Value based care leads um, perfectly into our next question which is digital health and value based care are two of the most talked about advancements in modern health care. Where do you see a natural intersection between the two? Can value based care arrangements drive the adoption of digital health and vice versa?

Speaker B: Yes, I do see an intersection for sure. I mean you know most fundamental level digital health is about new ways of delivering care and value based care payment models are about uh, paying for care differently to reward uh, Value versus volume and to incentivize the long form investments that are required for more preventative care, um, and effective chronic care management. Um, and so I do think the two can sort of be symbiotic if you will, in that um, value based payment creates a bit of a Runway for digital health companies that are in essence oftentimes trying to help individuals manage care more effectively, more upstream. And so it just stands to follow that with the right adoption and integration of digital health solutions, um, and a value based payment model that supports it, you can create the win win, win win that folks would be looking for across the plan sponsor, the payer, the um, risk bearing provider and ideally the patient as well.

Speaker A: Fantastic. And um, scan Health Plan CEO Dr. Sachin Jain published an article on Forbes last year about value based care and the issue of frequent member base changes. Dr. Jain credits you on the concept of long term enrollment. Uh, tell us more about your perspectives on how long term enrollment can drive value based care and how a future shift towards that system could be approached and what it might even look like.

Speaker B: Sure. Well I think Sachin's article did a good job of explaining it and I don't want to claim that I'm the only one who's come up with that idea but you know, the premise of it is as we were just discussing, you know, value based care is about enabling long term investments, right, um, that support the preventative and chronic care management and reward outcomes over value. And the issue as we know today is that most of the interventions that are out there that will actually bend the disease curve and bend medical cost trend, um, don't necessarily result in, in year actuarially verified um, returns and that's a standard by which they are um, assessed given that we operate in an in year benefit cycle. And so that's further complicated by the fact that we've got churn across members across health plans, employers, et cetera. So the incentives are just not really aligned for the types of interventions that would yield a multi year payback. And we know lifestyle factors of, you know, what you eat and how you sleep and manage your stress and exercise and so on and so forth and can account for 50 to 70% of the healthcare cost dollar. And yet those behavior changes which are really critical, um, don't necessarily yield the in year results. But if you're able to for example um, reduce someone's weight by 20, 30, 40, 50 pounds in a given year, it can indeed have a material impact in the odds of them having uh, a major acute event From a heart disease standpoint as an example, in a few years. And so you'd ideally like to try to incentivize and address that. And so, uh, the premise here is if we were able to shift from an in year benefit design model to a multi year benefit design model, you could start to create the right incentives, including the consumer incentives I should add, which is an area that's really underclubbed on today, uh, across the industry, uh, to be able to align uh, all the parties that are relevant against making the right choices, um, that can help uh, in the future. And so I do think that if, you know, for example in the Medicare space, if CMMI were to do some demonstration projects on this, that could have a material impact in influencing not just Medicare, Medicare, uh, Advantage, but have a downstream impact for the rest of the market, as oftentimes it's the case with CMMI demonstration project. Um, and then on the commercial side, if you, you know, if you envision more of a defined contribution model, not unlike what we saw with retirement benefits. Right, um, now this is this again, it's not something one can change on at the dime. There are a lot of regulatory and statutory related issues. You'd have to work with state departments of insurance and so on and so forth. But there is an opportunity to say how might we craft um, a multi year model that works? And certainly if one were looking to pilot that, you know, is in the Medicare arena, could be CMMI in the um, commercial arena, it could be partnering with providers that, excuse me, with employers that have highly tender tenured populations with great geographic density in a particular area, state populations, uh, et cetera, to see where and how we can start to move, uh, the dial on, um, investments that can make a difference and engage the member or the patient more actively. Because that's something now where we offer some incentives along the edges to folks, wellness incentives, et cetera, which um, may not be turning the dial in a significant way today. But one could envision how people have real clarity, not for everyone have to be opt in and it's only for certain folks to be clear. So it's not a panacea across the board. But for some folks, if we're able to identify upfront, hey, for you and your health profile, these are the biomarkers that matter. If you want to opt in to this following program and set of protocols, you could end it. And if you can hit these sort of hurdles, if you will, then um, you could regain X, Y or Z of your premium and you could choose how you use those benefits, um, in a way that matters to you, it seems so.

