Equity & Timely Access as a Stars Strategy

Leaders from Independence Blue Cross, Oscar Health and TytoCare explore how health plans can leverage various solutions effectively to optimize pricing structures; exploring technology adoption, cost-effectiveness, and market competitiveness. Our panel of industry experts will share successful strategies and real-world examples you can implement in your organization.   Topics covered include: Matching benefits with member personas Evolving virtual care beyond video Various innovations in product design  Bringing price transparency to ACA and Medicare Advantage products How to penetrate new, highly competitive markets   Guests: Jonathan Stump, Vice President, Product Services, Independence Blue Cross Bill Bradley, Vice President, Insurance Product Development, Oscar Health Meni Shikhman, Vice President, TytoCare   Bios: https://www.brightspotsinhealthcare.com/events/differentiating-your-product-in-the-healthcare-insurance-marketplace/   This episode is sponsored by TytoCare TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services, reduces the total cost of care by an average of five percent, diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.

Kody Kinsley, Secretary of North Carolina’s Department of Health and Human Services, joins Eric to discuss how his state is improving the lives of families and children by expanding Medicaid and improving the mental health system.    Secretary Kinsley shares strategies for improving behavioral healthcare access and benefit design for North Carolina’s Medicaid and Medicare members, including peer support programs, mental health crisis lines, and data systems to track the availability of beds and individuals in need.    The conversation also explores the importance of improving healthcare infrastructure through Medicaid, focusing on preventative measures and addressing social determinants of health.    About Secretary Kinsley Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget.   With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education, and labor policies and served as the COO and CFO of the U.S. Treasury.   Secretary Kinsley’s three priorities for the department include Investing in behavioral health and resilience, improving child and family well-being, and building a solid and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the most significant investment to bolster the mental health system in over a decade. Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley.   

Leaders from Humana, Blue Cross, and Blue Shield of Rhode Island delve into the dynamic landscape of specialty value-based care, sharing valuable insights and actionable strategies for navigating its complexities.    Show Guests: Alexander Ding, MD, MS, MBA, Associate Vice President for Physician Strategy and Medical Affairs, Humana  Nick Lefeber, Senior Vice President, Value-Based Care, Contracting, Data & Analytics, Blue Cross Blue Shield of Rhode Island Rachel Winokur, Chief Executive Officer, TailorCare   https://www.brightspotsinhealthcare.com/events/the-evolution-of-specialty-value-based-care/   This episode is sponsored by TailorCare   TailorCare is a risk-based care navigation program that provides deeply personal support to patients living with joint, back, and muscle pain. By combining a careful assessment of patients’ symptoms, health history, preferences and goals with predictive data and the latest evidence-based guidelines, TailorCare helps patients choose —and navigate—the most effective treatment pathway for them, every step of the way.  

Melissa Newton Smith, Founder of Newton Smith, and Keslie Crichton, Chief Sales Officer of BeneLynk, join Eric to discuss the introduction of the CMS Health Equity Index, which will replace the reward factor within the Medicare Advantage Star Rating program measurement. The Health Equity Index will be a seismic change for Medicare Advantage plans and impact revenue associated with Star Ratings. Melissa and Keslie share success stories from plans preparing for the change.  Links "Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use": https://jamanetwork.com/journals/jama-health-forum/fullarticle/2814604 Book Links   $2.00 a Day: Living on Almost Nothing in America:  https://www.amazon.com/2-00-Day-audiobook/dp/B012E8RDS2/ref=sr_1_1?crid=29MW28TUOFAG0&keywords=%242+a+day&qid=1708126201&s=books&sprefix=2+a+day%2Cstripbooks%2C125&sr=1-1   Because I Said I Would: https://store.becauseisaidiwould.org/store/thebook/?_gl=1*qfwy3p*_ga*OTY3NTIzNTYzLjE3MDgxMjYyNDc.*_ga_9YFXHXM1VK*MTcwODEyNjI0Ny4xLjAuMTcwODEyNjI1NC41My4wLjA.    The Ethical Case Manager: https://www.amazon.com/dp/194388918X/ref=cm_sw_r_apin_dp_GVBYY6XZGAK9RK9VRHE8   About Melissa Melissa is the founder of Newton Smith. She brings over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Most recently, she served as Chief Consulting Officer at Healthmine. Melissa is a well-known healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience.  About Keslie Keslie has worked in managed care for over 25 years, focusing on SDoH solutions that improve members' lives and provide a return on investment for our clients. Keslie drives enterprise growth and innovative partnerships to improve outreach strategies and health outcomes for our client’s members.  Keslie works closely with BeneLynk’s product team to offer differentiated services and capabilities to maintain its market leader position.    This episode is sponsored by BeneLynk BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. They serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.

