Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare
Date: November 23, 2025
Host: Jacob Emerson

Main Theme

This episode features Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare, discussing strategies behind maintaining high Medicare Advantage Star Ratings, addressing challenges in the evolving landscape of quality measurement, and the importance of aligning benefits with the real needs of members—particularly through robust provider partnerships and addressing social determinants of health.

Key Discussion Points & Insights

1. Dr. Saccocio’s Background and Role at Essence Healthcare

• Timestamp (00:29–01:15)
  • Dr. Saccocio is a family physician with extensive experience across clinical practice, academia, and executive health system roles.
  • As CMO at Essence, she is responsible for quality, population health management, care management, utilization, and overall cost of care.

2. Achieving and Maintaining High Medicare Advantage Star Ratings

• Timestamp (01:55–05:25)
  • Essence has 80% of members in 4.5-star plans for 2026, a notable achievement amid rising industry standards.
  • Key Strategies:
    • Strong Collaboration and Relationship Building:
      “Whether we're working with a multi health system group... or local independent physicians ... it's critical that we understand how they deliver care, first and foremost, aligning with processes and workflows they have in place.” (02:14 – 02:36)
    • Real-Time Data Access and Transparency: “What we bring...is real time data access...we’re accountable for transparency and that real time data for those gaps in care to close...” (02:41 – 02:59)
    • Comprehensive Approach (Multidisciplinary Teams, Holistic Care):
      • Stars go beyond quality measures—include medication access, member experience, preventive care, chronic disease management, and social determinants.
      • AI and personalized, yet aligned, member outreach are increasingly important—avoiding duplicative messaging with provider partners.
    • Benefit Alignment with Community Needs:
      “If you don’t understand the communities in which they live and where you’re serving, it creates a challenge in ensuring that the benefits match what the members need.” (05:10 – 05:19)

3. Challenges in Sustaining High Quality Ratings

• Timestamp (06:14–07:34)
  • Need for continuous refinement: What worked last year may not work next year due to changing industry benchmarks (“cut points”) and heightened performance expectations.
  • Quote:
    "The areas where we excel with the strong relationships and the multidisciplinary teams and that specialized message, we have to continue to evolve and get better at the work that we do." (06:16 – 06:28)
  • The quality bar is always rising for all health plans, creating constant motivation for innovation and process improvement.

4. Translating Ratings into Better Member Benefits and Experience

• Timestamp (07:53–10:08)
  • High ratings bring additional funding, enabling reinvestment in services for members—especially for those with low incomes.
  • Listening to physicians and care teams has refocused benefit design on essential needs:
    • Transportation, food security, and addressing social determinants.
    • Partnerships with community organizations are vital for understanding and serving diverse member needs.
  • Quote:
    “They shouldn’t have to make the decision between medications and their food because food is also medicine.” (09:00–09:08)
  • Health plans must go beyond traditional benefits to include food, shelter, and security as pillars of well-being.

5. Limitations and Relevance of Star Ratings

• Timestamp (10:50–13:17)
  • Star ratings are an imperfect measure but are rooted in outcomes that matter (preventive care, chronic disease management, patient experience).
  • Personalizes the challenge by referencing her own mother’s Medicare Advantage journey.
  • Quote:
    “It has given me an incredible...realistic view of how difficult it is to navigate care because every one of us is different and not all patients with diabetes respond the same.” (12:16–12:36)
  • Emphasizes the need for health equity and individualized approaches despite standardized metrics.

6. Member Awareness and Utilization of Ratings

• Timestamp (13:57–15:44)
  • Members generally don’t understand star ratings or their methodology.
  • Importance lies in translating these scores into impacts on daily life—such as chronic disease control, medication access, or benefit stability.
  • Members focus keenly on stability (pharmacy, benefits) and become acutely aware when benefits are reduced.
  • Quote:
    “We have to bring it back to the language that matters to them...let's keep it simple in language they understand and...drive back to what impacts their quality of life and their ease of accessing their benefits.” (13:57–15:44)

7. Final Industry Message

• Timestamp (16:00–16:56)
  • The core advice: Listen to people and act on their input.
  • Quote:
    “At the end of the day, people want to be heard, and it's incumbent upon us to listen and then to respond appropriately.” (16:01 – 16:08)
  • Teamwork and transparency—internally and with members—are essential for sustainable success.
  • "Teamwork truly makes that dream work." (16:47)

Notable Quotes & Memorable Moments

• On collaborative success:
  “We will be ultimately successful if we find ways to align with the best practices that are already in play.” (02:32–02:40)

• On the pressure (and opportunity) of changing standards:
  “Everybody else is as well. That means the cut points change on stars...and that can be a frustrating point...but this is a good thing.” (06:57–07:15)

• On community focus:
  “We have connected more deeply with our mission...We are so focused on the communities in which our patients and our members live.” (09:23–09:31)

• On individualized care:
  “Every member voice matters. And what’s critical for us is that we do focus on every voice that comes in.” (12:36–12:42)

Timestamps for Key Segments

• 00:29–01:15 — Dr. Saccocio’s background and CMO responsibilities
• 01:55–05:25 — Strategies behind high Star Ratings
• 06:14–07:34 — Challenges in maintaining high performance
• 07:53–10:08 — Linking Star Ratings to benefit innovation and social determinants
• 10:50–13:17 — Critique and personal relevance of Star Ratings
• 13:57–15:44 — Member engagement and benefit awareness
• 16:00–16:56 — Final advice to industry leaders

Conclusion

Dr. Saria Saccocio presents a clear vision for how high-performing Medicare Advantage plans like Essence Healthcare maintain their edge: through relentless collaboration, genuine community engagement, and a commitment to listening and learning. She underscores the importance of viewing members as individuals with diverse needs—both clinical and social—while also navigating the pressures of shifting performance benchmarks. Her advice for industry peers is straightforward but essential: prioritize listening and relationships; only then can organizations create meaningful, lasting improvements for their members.