← Becker’s Healthcare Podcast
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- [00:00]
A
Hello everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Dr. Saria Sacochio, who is the Chief Medical Officer at Essence Healthcare. Dr. Sacocchio, thank you so much for taking the time to be with me on the podcast today.
- [00:15]
B
Yeah, Jacob, this is going to be a lot of fun. Looking forward to it.
- [00:18]
A
Likewise. And Sareya, before we dive into everything we want to talk with you about, can you first tell us a little bit more about yourself, your background in healthcare and what it is that you do today at essence?
- [00:30]
B
You bet. So in my role as the CMO for essence, I'm responsible for quality and ensuring that our members receive an excellence experience every time, in every encounter. So this includes population health management, care management, certainly clinical utilization of the services we have and overall cost of care. And as a family physician by training, I've worn a few hats in the past from being in solo practice. I academics a CMO on the health system side to truly understand how healthcare is delivered in our communities. And of course on the health plan space, which has been so enjoyable and an opportunity to integrate all of these perspectives again to focus on the patient, the members that we serve.
- [01:16]
A
Wonderful. Well, Syl, like I said, we really appreciate you taking the time to chat with us today. I wanted to get started by talking a little bit about Medicare Advantage star ratings. Of course, we're right in the middle of the open enrollment period. Star ratings are now now out. Essence did fantastic once again. Yeah, you've got 80% of your members in four and a half star plans for 2026. So talk to us and our audience a little bit about some of the strategies that have been most effective internally for achieving that, for maintaining those high star ratings, particularly given the fact that you operate in multiple competitive markets like St. Louis, Chicago, Louisville, what's. What's gone into those ratings?
- [01:56]
B
You bet. And Jacob, I'll just say we are so very proud, I am particularly proud of our health plan that can consistently deliver high quality care. So thank you for the call out and the opportunity to represent why we do what we do. And most importantly here is how we do it. So how we do this is with strong collaboration and relationships. That is critical. But whether we're working with a multi health system group that reaches across the US or we're dealing with local independent physician, advisory or association, it's critical that we understand how they deliver care, first and foremost, aligning with processes and workflows they have in place. That's so important. I call this the we see you piece of the work that we do and understanding that relationship. We're one of many health plans out there and we will be ultimately successful if we find ways to align with the best practices that are already in play. Now what we bring to the table as a Medicare Advantage health plan is real time data access. We have partners that have full risk and of course in a full risk relationship, we're accountable for transparency and that real time data for those gaps in care to close and sharing those best practices to help them achieve those goals. Because listen, at the same time they care about the same thing we do and that's the patient receiving high quality of care. We embrace that, we take that forward with a multidisciplinary team on our end. So we know that stars is more than just HEDIs. It's, it's more than just the quality, the prevention, the chronic disease that's important, but it's also the medications that our members take and ensuring that they have access to those when they need them, how they need them. Health outcomes, these are the other pieces of the puzzle of what includes their exercise, their mental health and all the other pieces of that health outcome survey that matters to us and matters to our partners and certainly to our members. And then finally with operations and improvement. And I mentioned each one of these components within stars because you can't do just one. Well, you can't just do quality. You have to take care of the entire experience and help these members navigate their path to create the highest quality of life possible. So you can't do member care without the members at the center. And, and this is a complexity that we continue to learn from. As we know, AI is playing a significant role in healthcare across the board and that includes member outreach. But we're not the only ones. As a health plan, we ensure that we partner with those healthcare providers so that we're not duplicating messaging, but we're aligning messages together that includes a systematic and also personalized outreach in the work that we do. So and finally, what I'll say in this section of what's helped us be most effective in our higher star ratings is aligning the benefits with the needs of our members. 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. And that's what we've done really well.