  Leaders from Independence Blue Cross, Banner| Aetna, and Scene Health share exclusive insights on successfully accomplishing chronic condition management success with fewer resources.    Our expert panel explores patient-centered and technology-enabled approaches that elevate chronic care management efficiency and effectiveness. Don't miss the opportunity to learn about strategic solutions tailored to the unique challenges of Medicaid and Medicare health plans.   Panelists: Robert Groves, MD, Chief Medical Officer & Executive Vice President, Banner| Aetna Reetika Kumar, MD, FACP, Vice President, Market Clinical Solutions and Pharmacy Services, Independence Blue Cross Sebastian Seiguer, CEO & Co-Founder, Scene Health Bios: https://www.brightspotsinhealthcare.com/events/meeting-goals-for-chronic-condition-management-with-fewer-resources/   This episode is sponsored by Scene Health Meet Scene Health, the industry leader in MedEngagement. They are going beyond traditional medication adherence to transform disease management.   Scene’s MedEngagement approach uses 1:1 async video to deliver medication support at scale.   Scene helps members get better fast—getting to the doctor, getting their meds, taking them as prescribed, and getting labs and vitals—driving cost-effective utilization and improving multiple clinical and quality measures in as little as 90 days.   Scene was commercialized out of Johns Hopkins, and has developed the most extensive catalog of peer-reviewed publications among medication adherence companies. Visit its website at www.scene.health for more information.

Leaders from Blue Cross and Blue Shield of Illinois, Independent Health, Evry Health and Vori Health discuss GP-1s and their role in addressing the global challenge of obesity. The panel shares innovative, multidisciplinary strategies you can implement to complement lifestyle interventions and other therapeutic approaches in your organization. * Improving outcomes by pairing GLP-1s with evidence-based behavior change * Considering musculoskeletal (MSK) health in obesity treatment * Understanding the role of GLP-1s in delivering value-based care   Panelists: Shelley Turk, Divisional Senior Vice President of Health Care Delivery, Blue Cross and Blue Shield of Illinois Martin Burruano, Vice President, Pharmacy Services, Independent Health Mamata Majmundar, MD, Chief Medical Officer, Evry Health Mary O'Connor, MD, FAAOS, Co-Founder & Chief Medical Officer, Vori Health   https://www.brightspotsinhealthcare.com/events/how-innovators-are-addressing-glp-1s-obesity-and-msk/   This episode is sponsored by Vori Health Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members get back to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spend with up to a 4:1 ROI. For more information visit www.vorihealth.com.

Seema Kumar, CEO of Cure, an innovation campus in New York City, joins Eric to discuss how artificial intelligence can positively impact healthcare and lead to more innovation. She shares how AI has been used in healthcare and the promise it holds for the future.   The conversation also highlights the Cure Xchange Challenge: Health AI For Good, an initiative to incubate innovations by healthcare startups and entrepreneurs across disciplines and sectors to use artificial intelligence (AI) responsibly and equitably. Cure collaborated with MIT Solve for the Challenge and an independent board of judges selected the ten finalists. The winners will be announced later in the First Quarter of 2024.   Seema shares the stories of several finalists, including Oben Health, an AI-enabled platform that facilitates the delivery of healthcare screenings, education, and treatment via barbershops and salons, and Nutrible, artificially intelligent social workers.   This episode is part of a series of episodes featuring the Clinton Global Initiative Commitments to Action from the Clinton Global Initiative. Please listen to the previous episode,  Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care.   About Cure   Cure is an innovation campus in NYC boasting laboratories, lecture, and office space, as well as technology and other amenities to set up innovators for success across the healthcare industry, including academic institutions and other nonprofits. Visit the website at: https://cure.345pas.com/

Blue Shield of California, Highmark, Intellihealth and NourishedRX discuss how they are mitigating the high costs of GLP-1s with lifestyle interventions such as behavior change, physical exercise, nutritional counseling and coaching to optimize outcomes for members living with obesity and diabetes.   Hear real-life examples and best practices to equip your members with the tools and strategies to achieve lasting success in managing obesity and diabetes beyond the limitations of GLP-1s.   This episode is sponsored by NourishedRX   NourishedRx is a leading digital health and nutrition company specializing in comprehensive nutrition solutions for consumer and health plan members living with diabetes, obesity and other diet-related conditions.   NourishedRx recognized food's healing and connective power, and partners with healthcare organizations nationwide to address the nutritional needs of their most vulnerable populations.   The NourishedRx B:B:C health and nutrition platform facilitates and optimizes personalized, culturally concordant food in addition to the tools necessary to drive lasting behavior change – leveraging technology so YOU can all deliver at scale.   Beyond diet, NourishedRx engages with health plan members and patients to support their whole health and lifestyle more broadly. They engage consumers with omnichannel wrap-around support and education, enabling individuals to make informed choices and gain a deeper understanding of the impact of their diet and lifestyle on their overall well-being, empowering them for the long term.   NourishedRx is well suited as an early alternative and/or companion therapy to specialized obesity treatment, including GLP-1 and other Anti-Obesity Medication therapies.

