Healthcare strategy and innovation leaders from Aetna, Contigo Health, and Clarify recently hosted a webinar discussion about innovations in provider network design and management to drive higher-value, more affordable, and more accessible care for members. Watch the recording or read the transcript for unique perspectives on the intersection of technology, provider performance, and value-based contracting.

Webinar transcript:

Keith:

I’m excited to have a great panel today to talk to you all about network strategy, network innovation, and how we think about building, optimizing, growing really high performance networks that deliver the kind of value and economics that help keep our system affordable in ways while also obviously delivering the types of outcomes that are really important for us.

So what I think we’d like to do is I want to introduce my amazing panelists. I’ll give a quick introduction of myself and then I think we’ve got some really excellent questions around how they think about this in the business that they’re in, the projects that they’re specifically related to.

But just for folks who don’t know me, my name is Keith Florance. I’m the Senior Vice President and General Manager of the Payer vertical at Clarify Health. And part of what we do at Clarify Health is support the optimization of networks and helping identify who really are the highest performing, highest value providers in any given market so that you can construct, you can optimize, you can sculpt networks in ways that are really ideal for the types of strategies that you have in the market, whether they’re fee for service or value strategies as well.

So I’m personally really interested to hear in how this team thinks about how they do that in different value ways or otherwise. I’ve personally been in the value-based care, value-based economic space for about 15 years. And I know it’s been a slow haul, but seeing some of the ways that the companies from the panelists that are working against that, I’ve been really impressed by the moves that’ve been making. I’m really interested to dive deeper into how they think about it. So I’ve got Heather and Elyse with us today. And Heather, if you wouldn’t mind giving a quick introduction and then Elyse.

Heather:

Sure. Thanks Keith. My name’s Heather Ridenoure, I’m the Vice President Centers of Excellence, Segment Leader for Contigo Health. I’m working in this space of Centers of Excellence in surgical and chronic conditions direct to self-funded employers. Thanks for having me.

Elyse:

And hi, Elyse Pegler. I’m with Aetna, a CVS Health company. I lead our value-based care strategy within our network solutions and network innovation team.

How do you identify and select high-value providers to build and maintain a high-quality, cost-effective network?

Keith:

Wonderful. Thank you very much. I’d love to just kick things off just from a general provider network strategy, can you tell us how do you identify and select high value providers to build and maintain a network that delivers quality care but also cost savings at the same time? And you each will have a very different perspective based on your pieces in the industry. But Elyse, I’d love to hear how you think about that in terms of the value networks that you’re creating.

Elyse:

Sure. So we think about it in a multifaceted way. So in terms of our broad network, we are completely focused on the needs of our members. And so when we sort of flip that orientation between a health plan centric view of a network and where it’s really about all those provider transactions to instead starting to think about it from the member’s perspective and then building the network around that. We want as many of our providers that are in our broad network to be on this path towards value. And we support our providers in every way that we can along that path because first we want to meet them where they’re at, and that means that we have a range of models and dipping your toe in the water paper performance all the way to full risk. But no matter what we do, no matter how we engage with the providers, again, when it’s a value-based care arrangement, it’s flipping the paradigm on its head.

It’s becoming now where the provider and the health plan have shared goals. And our shared goals are to deliver that better care model for our members. And again, that’s where we get to that member centric view. We also care about access in our broad network. And so we also think about balancing that access with meeting providers, clinical social convenience needs. We think about integrating primary care, non-traditional providers, independent physicians, local providers, health systems to really make sure that we are again focusing on the whole person… Needs of our members. But again, we’re really trying to engage with all of those different kinds of providers to work on delivering that better care model. We also have performance networks that are very specific sets of providers that are our high value providers and they do include specifically our providers who are in value-based care. And that is an option for an employer or plan sponsor to choose when they’re selecting from our broad network and or our performance network.

And the real difference there is that we’re layering on top of the provider incentives, we’re layering now a member incentive through either benefit design differences, lower copays if you go to this provider or that provider. So we’re really trying to shift the members who are seeing perhaps lower value care providers to higher value care providers. And for those, we do have a more strict set of criteria around quality and utilization. We look at adverse events, average length of stay, readmission rates, quality. We have institutes of quality, which are our CoEs, which I know Heather will be talking about, but it’s really all about the right care at the right time and the right place, and we’re really trying to make sure that we are attacking that from all fronts.