- [05:26]
A
Absolutely. I appreciate the detail there, Sareya. In terms of it's really understanding the member, it's those Strong provider partnerships and then those really regimented processes, processes that you talked about to really achieve these ratings, which for any of our audience, our audience that might not be familiar, you know, a four and a half star rating or having the majority of your members in, in such high rated plans is, is very difficult. As you know, there's really only a handful of health plans around the country that have achieved this. And so I wonder, because it's been getting more difficult year after year to maintain and achieve such high ratings. What, what are some of the biggest challenges right now either this year or, or as you think, in achieving these ratings? Because I know that's already starting and in place. What are some of the biggest challenges ESSENCE is navigating in this space right now?
- [06:15]
B
Well, first and foremost, I could just say repeat when it comes to the challenges. So 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. And why we continuously learn from what we did last year. What we did for our work plan for 2025 has changed significantly in 2025 and our team knows in 2026 it will continue to look different. And that's because not only are we striving for perfection, that's what's important here. Every member deserves 100% quality of care and the experience that they deserve it. And we'll have to keep changing. Now that being said, everybody else is as well. That means the cut points change on stars. This we know. And that can be a frustrating point, which I understand and I always reflect back to our board and to our team members that this is a good thing. Right. I think we would all agree that it's critical that we continue to perform better. And not only ESSENCE Healthcare, all Medicare Advantage plans, and in fact every health plan and every provider, it is imperative that we continue to look for the best ways to deliver that care because that's what our members deserve at the end of the day.
- [07:35]
A
Absolutely. And speaking of good things, I mean these high ratings means more funding for you to invest back into better benefits. So what does that mean moving forward? How, how does achieving these ratings so high, how does that influence benefit design and member engagement moving forward for you all?
- [07:53]
B
Well, I appreciate the insight and you're absolutely right, year over year should indeed build on top of a previous successful experience for members. Now that does require money to invest back, which we've got to put the right care in the right place at the right time. Because in order to invest back in, you've got to be able to meet the margins, frankly. Now, that being said, what I am thrilled about for 2025, for particularly our low income subsidized members, is we went back and we asked the physicians, physicians, what do your patients need? And what we heard loud and clear is transportation matters, food matters. Social determinants of health across the board are what make a difference. So we have dialed in with our care management team, our social workers, to ask them, what are you hearing, what are you experiencing and what do the members need? I think this will become more complex as we hear. I mean, you can't avoid listening regardless of if it's social media or the news or wherever you get your information. People are struggling and for many reasons. We need to make sure they have food in their bellies because they shouldn't have to make the decision between medications and their food because food is also medicine. That means we also have to think about cost effective pharmacies that work and community engagement. So yes, we focus on official benefits and I named a few just a moment ago. But we have connected more deeply with our mission, Jacob. We are so focused on the communities in which our patients and our members live. And for that reason we have identified community partners that are helping us understand how these members within their neighborhoods receive the best care. And the best care, as I mentioned, is not just medicine. It's also food, it's shelter, it's security across the board. So those are things that we don't always talk about. But I'm seeing more and more in a very positive way that my peer health plans are doing the same. Let's care about community and serve up an environment that is most beneficial for our members.
- [10:08]
A
Absolutely. Addressing those social determinants among your members is clearly crucial here and it obviously reflects in your ratings. I wonder, Srila, I want to ask your perspective. Given that you've been in this industry, in different parts of and leading such large organizations or in parts of them, how do, how are you thinking about the relevance of STAR ratings right now in terms of truly reflecting health plan quality? Do you think that the existing methodology is effectively capturing the complexities of, of care delivery of coverage, especially for such vulnerable populations that you serve? What's, what's your perspective on the STAR ratings process right now?