Leaders from Blue Cross and Blue Shield of Michigan, Highmark and Quest Analytics discuss how health plans are examining and reimagining their provider strategies to stay competitive and meet their members' evolving needs. By focusing on areas such as compliance, network adequacy, data integrity, and performance metrics, plans are redefining their own roles and enhancing quality and affordability for their members. Our panel of experts will share their insights and experiences. Possible topics of discussion: Compliance Network adequacy Data integrity Performance metrics & goals  https://www.brightspotsinhealthcare.com/events/differentiating-your-health-plan-reimagining-your-provider-network-strategy/ Quest Analytics sponsors this episode Quest Analytics’ software platform empowers you to analyze, expertly manage meticulously, and impeccably report on your provider network‘s adequacy and the provider data accuracy across your entire organization and all lines of business. You can trust them! CMS does, and they are among eight of the nation’s largest health plans that leverage its software and services, not to mention multiple state regulatory agencies and many of the nation’s leading health systems and provider groups. They manage, measure and monitor health plan network performance so that together, we can elevate the health of communities nationwide. They also enable health plans to differentiate their position in the marketplace through a vastly superior provider network. My words, not theirs, and I know I am simplifying things a bit …but think of them as the Kayak for physician quality and accessibility data. For more information, please visit the Quest Analytics website at http://www.questanalytics.com./     Connect with us on social media: Facebook: facebook.com/brightspotshc Instagram: instagram.com/brightspotshc LinkedIn: linkedin.com/company/shared-purpose-connect Twitter: twitter.com/BrightSpotsinHC TikTok: tiktok.com/@brightspotshc    

Sonny Goyal, Senior Vice President of Diversified Business Group and Chief Strategy Officer of Blue Cross Blue Shield of North Carolina (Blue Cross NC), joins Eric to share some of Blue Cross NC’s successful initiatives to help members live their best lives. Sonny discussed Blue Cross NC’s approach to mitigating social determinants of health, explaining the insurer is utilizing test-and-learn models to build quantifiable evidence, scale up successful models and, eventually, expand those ideas through its benefit offerings across the state. Sonny and Eric touch on several topics, including Blue Cross NC’s recent food insecurity pilot program, value-based care, provider relationships and community health initiatives. After listening, you’ll have many bright spots to consider implementing in your organization!   Links to articles mentioned during the discussion: https://www.bluecrossnc.com/blog/expert-takes/transforming-health-care/food-is-medicine https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0351 https://mediacenter.bcbsnc.com/news/blue-cross-nc-donates-500-000-to-the-forward-fund-established-to-support-transition-efforts-following-mill-closure   About Sonny Sonny leads the diversified business group at Blue Cross and Blue Shield of North Carolina (Blue Cross NC) while also serving as their chief strategy officer, He is responsible for thoughtfully guiding the company as it seeks to achieve sustainable long-term growth by enhancing its existing business and identifying opportunities to expand beyond via inorganic growth. Among other responsibilities, Sonny is accountable for managing and maturing the company’s best-in-class business partnerships and assets, shaping Blue Cross NC’s short-term goals and long-term strategy, portfolio planning and prioritization, corporate development and utilizing strategic intelligence to improve the experience of key stakeholders across the state. Before joining Blue Cross NC, Sonny served in leadership roles at several other leading companies in the healthcare, venture capital and finance sectors. Most recently, he was Executive Director for Corporate Strategy and Development for the Advisory Board Company in Washington, DC. Before that, Sonny led Mergers and Acquisitions for Highmark Blue Cross and Blue Shield; brokered acquisitions, divestitures and capital raises ranging from $250 million to $12 billion at Wells Fargo; and assisted in assessing venture capital investments for Garage Technology Ventures in Silicon Valley.  Connect with us on social media:  Facebook: facebook.com/brightspotshc Instagram: instagram.com/brightspotshc LinkedIn: linkedin.com/company/shared-purpose-connect Twitter: twitter.com/BrightSpotsinHC TikTok: tiktok.com/@brightspotshc