Keith:

Excellent. And I have a follow-up that I’m dying to ask, but I’m going to have Heather talk from her perspective first.

Heather:

So from our perspective, there’s several steps in provider selection, but one of the first steps is looking at the reputation and available public data. We do feel that that’s important. That’s what a lot of our employers and healthcare consumers see. So we do evaluate that. We do that regularly with all of our providers and network because it’s important. So that’s a first step. Another step is looking at their quality and we use Clarify to do that. So we are able to see and clarify a full view of providers all the way down to the code level. So we look at facility and the actual provider of the service and we can look at the code level around complications, infections, length of stay, readmissions, and we use that to say, okay, is this someone that is of high quality that we would want to reach out and invite to participate in our program?

From there, we connect with the providers to see if they’re available to partner in a bundled type arrangement like we have. And that’s really where there’s some support needed because a lot are not at a place to do that, and there’s many limiting factors there for them. So we reach out to providers to see if they’re willing to partner and want to have a relationship in the Centers of Excellence type of solution. We also have experience as a part of our value equation. So we will site visit all potential providers and through that funnel, then the ones that pass all of those items and standards that we have will then be invited to be a provider inside of our high performing Centers of Excellence network. So it’s a complex process. We have sped up that process quite significantly using Clarify, I have to say. So this used to be… It’s always been the way we’ve worked, but it used to be very manual direct with provider data and you can imagine a lot of volume of data and our team would tell you extremely labor-intensive.

So we’ve been able to speed up that process using Clarify as a tool to actually get more insight into provider performance around the specific areas that we’re addressing in our solutions. So we then continue that process regularly with our providers in annual review and quarterly updates. So in that we’re partners with them, we’re reviewing the data, the data is directional for us, not definitive. And so we use that data for conversations and we have conversations with our providers for them to validate and discuss the data with us. And that really is where the collaboration and partnership is around what their needs are to be a high performing participant in our program. Sometimes that’s case specific, sometimes that’s data specific, but that partnership is really critical for us to continue the relationship and to have the ongoing monitoring and ensure the continued performance and value for our clients in our program.

Keith:

And Heather, can you dive a little bit into that? Can you tell me what does that provider meeting look like? Because that’s always such a hard thing when you’re saying to a provider, you are or are not in our preferred network, but here’s why.

Heather:

Yeah, I think crucial conversations are a big part of it. And understanding that data’s directional. So it’s starting the conversation. So we’re not saying that the data is the whole story, and I think that’s important because our providers have an opportunity to see what we see and then have a conversation about that and discuss what the validity of that is, the sample size adequate, does there other data that we’re not seeing that we need to consider in the discussion? And so I would say it’s crucial conversations with them about this is concerning, or we see something here, is this real? And then them having an opportunity to truly evaluate what they have and bring that back as the experts providing care. So we’re not claiming that we’re the experts in the provision of services they are, but they have things they need to bring back to the table in that conversation.

So I would say it’s very iterative back and forth, but ongoing transparency into what we see and what we think inside of the data is a critical piece. And they want to know that too, frankly. Our providers want to know what do we see about them that may be important not just in our relationship but in other relationships they may have. And so we feel like we’re bringing value to them too and telling them what we can see in data. And frankly in our cases, right? All of our patients… We have daily huddles every day on every case. That is not what we would expect. We bring that to our providers too. So we really feel like it’s an opportunity for them to learn, improve and expand what they do outside of us. But it’s a crucial conversation, frankly, is what it is back and forth.

How do you inform members about the network you’ve created and enable them select the best provider within a preferred network?

Keith:

I appreciate that. And Elyse, I promised you that I would have a follow-up for your comment as well. And you began the comment around member centricity, and we already have a follow-up question on that in the Q&A, which I’m excited to get to, but I’m actually personally curious… The way that you put it, how do you actually inform the members around the network that you’ve created to enable them to support the right decision making or the right navigation within that?