Speaker A: It's so simple in a way. Uh, we wouldn't talk about it philosophically as in we just need more time to provide uh these initiatives, um, access and measures to kind of see what the impact and outcome is looking like and be able to extract that uh, information and data. And I notice a lot of times organizations come to us saying one of the main challenges that we keep on seeing so much churn, the members come in, they come out and then the members don't even know how to track what uh, programs they're currently leveraging or which ones will transfer over. And so you have this kind of gap in between as they jump from employer to employer to um plan to plan. Um and uh, there has to be kind of some consistency whether it's in long term enrollment or being able to kind of have some horizontal layer on top of that as they transition from um insurance to insurance. Um, so I really really resonate with that. Um, now getting into our latter half questions or our last couple questions, um, curious to learn a little bit more about um, Blue Cross Massachusetts as it relates to the new Blues Network. So how does Massachusetts receive support from the Blues ecosystem? Putting your consultant hat on. How might smaller independent state based or regional plans approach innovative technologies or strategies without the support of a Blues like ecosystem?

Speaker B: Well our Bluecrest showed of Massachusetts members I think benefit greatly from the um, the Blues Network. So the Blues Network across The country comprises 110, 115 million members and there are a multitude ah of benefits but I'll highlight a few. The first and foremost at its core is the ability for members to access the Blue Card network which in essence enables members in a given state to be able, who are Blue Cross Blue Shield number to be able to access the UM coverage that they would like in other states. And as you know most Blues plans have um, the largest networks in their given region in terms of having doctors in network and um have better pricing or rates associated with that. And so that alone is a big benefit. Um, the second piece is around policy and advocacy. Uh, with the BLUES coming together there's no dearth of challenges in health care and we all want to try to make a dent in some way, shape or form. And it's easier when we're all pushing and pulling in the same direction. There are selected areas where um we'll focus. For example one big area of focus currently for the association and many of the BLUES is around maternal health and equity. That's something where we're joining hands together. Um, the third one that I will highlight is around future facing capabilities that would be hard to invest in at scale um on our own. And so one that is uh, perhaps most um prominent in my mind at this stage is the formation of a company called Synergy Rx that Chem Keck, the current Blue Cross Blue Shield association president CEO really sort of has rallied the troops on so to speak. And that is an entity that is playing a major role in trying to ensure that there is more efficient and effective contracting or medical benefit prescriptions. So these are things like infusions and injections that would happen in a medical setting, um, enabling more effective contracting and um, rates for those types of drugs which as you know are a rising part of the overall cost equation. And so um, with the advent of cell and gene therapies et cetera, uh which are exciting in terms of the impact that they can have and are daunting in terms of the costs. And some of these things can be multimillion dollars of cost. Sometimes even for one instance of them um, it's a big benefit. And that was actually also um, the catalyst for the formation of Synergy was um, the formation of a company called evorx which a handful of Blues including Blue Cross of Mass was involved in. And it's a company um, that we have with four other Blues plans which is really focused on saying similarly how do we reimagine the prescription drug chain and use real world evidence as a basis for ensuring that we can um, have value based pricing for prescription drugs um in a way that enables our members to get access to the drugs, the right drugs that they need at the right time at a better price. And then to the second part of your question, uh what can other plans that are regional or smaller in nature but not part of the Blues Network do to try to access similar benefits? You know certainly on the network side they can partner with other national health plans which many of them do. So for example point 32 here in Massachusetts partners with United to get access to the network rates. From an advocacy standpoint there are other um, industry associations that they can work with, AHEP being one example. But there are others that are focused on regional health plan in terms of the future facing capabilities fund. Putting my old consultant hat on as he suggested, what I would um, say there is, I think there's a real opportunity for regional plans to work together perhaps in concert with um, a like minded uh, venture capital and or growth equity firm that is willing to put capital on the table to bring some of their portfolio companies to bear to help co create product roadmaps of um solutions that best meet the needs of those health plans. And then those health plans would benefit from um advantage pricing, not have to put as much capital onto the table in exchange for guaranteeing some level of adoption of their services and so forth. And you know, it's not unlike I think what um, my understanding is general catalyst is trying to do with the health assurance um, transformation effort that they have that's a bit more health system focused. This could be a corollary on the payer side.

Speaker A: Yes, that's super interesting. We recently had Rebecca d', Amico, um, chief financial CEO of uh, PCSA on our podcast and she was telling us a little bit about synergy, how um, that kind of came to be and the work that they're doing. Um, and now they're trying to replicate similar type of models in other types of areas and industries. But we're curious to see how that plays out. Um, and yes, uh, I really echo your sentiment around um, Hatco. Uh, it seems like what Hemantinesia is doing on the health insurance front is the right kind of cutting edge of how do we just bring all these players into the ecosystem naturally and then tie um and create connections between each of those organizations to see what the impact can be at scale. Um, I'm curious to know if there's any, just my curiosity here, just any initiatives from the Blue Venture Fund or from Echo or from Cambia and to see how those interact and if there's an opportunity there that would be um, really, really interesting.

