Dr. Brian Smolich, Vice President, Health Alliance Quality and Managed Care Operations, Carle Health

Summary

Becker’s Healthcare Podcast: Detailed Summary of Episode Featuring Dr. Brian Smolich

Podcast Information:

• Title: Becker’s Healthcare Podcast
• Host: Haley Rutger
• Guest: Dr. Brian Smolich, Vice President, Health Alliance Quality and Managed Care Operations, Carle Health
• Release Date: June 30, 2025
• Duration: Approximately 7 minutes and 31 seconds

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Introduction

The episode kicks off with an introduction by Haley Rutger, recording live at Becker's third annual Spring Payer Issues Roundtable. She welcomes Dr. Brian Smolich, Vice President of Quality and Managed Care Operations at Health Alliance Medical Plans and First Carolina Care, part of the Carle Health System.

Key Introduction Points:

• Dr. Smolich’s Role: Oversees pharmacy, medical management, quality, and member relationship appeals across central and Southern Illinois and North Carolina.
• Organizational Focus: Ensuring high-quality care while managing costs effectively.

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Balancing Affordability and Quality

Haley initiates the conversation by addressing the critical balance between managing the cost of care and maintaining or improving member outcomes.

Dr. Smolich’s Insights:

• Quality-First Approach: Emphasizes that quality is paramount and should precede cost considerations. “Quality is at the center of everything that we do” (01:40).
• Financial Stability: Acknowledges the necessity of balancing premiums and revenue with rising costs to sustain plan offerings.
• Collaborative Efforts: Highlights the collaborative approach with providers to ensure optimal patient care.
• Innovation in Pharmacy Benefits: Focus on biosimilars to reduce medication costs without compromising access. “We’ve put a lot of focus in the biosimilar space, at least on the pharmacy benefit side. That has really helped us reduce costs on medications without compromising patients’ access to care” (02:10).

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Member Satisfaction and Engagement Strategies

The discussion transitions to strategies for enhancing member satisfaction and engagement, along with metrics for measuring success.

Effective Strategies Identified:

• Net Promoter Score (NPS) and Member Promoter Score (MPS): Utilizes these metrics to gauge member satisfaction on both provider and health plan sides.
• Customer Solutions Team: Engages members effectively, connecting them with clinical experts and facilitating access to medical management resources.
• Digital Solutions: Implements digital platforms that gamify healthcare behaviors, such as medication adherence, leading to positive member engagement.
  • High-Touch Engagement: Members interact with apps daily, earning rewards and receiving prompts for necessary actions, which enhances participation and adherence. “Members will be in apps daily, completing tech activities and earning rewards” (03:30).
• Collaboration and Accessibility: Emphasizes making it easier for patients to navigate the healthcare system through integrated support.

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Reducing Costs, Improving Quality, and Advancing Health Equity

Haley steers the conversation towards aligning cost reduction, quality improvement, and health equity within the organization’s strategic vision.

Dr. Smolich’s Approach:

• Community-Centric Focus: Tailors strategies to the specific needs of communities in central Illinois and North Carolina, ensuring that efforts are impactful and relevant.
  • “We directly interact on a daily basis with individuals that have our healthcare coverage” (04:42).
• Philosophical Alignment: The overarching philosophy revolves around improving care and access to healthcare, thereby bettering the population’s health as a guiding principle.
• Cost Reduction Within Control: Focuses on reducing costs through controllable measures while maintaining high standards of care.
• Reinforcing Quality as a North Star: Ensures that every decision and strategy aligns with the mission of delivering quality healthcare to the communities served.

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Future of the Payer Space

Looking ahead, the conversation explores the biggest opportunities for payers to transform care delivery and drive better outcomes.

Opportunities Highlighted:

• Bridging Provider and Health Plan Gaps: Advocates for a collaborative rather than adversarial relationship between providers and health plans to simplify healthcare navigation for patients.
  • “There’s often an adversarial approach. We’re trying to work collaboratively with providers” (05:59).
• Reducing Administrative Burdens: Seeks to streamline processes like prior authorizations to alleviate the burden on providers and enhance patient care.
• Information Sharing: Emphasizes the importance of sharing information seamlessly between health plans and providers to improve care coordination.
• Promoting Providers as Key Resources: Recognizes providers as essential partners in the patient’s healthcare journey and aims to support them in delivering affordable care.

Actionable Steps for Leaders:

• Build Bridges: Continuously work on strengthening relationships with providers.
• Facilitate Access to Care: Ensure that providers have the tools and information needed to deliver efficient and effective care.
• Promote Affordability: Keep healthcare affordable through collaborative efforts that benefit all stakeholders, including patients and providers.

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Conclusion

The episode concludes with Haley expressing gratitude to Dr. Smolich for his insights and participation in the live recording.

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Notable Quotes

• Dr. Brian Smolich on Quality: “Quality is at the center of everything that we do” (01:40).
• On Biosimilars and Cost Reduction: “We’ve put a lot of focus in the biosimilar space… reduce costs on medications without compromising patients’ access to care” (02:10).
• Digital Engagement Benefits: “Members will be in apps daily, completing tech activities and earning rewards” (03:30).
• Collaborative Provider Relationships: “We’re trying to work collaboratively with providers to pass more information… make sure that healthcare remains affordable” (05:59).

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Key Takeaways

• Quality Over Cost: Prioritizing quality to ensure sustainable and effective healthcare delivery.
• Innovative Cost Management: Utilizing biosimilars and digital solutions to manage costs without sacrificing care.
• Enhanced Member Engagement: Leveraging digital platforms and dedicated teams to improve member satisfaction and outcomes.
• Collaborative Healthcare Ecosystem: Fostering strong partnerships between health plans and providers to streamline care and reduce administrative burdens.
• Forward-Looking Strategies: Identifying and acting on opportunities to transform the payer space for better healthcare outcomes.