Elyse:

Right. So again, it depends on if we’re talking about our broad network. So in those cases, we do have a team at Aetna that is focused on the next best action and can actually reach out. I know I received a call one time, it was great from a value-based care perspective, I had to get an MRI for my daughter and I was looking at a facility instead of a radiology outpatient center, and I got a call saying, “Hey, did you know you could actually save a lot of money if you do the outpatient?” And I appreciated that, there were reasons why we need to look the other way, but anyway. So we do have that kind of support where we are being proactive because another point in terms of our member-centric view, is that when we talk about total cost of care savings, certainly that accrues to us and it accrues to our plan sponsors, our employers, but it also… If a provider’s in a value-based care arrangement, it accrues to the provider because they will receive the incentive payments and the bonuses.

But importantly, lowering total cost of care also accrues to the member. It means lower out-of-pocket costs, it means lower copays. So in addition to just those quality of life factors when we talk about avoidable utilization, we always want the right care, but when care is avoidable and certainly there’s quality of life aspect to it, nobody wants to be in the hospital. But there’s also an affordability aspect to it for the member. So those are some ways that we handle that in the broad network perspective. And then for our performance networks, that is because it’s really the plan sponsor that is choosing that for their employers. They do a lot of that communication and we have worked really hard to make sure that those employees have access to care when they travel anywhere, they can see any providers. So we are really trying to avoid that idea that we’re limiting choice and really trying to frame it that we’re trying to just incentivize members to engage with providers who we believe are really high value. So again, we have lots of different approaches, lots of different ways to tackle these issues.

What criteria or performance standards are essential for managing provider networks? And how do you actually monitor and enforce those standards?

Keith:

Great, thank you. So now that you’ve built the network, you’ve determined who is high performance, who should be in, where your volume should flow to. Can you share just a little bit about the criteria or performance standards that you put in place that you think are really essential for managing the network? And then how do you actually monitor and frankly enforce those standards? And Heather, I’m going to start with you this time.

Heather:

Yeah. As I mentioned earlier, so the clinical monitoring is ongoing with daily huddles with our nurses. So our nurse team that’s supporting these members through our programs, anything that would be out of expected is managed daily. So that is reviewed in a daily huddle of nurses and clinical leadership. And then we track and trend all of that and we bring that back to our providers. So if we see an opportunity with one specific service at a facility or one specific service with a specific surgeon, we will bring that back to our providers in a direct conversation. So that’s one way. I think the other way that we monitor is timeliness and access to care. So we are looking at turnaround times and how quickly patients are getting the services that they need. And then we monitor experience. That’s a big part of our value equation as well.

So we have patient experience measures that we are continually collecting and evaluating, and then we’re bringing that. So we have a regular annual conversation with providers on all of those, but we’re regularly giving them anything that is out of ordinary as well. And then we’re responding to that in the case of a sentinel event or an issue we would need to address. We have a clinical team that works directly with our providers on root cause analysis and evaluates and makes decisions there together directly with our providers. So ours is ongoing on a daily basis and they’re aware of what we see and what we’re thinking and what we’re doing as well. So it’s a regular communication in the daily interactions as needed, but then ongoing trending and discussions as well.

Keith:

And that’s really quick. Daily basis is very frequent. Do you have particular challenges in getting the most timely information to allow you to pursue those types of conversations?

Heather:

Yeah, so I would say there’s definitely challenges because our providers are working through different challenges in the daily provision of care, but they are regularly communicating with our clinical teams. So their teams to our teams is regular communication around patients. There’s sometimes a lag where things will occur and we may not know until the next morning or the next day that Patient X was here and here’s what happened. But they have dedicated resources that work with us and that makes it much easier that are in contact with their surgical teams and their clinical teams. So that’s what makes it a little bit easier is their ability to put specific resources for this communication. We also have a provider portal that they can communicate with us directly as well that goes into our system for our navigators and case managers. So that interaction is critical piece for us to be able to do it so quickly as well.

But we feel like… And I always say, if I wouldn’t send my mom somewhere, I don’t want to send a patient there. If there’s something we need to address between parties, we need to address it as soon as we can because another patient’s going to be going there. And so it’s very important for us to do it as timely as we can. I would say it’s not… It’s people dealing with people. So there’s never a perfect process. It’s not like an assembly line, but it is a pretty refined process that I think works very well between our teams. And frankly, I think our providers appreciate the regular feedback as well from us. We have provider relations teams like most, and they’re interacting as we need as well. So we try to make it something that is as quick as possible with the appropriate communication and the appropriate parties because that’s a big piece of resolution, the right parties at the right time to resolve. So that’s our goal so we can resolve quickly.