Speaker B: Indeed.

Speaker A: Great. So, uh, Blue Coast Massachusetts is consistently rated among the nation's best health plans in prevention, equity and treatment. Providing a plethora of care options and health benefits is only beneficial and effective when members can access them. What is Blue Cross Massachusetts secret sauce in engaging members,

Speaker B: I would say first and foremost it is our associates who are engaging our members on a daily basis. And um, having had the benefit of listening to their calls on a monthly basis, but also having had the benefit of serving um, many of our uh, call center associates, it's really remarkable. I have to say. Hats off to them. They're incredibly empathetic, kind, resourceful. They are working with members who are oftentimes at their most vulnerable point. Many of us have been there when you're near your breaking point, dealing with the healthcare system, when you or a loved one is sick and in need and it's a complex system to navigate and they are there working across multiple screens, across multiple applications, across, you know, having to manage upwards of thousands of workflows given the complexity of all the various products and derivatives of products that we have and so forth. And um, they're there to try to ensure peace of mind for our members. And so they really um, play a key role. And as, as uh, I'm sure you and many of um, the listeners have experienced, there are times when it just makes all the difference in the world to talk to someone when you're in need, who's kind and understanding and who will listen and who, even if the answer isn't what you want, you know, they're trying to help meet you where you are. And so hats off to our associates for all of what they do on that front.

Speaker A: Amazing. Um, last question for the newsletter and podcast today. What are you most looking forward to for the rest of 2024? What are some changes or trends in health care that you are most excited to witness?

Speaker B: I think what I'm most curious about for 2024, the balance of 2024 and beyond for that matter, is um, what is going to happen with the Medicare Advantage landscape? And so as we know, you know, Medicare Advantage has been a major growth arena for most health plans. Um, you know, there's a silver tsunami age wave of folks aging into Medicare on a daily basis. Um, and with the right Medicare specific operations and focus, um, it's an attractive marketplace or has been an attractive marketplace for health plans. And um, the penetration rate of Medicare Advantage is as high as it's ever been with you know, on average one out of every two Medicare eligible Americans, um, choosing Medicare Advantage. And yet as we know in the last few months in particular the landscape has started to shift a bit. Um, with CMS's, um, rates coming in lower than many had anticipated, with escalating medical utilization, with the rising bar of requirements for achieving four plus star, um, uh status and the associated quality bonus payments, which are a big revenue driver for a lot of health plans. With the changes in the risk adjustment uh, rules as we enter into um V28 and so forth or RN V28,

Speaker A: um,

Speaker B: it's a different landscape. And this is all against the backdrop of a setting where we've kind of preconditioned the marketplace to expect what some would call almost like an all you can eat buffet. Right? So as folks have raced to try to capture the Medicare Advantage member, um, we've loaded up lots of benefits, supplemental and otherwise. M 5, 6, 7 um, you know, uh, $0 plans that are being, uh, put in place. And so that's sort of the expectation that we're operating with now. And now with this new, um, you know, this, this bid season, many plans have been, uh, finding ways to, uh, to hone in on what are the things that they think will really turn the dial and have had to tailor things, tailor benefits back. And we've heard about many national plans even publicly declaring that they're anticipating losing, uh, 5 to 10% of their Medicare Advantage membership and so forth. And so I do think this is an interesting space to watch. Um, necessity is a mother of invention. And I do think it will place a greater emphasis on health plans that really want to compete effectively in Medicare Advantage, sharpening their focus on what really matters. And then, of course, we've got the complexity of it being an election year, um, added to the mix there. So that's something I'm curious to see unfold.

Speaker A: Very interesting. It's almost like the constant, uh, lemonade, business school, lemonade stand, case study of are you going to drop prices? How can you drop them lower than zero? Are you providing silver sneakers? Are you providing these type of transportation benefits, uh, additional health benefits? Um, so I'm very curious. We had John Blum, um, CEO of cms, on recently and he mentioned that they are actually trying to find ways to amplify the existing capabilities of traditional Medicare as a competitive way to nudge some of these MA plans in, um, innovating. And so, again, I'm as curious as you are. Um, this has been amazing, Sukhanya. Amazing insights, really appreciate the words of wisdom. I'm going to throw a surprise question to you. Are there any one or two healthcare executives that you look up to, um, that you would love to see us interview on the Front door newsletter?

Speaker B: Sure. You already mentioned him. I'd recommend you guys chat with Sachin Jane.

Speaker A: That'd be fantastic. We'll get in touch. Amazing. Thanks again.

Speaker B: All right, take care.