- [10:50]
B
Well, thank you for this question, Jacob. And frankly, we could do a whole podcast on this alone, right? How was it calculated and what we shoot for here? But it boils down to this for me and what I try to Inspire my team members to consider and those that we support. At the end of the day, what CMS is doing here, and frankly other health plans, including us, is let's do what matters. You could take any of these measures of all the components and relate it back to why it matters for health. Do I always agree with gosh, missing a star by minus 0.404? No. But I do understand why we have to have cut points. I do understand why we focus on prevention of cancer. It's a significant cost of care, but it is ultimately an impact on the quality of life that we have on this earth and chronic disease management. For the same reason, if you know or have diabetes yourself, you know that that is a challenging disease, that it is incumbent upon us to make sure that we're delivering comprehensive care. Now, that being said, the experience is just as important in every member matters. And I oftentimes think of my own mother. I call her Mimi because that's what my kids call caller. And she is in her 70s. She is the prime Medicare Advantage patient. And I often ask her, mimi, what does this mean to you? How would you respond to this type of situation? When you go to speak to your family doctor, what do you ask? What do you need to know? What do you need to hear from them? And it has given me an incredible, incredible and 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. Need the same care plan. And we could walk through health equity for the same reason. Every member voice matters. And what's critical for us is that we do focus on every voice that comes in. But that's what CMS wants to do. It's challenging to do population health when at the same time it's critical to personalize that care. But at the end of the day, I think that's what you would want for your care. That's what you would want for family and what I certainly expect for mine.
- [13:17]
A
Absolutely. And I appreciate you sharing that personal anecdote with your mother, Saria. It's a great example. And I, and I think that leads me into my, my last question for you in terms of how are you perceiving members actual awareness and utilization of these ratings when they're selecting these plans? Because as you just explained, the, the methodology that the cut points, for example, it's, it's very important to somebody in a role like yours, but that, you know, the person on the ground, the Medicare Advantage enrollee likely doesn't know anything about cut points and how that trickles down to a final star rating. So what, what are you hearing out there about how members are engaging with these ratings today?
- [13:57]
B
Well said. We have to bring it back to the language that matters to them. If you straight out give a star performance, that doesn't mean a whole lot. But when you can reflect back in your communication of why it matters, that your diabetes is controlled and we're able to save your eyesight when we can focus on your blood pressure and why that matters and finding a health plan that also believes that that's important, we know that we reduce heart attacks and strokes and everybody understands the impact of cancer because you've either had it yourself or you know someone personally who has been on that journey. So this is part of understanding what the individual expects and what members are wanting. I have tuned in very closely to our members at this time of year, as, of course, we're in the annual enrollment period and they're telling us, they told us what they care about pharmacy plans. They want to know that they're remaining stable when it comes to the benefits available to them, or let's say a flex card. They want to know that it's going to be consistent next year. And as we see tremendous disruption across the market during this annual enrollment period, it's because members have become more educated and know what they want. And frankly, they know what they've had most recently. And whenever we pull back benefits, it pullbacks pulls back the benefit to the member. And that's what we need to be mindful of, being stable, because that's what they want from us. I don't believe members choose to change plans every year, but their experience is guiding their way. So let's keep it simple in language they understand and language that we understand together and drive back to what impacts their quality of life and their ease of accessing their benefits.
- [15:45]
A
Well, Saria, before we go, you've got the ears of a lot of other industry leaders listening in from all over the country. Any final thoughts for them, final bits of advice you want to share as they navigate similar challenges in the year ahead?
- [16:01]
B
Sure thing. And I'll keep it simple. At the end of the day, people want to be heard, and it's incumbent upon us to listen and then to respond appropriately. And so as I've joined essence, and it brings a huge smile to my face when I hear repetitively across departments. Now, we use the language you spoke, we listened. Here's what's happening. Hearing people out, listening and processing what matters most. And then reflecting back what's changed because of their input creates the strongest relationships and what we're committed to. And I'm very proud of our team for that. It takes the entire team. We also say teamwork truly makes that dream work. So I'm grateful for our teams for the opportunity to celebrate their success and share that message with our members as well.
- [16:56]
A
A simple message, but a very impactful one. Dr. Sacochio, thank you so much for taking the time to join us on the podcast today and for sharing your insights with our listeners. We really appreciate it.
- [17:08]
B
My pleasure. And thank you. And be well.
- [17:12]
A
You as well. And to our listeners. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit Becker's Hospital review dot com.