Keith:

Great. And Elyse, same original question to you around how do you manage the performance standards? And I’m really interested to hear, especially in how you think about this in your value contracts as well. How do you enforce those? What is the consequence or what is the reward?

Elyse:

Yeah, exactly. I was going to address it in two ways. So exactly what Heather was talking about, how we have the continual… We do have a continuous improvement, performance improvement function where we have engagement managers who work one-on-one with every single one of our value-based care providers. And they are meeting quarterly in JOCs to review the data and identify where they are in a strategic roadmap. They are looking at the data to inform where those areas for performance improvement care transformation capabilities are, where we bring in our clinical teams. We also have joint case rounding, we have reviews, we work together, we have monthly clinical calls. So we have that function as well because again, we don’t want to think about value-based care as this… Where we set up the provider incentives and then step away and see if it works. That’s just not what we believe.

We want providers to be successful. We want providers to deliver this better care and move along this care transformation journey. And in terms of our contracts and how we hold our providers accountable, so the first principle of ours in terms of our value-based contracts and evaluation is providers have to meet their quality goals first. So we don’t share any savings back unless a provider has met those quality targets. And the quality targets are pretty much what you would expect, so in Medicare, they’re aligned with Medicare Advantage star ratings and Commercial, they are including HEDIS. We strive to have a little bit of that standardization, so it’s not an additional burden on providers. And then we also measure efficiency. And so even though these are total cost of care models, we also want to make sure that we’re not having any adverse events. And so we’ll look at impactable admissions, for example, ambulatory care sensitive admissions where, by definition, that admission for diabetes or COPD, that should have been taken care of in an outpatient setting.

And so by definition, that is an avoidable admission. So we look at that, we look at readmissions because we certainly don’t want… With the focus being on total cost of care, we don’t want a patient to bounce back because they were inappropriately kept out of the hospital or what have you. We look at radiology, we look at generic drug prescriptions, we look at avoidable emergency room visits. There are many ways to look at the different kinds of ED visits in terms of the severity and there’s also algorithms out there that help indicate whether this was again, a preventable ED visit, whether that could have been addressed in a primary care or an urgent care setting.

Keith:

Are all these parts of the equation? Do these all go back into how you originally designed your network to begin with?

Elyse:

Yeah, I mean-

Keith:

And actually my question is almost… Do you feel like you’re enabled in the right data? Are you able to do that when you’re building a network to begin with?

Heather:

We lost you for the first part of the question. We’ve got you back.

Keith:

Am I back now?

Heather:

Yeah, you’re back.

What data gaps exist in your current network analyses or performance management programs?

Keith:

Okay. I’m sorry. I’m sorry. It was almost like those are all amazing things, amazing measures that you can use to help manage and help keep the performance going in the network you created. Are those gaps… When you are actually going back to the original question, are those gaps for you in terms of when I am building my network to begin with, I wish I could know all of these things in advance about what that’s going to look like, or do you feel like you’ve got all of the right data to be able to perform a good set? What’s really missing for you? And Heather, you’re smiling, so I’m going to ask you first.

Heather:

I mean, I think there’s always more insight that we would love to have, and I think integration with providers is a critical piece here. So we don’t have full line of sight into everything that’s happening, and we’re using data in claims that goes through coding, et cetera, to get some of our pictures. But I think where we close that gap is in the relationship with the provider and the discussions. So I would say that we definitely have enough data to be directional and to have discussions, and that’s really what we’re doing with data. And again, it’s actionable for us too. It’s not a static piece of information. It’s actionable for us too. So would I say we want more? Of course. I think we always want more information because I think then that assurance of what we’re doing and how we’re doing things, it becomes easier to do the work and it becomes better assurance for us.

But I would say that we close the gap with that relationship and that’s how we manage today. So could we get more information? Sure. And we’d love any help we can get with it to get more information and feel better about it. But I think we feel pretty solid today. I think our team feels solid with where we are, and we’ve relied on good information to make good decisions with what we would make it with as independent consumers and clinicians. So I think we feel good about it, but I think there’s always opportunity.

What strategies have proven successful for in expanding and fine-tuning your provider networks to meet the evolving needs of your members?