This episode provides valuable insights into how Health Alliance Medical Plans and First Carolina Care are navigating the complexities of healthcare management by prioritizing quality, embracing innovation, and fostering collaborative relationships to ensure affordability and enhance member satisfaction.

Transcript

[A]

Evernorth brings the power of wonder and relentless innovation to create world class pharmacy care and benefits solutions. Barriers to care can lead to gaps in care which can drive up the total cost of care. Our capabilities work seamlessly together to create innovative pharmacy care and benefit solutions for today and tomorrow. Our connected health services make the treatment, prediction and prevention of healthcare's most complex conditions easier and more accessible as we drive organizations and people forward.

[B]

This is Haley Rutger with the Beckers Payer Podcast and we are recording live at the Becker's third annual Spring Payer Issues Roundtable. Today I am thrilled to be joined by Brian Smolich, VP of quality and Managed Care operations at Health Alliance Medical Plans. Brian, thank you so much for being with me today.

[C]

Yeah, thanks. Good morning.

[B]

Good morning to you too. So before we begin, I'd like to have you just introduce yourself and share a little bit more about your background and your organization.

[C]

Sure. So my name is Brian Smolich. I serve as vice president of quality and managed care operations for Health Alliance Medical Plans and First Carolina Care. We're part of the Carle Health System and we serve patients that are primarily located in central and Southern Illinois as well as North Carolina. I have responsibilities of pharmacy, medical management, quality and our member relationship appeals team at our Health.

[B]

Well, thank you so much for sharing a little bit about your background. Now to begin our conversation today, I'd like to kick it off by talking about balancing affordability and quality. So how is your organization innovating to manage the cost of care while maintaining or improving member outcomes?

[C]

Yeah, so at Health Alliance Medical Plans and First Carolina Care, quality is at the center of everything that we do. You know, you really have to put quality in front of cost and affordability. But you know, we, we do realize that if, if you're not financially sound and you're not able to balance premiums and revenue with rising costs, then it's going to be difficult to, you know, offer the plans and benefits that you want to members. But for us, I mean, our people are exceptional. They have a wonderful engagement with our members, our customer solutions team, our case management team and our clinical platforms. Our really take the view of working collaboratively with the provider to ensure patients have the best care. So far as innovation, you know, we've put a lot of focus in the biosimilar space, at least on the pharmacy benefit side. That has really helped us reduce costs on medications without compromising patients access to care or helping us to afford additional therapies that are newer or novel.

[B]

I'd like to explore that a little bit further on the basis of member satisfaction as a whole. So what experience or engagement strategies have proven effective for your organization and how are you measuring that success?

[C]

Yeah, so our organization tracks not only on our vertically integrated health system, the provider side NPS score, but we're also tracking health plan MPS score. And I think we do an exceptional job of engaging members through our customer solutions team. They also have the resources to tap into our clinical experts. So there's a lot more collaboration on individual patient cases, connecting the dots and getting patients access to our medical management team, a pharmacist, our population health or care coordination team. I think really making it easier for patients to navigate has been helpful. We've also utilized digital solutions and vendors, so some of which have gamified healthcare and healthy behaviors like medication adherence. And we're seeing a lot of positive outcomes from member engagement through those digital platforms. The other benefit they provide for us is their high touch. Members will be in apps daily, completing tech activities and earning rewards. And we can also then engage them with prompts and gaps in care and things that they need to do where that becomes much more difficult when you're trying to engage a member just telephonically and the hesitancy to pick up a phone. So I think we really see how the digital solutions that we employ can supplement all the great work that our people are doing at Plan.

[B]

Absolutely. And I'd like to pivot our conversation just a little bit to the imperative to reduce costs, improve quality, and advance health equity. So how do you approach aligning these priorities in your organization's strategic vision?

[C]

I think it all goes back to quality. And I think our geography in central Illinois as well as in North Carolina, being a regional health plan, we directly interact on a daily basis with individuals that have our healthcare coverage. So I think that becomes the center of what you do. You know that you're improving the care within your communities, and that makes the work that we do very rewarding. I think overall, we look at approaches to reduce costs within what we can control. But I think the general philosophy of improving the care and access to health care in our communities and bettering the population is kind of our North Star in knowing that this is healthcare that impacts those that we work with, our family, our friends. And I think that really becomes impactful when you think about quality in the patients we serve.

[B]

And looking ahead, I want to talk a little bit more about the future of the payer space. So what do you see are the biggest opportunities for payers to lead the charge in transforming care delivery and driving better outcomes for all stakeholders. And how can leaders take a step in this direction now?

[C]

Yeah, I think a big area of opportunity is to continuing to bridge the gap between providers and health plans. Know, for years and even today, there's oftentimes an adversarial approach. And I think that puts the patient in the middle of a lot of dynamics that make navigating healthcare more difficult. I know at our healthcare organization, we're trying to work collaboratively with providers to pass more information, to make, you know, access to information that the health plan has easier and to reduce some of the burden and prior authorization. But really involving the provider in finding a solution where we can work collaboratively with them to have a win, win situation and make all of the navigating of healthcare and promoting providers as key resources in a patient's healthcare journey, as well as the provider recognizing that the health plan is trying to do the best interest in the patient and making sure that healthcare remains affordable, affordable. I'd like to see that dynamic happen. And I think it's just continuing to build bridges with providers, trying to see how we can make their lives easier on providing access to care and reducing some of the challenges that they face on a daily basis.

[B]

Well, Brian, thank you so much for taking the time to have this conversation with me today. Again, this is Haley Becker with the Becker's Payer podcast, recording live at the Becker's third annual Spring Pear Issues Roundtable Spring. Thank you so much.

[C]

Thank you.