Keith:

Great. Thank you. Well, and so we’ve talked a bit about building network, we’ve talked a bit about managing the network. Now I’m curious about how do each of you approach network growth? What strategies have proven really successful for you in expanding and fine-tuning your provider network to meet the evolving needs of your members? How does it change? And Elyse, I’ll start with you on that one.

Elyse:

Sure. So again, I spoke a little bit in the beginning about our network strategy evolution. And again, I’m talking about our broad network from thinking about it from the perspective of the health plan and the provider to thinking about what members need. And when you do that, you do tend to think differently about the kinds of providers that you want in the network. So again, we’re really focused on value and quality and outcomes, but we’re also focused on comprehensiveness and access. And by access, I don’t just mean like network advocacy. I mean, access as in convenience as well. So for example, we include virtual care in our network… We include virtual care providers in our network because the idea is that many of our members can’t get an appointment quickly with a PCP. It’s just the reality of the physician shortages that we all know about, or they don’t know who to go to, or they don’t have a really great PCP in their area.

So we have a virtual primary care offering that is a provider just in our network like everybody else. And we do make sure we’re really thoughtful about that because we don’t want to be taking patients away from PCPs that have a really strong relationship with their providers. So again, we really see this as meeting the holistic needs that there are some patients who have really great PCP relationships and we are working with those providers, get them into value. Once you’re in value-based care, the incentives are aligned to have same day appointments and so forth. So we’re working on that angle, but for those who don’t, we’re also offering virtual care providers to ensure that members can get that appointment in the next day. And then we have our virtual care provider group has an entire care team, and they’re focused on coordinating care to make sure that it’s all integrated into the continuum of care.

And that’s just one example. We also have examples of non-traditional providers. We have access to… For example, in Maryland, we have a program running that provides doula services to our members. That’s a non-traditional provider, but it’s something that we think is really important, especially given maternal health crisis in this country. We also do things like where we have innovative solutions to support our current providers. For example, specialty e-consults, where we are enabling our PCPs to have access to expertise where they can check in, get a second opinion, should I refer this patient out to specialists or not? And so it’s another way of helping to… Again, think about that member centric way of thinking about our whole network.

Keith:

Just a quick follow-up, do you look at that as a fill in the gaps or do you look at that as a fill in the gaps plus carve out things that were already… service mix that is already in our network as well? And how do you sort of merge that with the in-person care that you’re also… Specifically around the virtual side?

Elyse:

Yeah, so unlike some other health plans out there, we were very intentional about not doing a virtual first or virtual only plan.

Keith:

So no attribution? Okay.

Elyse:

The idea is that… Again, we want to increase access. That’s our goal, access to primary care. High quality primary care. So we again, strive to pay our in-network, our normal network physicians parity that if that provider wants to offer an in-person or a virtual care visit, which again, we hope will increase the access, but we also offer this as just another kind of provider. Same with our MinuteClinics, same with… We have complex specialty care, advanced care partners who are focusing on the very, very complex who need in-home visits. Again, we’re really trying to think about all of the different areas of our members’ needs and making sure that we have providers to meet those needs in a way that’s delivering outcomes.

Keith:

My mind is spiraling into all the complications of… Well, back to the real question then with all those different models in place, how on earth do I find… From a member-centric perspective, from a provider-centric perspective, and from a plan perspective, how do I get all the information I need to select not just who it is, but how I pay them? How do they exist in merge into the model? There’s just so many different pieces to think about. And the data to support those decisions has to just be a tremendous challenge. From a biased point of view, these are the types of challenges that I want us to be able to solve.

Elyse:

Well, right. And exactly. And so from an internal perspective, I think we’re thinking of it as a yes, and. So again, the more ways that members can engage with providers who are on this journey, the better. And from a member perspective, we’ve been having a lot of conversations about navigation and utilizing AI to help members understand who are the high value providers in their area just when they go into our directory search. So it’s a bit in development, but we’re really excited about it and we think that that will help too. Again, coming at it from the provider side and coming at it from the member side to get us towards these goals.

Keith:

Excellent. And then before we go into some of the attendee questions, Heather, I wanted to ask you specifically around self-funded employers. They’re looking for payers to support and solve a lot of these integration problems as well. How are you thinking about that, especially as you’re doing similar growth and optimization activities that Elyse was already talking about?

Heather:

Yeah. We like to think of ourselves as the integrator. So we really feel like there’s a role for us to sit in the middle of a lot of pieces and pull them together around a member because there are disparate pieces and parts. So we regularly work with all of the parties, a virtual provider in a lot of our newer solutions and an in-person provider. And we integrate between the two for the total care for the member. We also work directly with all of the carrier nurses and nurse teams that our members are integrated with. And so we feel like truly our role is not to pull patients into a separate solution as a carve out solution. And historically, to be very honest, that’s what a lot of our solution was thought of as… It’s a true carve out, has been the words that I’ve used. And there’s really a lot of inefficiencies and ineffectiveness for patients when you’re carving them out. We’ve always integrated with the carriers.

We don’t pull them out of their plan. We don’t pull them away from their nurse case manager at their carrier. Instead, we’re providing services, but our nurses are working directly with the carrier nurses, so it’s not a true carve out. So I think that’s a big part of our role is putting our arms around that total episode of care and where do the pieces need to fit together? Where does the information need to be exchanged? Where do the clinicians need to be connected in peer-to-peer conversations? And that’s really our role to facilitate. So that’s the role that I think we’ve moved into in a lot of our newer solutions, putting together virtual and in-person hybrid models of care, continually working with our plan sponsor carriers as well. So I would say that our role is that integrator piece as we’re positioned to do a lot of that, the way we sit.

Audience Q&A:

Keith:

Awesome. Thanks Heather. And so I’d like to go over some of the audience questions at this point. There have been many submitted beforehand, and there are a few in the open Q&A. And if anybody wants to add to the open Q&A, please feel free to. But I’m going to start… Christina Cooper came in with a quick or pretty early one. So we had talked about the concept of patient-centric networks. And her question is, what are the analytics that really support that perspective? And maybe we can start with Elyse.

Elyse:

Sure. So again, we’re looking at our members’ needs. So we do have lots of analytics that tell us what are the specialty conditions that are the major drivers of cost. We will look at our patient experience data. Heather, you mentioned patient experience. I forgot to mention it in my spiel, but we absolutely look at that, and we do include that in our measures of success as well. And so we are looking at where those pain points, we have different mechanisms. So we have a product innovations team that has a whole process for… I think I heard them say, they comb through hundreds of thousands of pieces of consumer feedback to us and really look at and analyze what are the issues that are bubbling to the top. We also internally think about our strategy and think about what… Yeah, we try to look around the corner and what is happening and looking at different just publicly available member needs surveys, employer needs surveys, what are the needs that are out there? So I think it’s a combination of looking at our claims’ data, our experience data, and applying a strategic lens to that.

Keith:

Excellent. Heather, do you have anything you’d add to that?

Heather:

No. I would almost have a word for word, same answer there. I would say that it’s listening to the consumer and truly… First of all, we’re all consumers ourselves. So everyone on our team has input as a consumer. But then I think looking at the data of experience and our consumers and what we’re seeing for why patients aren’t utilizing a service or what needs are not met, and providing that feedback to our strategy and product teams, but also providing that feedback to our employers and to our providers. Because I think us all understanding what the consumers are is very critical, what their needs are. And so we’re trying to meet people where they are, not force them into a model that we’ve pre-designed and say is good for them. And so by doing that, we have to be listeners to that and responsive to that as well. So our strategies are continually adjusting based on that feedback.

Keith:

Okay. All right. The question just came in from Max Holford, that is very near and dear to my heart. Due to the time I’ve spent in behavioral science and behavioral economics and how to change the way that providers make decisions, particularly around this question for, how do we actually get the volume to move to the subnetworks that we have, the high performance networks that we have? So he asks, including narrow networks and more traditional benefit design, what are the most effective strategies to shift volume to high provider or to high value providers? Is it provider search enhancements, member cash incentives, travel benefits, any best practices?

I’ve got my own because I’ve helped build a model around micro incentivization for providers in the market to make high value decisions. I want to understand what has worked for you all and how do you plan on making that shift happen? And Elyse, if you wouldn’t mind going first.

Elyse:

Sure. So I would say all of the above. Again, as I mentioned, we’re working on those provider search enhancements using AI to highlight. So it’s not like those are the only providers that would come up in a direct research, but to highlight that these are providers that we have vetted that have met our quality and efficiency criteria that we really recommend. And then we are also doing member incentives. So again, in our performance networks, it’s really that benefit design differential. But we are doing some really interesting things in Medicare Advantage through the value-based insurance design. Where we are in several of our markets, we are offering additional supplemental benefits. And in this case, it is money on a card. We call it the extra value card. If a Medicare beneficiary chooses one of our high value providers. And so that is the first time we’re doing it, but we’re really excited about it and we want to see how that rolls out.

We have our CoE models. Again, where there’s that institute of excellence piece, we have provider designations, we have badges on the provider directory. So again, we’re really trying to get as much of the information in the hands of the member to make the best decision that’s right for them, and at the same time leverage any other levers that we have to influence that in a carrot sort of way. And then you talked about micro incentives. That again, I think of as more on the provider side, but we absolutely are doing the same thing where we’re really trying to incentivize providers around care gap closure and so forth and points and et cetera. So again, we’re really trying to come at it from all the different angles that we possibly can. We have these levers and we want to use them.

Keith:

Thank you. And Heather, Contigo is a very different company, right? You don’t necessarily have members. Do you think about this any differently being sort of a cost containment or wrap network?

Heather:

Yeah, so I think what we look at in our Centers of Excellent solutions specifically is benefit design. And truly that’s incentive based, right? A hundred percent coverage for our services is a typical model. And some have different coverage if they actually do not use our services. For example, if you’re going to go through the Centers of Excellence solution for a procedure, if you don’t go through it for that same procedure, you may only have a 50%, 80% coverage on your standard plan. And so truly, I think benefit design has been the lever that we’ve pulled historically in our solution. But I think the key to what we provide is truly people knowing about the opportunity at the time of medical need. And I think that’s been something that the entire industry has been trying to solve forever. No one really thinks about or cares about a lot of their benefits until they need it.

And at that time, do they know where to look and how to get the information? So I think that member activation to change behavior and move to something that they may not think of typically, is a challenge that the entire industry has faced forever just because of the nature of healthcare concerns and needs of members. So for us in member activation, it is that working with our self-funded employers to say, how will people know about this benefit at the time of need? And there’s a lot of different strategies and conversations around it for sure. And each of our self-funded employers approaches it quite differently depending on their population. So a construction group may approach it quite differently than a group that has employees or associates that are more office type of workers. So the strategies are definitely customized by each individual and self-funded employer.

Keith:

Got it. Well, rapid fire follow up because we only have three minutes left. I’m really curious on… You both talked about benefit design and it’s great to have that benefit exist for the member. It still is difficult, in my mind at least, for the member to know exactly how to get that benefit, how to use that benefit. So quick, rapid fire for each of you. Is there any one tactic that you’ve seen that gets the information right in front of the member that says, “This is who you need to see because this is going to both create better value, reduce your cost, and impact your benefit?” Elyse, I’m going to go with you. Quick fire.

Elyse:

So again, we’re working on that. We’re really excited about [inaudible 00:47:04] our new tool. But I think again, it’s multipronged, because members come in different ways. So we’re working on enhancing our apps to be able to do that, our websites to be able to do that. We’re working on making sure that all of that information transmits to our customer service center so that when a member calls in, they can really address those questions right away. But I also think that it involves the provider because that’s the trusted relationship is between a patient and their physician. And so if the physician is informed and has the information, then that is really the gold standard. So we’re working on all of them.

Keith:

Excellent. And Heather, 15 seconds.

Heather:

I’d say there’s not one way. There’s not one way to attack this at all. I think that it’s multi-pronged as well.

Closing remarks

Keith:

Awesome. And just to wrap up and thank you. Jim Bailey actually asked a really great question that I promise I’m going to follow up with both of my panelists and get a good answer to. But he says, “My sense is the provider community is overwhelmed with different payer solutions. So do you hear this when convincing providers to join your efforts, to be part of your networks, to be part of the different models that exist?”

We don’t have time for that today, but Jim, I promise I will give us a good follow-up on that because I think it’s a really good one. Thank you both for being part of this conversation today. I certainly learned a lot from both of you around how Contigo looks at it, how CVS Aetna looks at it. I hope folks on the call were able to learn something as well from both the strategy and the tactics that you’re doing to build, grow, sculpt, optimize networks that you’re using both for value and actually just to be more member centric and grow your own businesses. So appreciate the time today and thanks everybody, all the attendees who were able to join.