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- [00:00]
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- [00:39]
Jacob Emerson
Hello everyone, this is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by John Burns, who is the Chief Operating Officer at Banner Aetna. John, thank you so much for taking the time to be with me on the podcast today.
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John Burns
Hey Jacob, thanks for having me.
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Jacob Emerson
Yeah, absolutely. And before we dive into everything, we want to talk with you about, John, can you tell us a little bit more about yourself, your background in healthcare and what it is that you're doing today at Banner Aetna?
- [01:05]
John Burns
Sure, yeah. Happy to. So, as you mentioned, I'm the Chief Operating Officer of Banner Aetna, which is a joint venture health insurance company based out of Arizona. I stepped into this role in April of this year after having spent more than a decade with Aetna and CVS Health. And in that role I was really did a number of different functions covering government affairs, enterprise strategy, product design, and most recently was in clinical network operations for about five years for the company, focused nationally on all of our various network operations across care management, utilization management and the like. So that's where I'm coming from. In my current role as the CEO of Banner Aetna, I'm responsible for leading the development and execution of our integrated strategic plan. And that's really with a focus on aligning our payer and provider capabilities, affordability, enhance quality and deliver a seamless member experience for our customers. And I'm also responsible for oversight of our day to day operations, which covers everything from medical cost and network performance, clinical quality, service operations and compliance as well.
- [02:19]
Jacob Emerson
Fantastic. So you were at CVS for a long time. Now you're back at Banner Aetna, which of course you helped launch, and you're returning to the company during a time for the industry where there's a lot of pressure on the traditional insurance model. And really it seems to be across every market at this point. So talk to us. What's your perspective on all of this? What's your vision for scaling the impact of Banner Aetna? And what does success look like right now in terms of operations and clinical outcomes, given the state of the industry?
- [02:54]
John Burns
Absolutely. You know, I'm really excited to come back and work with this business. I think, you know, from the beginning, Banner Aetna was built on a clear and compelling vision, which was to reimagine the healthcare experience around the needs of the individual. And the founding principles that we crafted when this business was stood up were really designed to move beyond transactional health care by delivering personalized, seamless and affordable experiences that empower members to really achieve their best health. And at the heart of that strategy is a belief that success comes from tightly integrating the payer and provider capabilities to deliver those results. And that's not just in theory, but really in practice. And I think that this approach and the business that has been stood up is really uniquely suited to Arizona's diverse and dynamic market. When we think about what that means for our operational success to date and where we go from here, we're really focused on four primary levers operationally to drive efficiency, engagement and value for our customers. And that covers everything from things like real time data integration. So how do we strengthen the data and workflow between the health plan and the care delivery teams to improve decision making, reduce administrative friction and enable more effective care management? It also covers things like virtual care expansion. So with our consumer expectations and seeing how those are shifting in the market, we want to scale seamless and digitally enabled care options that are fully integrated into the member care journey, so that members can access care virtually or in person, depending on their needs, where they are geographically located and so forth. And really helping by doing that, helping reduce inpatient utilization and enhance that access, especially in rural and underserved communities. Another thing we're looking at operationally is with the advent of AI and how much that has, has started to really mature over the last 18 to 24 months, is looking at how we can leverage some of those AI capabilities to better drive predictive analytics, help integrate some of those AI capabilities into the operations. And really in doing that, driving better outcomes, as well as enabling and empowering clinicians to deliver best care possible. And then I would say operationally, the last thing, and the fourth lever is really around how we think about this from an employer centric standpoint. So we obviously have a lot of self funded employers of varying sizes across the state and really thinking about how do we empower and enable them to manage the rising cost of healthcare for their workforce while at the same time empowering and helping to improve the health of those members. And really the success tied to that is are we able to help support enrollment growth, drive administrative efficiency, and ultimately help the employer to have some long term retention with their employee base. So that's operationally how we think about kind of where we go from here. I would say from a clinical standpoint, we will continue to demonstrate that the integrated care of this joint venture can outperform the traditional models and fee for service and that really results in better health outcomes at lower cost. For this, we're focused on a few different critical pieces of it. Clinically. One is around chronic condition management. We've already seen some really great outcomes in diabetes reversal through our partnership with Virta Health, both on the A1C reduction side as well as a substantial reduction in diabetes medication and then just overall weight loss. And I think that has been a real use case and some of the demonstrated proof points around that that has given us an opportunity to build from as we think about the momentum and looking at other conditions like kidney and cardiovascular disease and how we better support and help members manage those conditions with this arrangement. I think preventative care and early intervention is another one where we're really focused clinically on how do we increase screening rates and timely interventions for members, making sure they're getting in to see a primary care provider, making sure that they are avoiding unnecessary hospitalizations and really take advantage of the full suite of services that are available to them. And then when we think about hospital utilization, we're also looking at it from the standpoint of when a member goes into those care settings, how do we make sure that we're wrapping around them with the right level of care and support. So everything from proactive care coordination to post discharge follow up, how do we make sure that we reduce those unnecessary ER visits and that when a member leaves a care setting, they're equipped with the right level of education, the right level of care support and follow on care to be able to avoid an unnecessary readmission. And that's particularly true for high risk populations.
- [08:06]
Jacob Emerson
Absolutely. And you know, John, we've heard from several banner Aetna leaders in the past always pointing to your value based integrated model as a key differentiator in the market. So talk to us about why you think Arizona is such a uniquely strong market for the type of transformation you just described. And can you explain, expand a bit for us about how you're leveraging those local dynamics to push this model even further.
- [08:32]
John Burns
Yeah, absolutely. I mean, if you look at Arizona, it really represents a uniquely fertile environment for value based integrated care. And I think Banner Aetna is purpose built to lead that transformation. It's obviously not the only player in this space, but the way it has been configured and just the opportunity of these two large organizations is in a lot of ways unparalleled. But if you look at the state's health system landscape broadly, it's highly consolidated, you know, among a handful of hospital systems, Banner being one of those. But then you have Honor Health, Mayo, you know, Abrazzo and others. I think this concentration of system of health systems in the market, and with Banner alone commanding nearly 50% of inpatient volume within Maricopa county, it really creates a perfect scale for the integration and data sharing around these aligned incentive models. And what we're going after, the other piece of it, if you think about the uniqueness of Arizona, is the demographics of the state relative to the population. And you know, Arizona has 49%, roughly of its residents that identify as black, Hispanic, Asian or Native American. And with that comes the need for culturally tailored and personalized care that is accessible across the state. And so when we think about that relative to our business, you know, Banner Aetna was specifically designed to take advantage of these dynamics as a joint venture between the national scale of Aetna as a health plan and then Arizona's health system. With Banner and the breadth and depth of that system, we're not simply coordinating care, we're really integrating it. So this model breaks down the traditional barriers between the payer and provider to deliver that more connected, accountable experience across the continuum. This means that we can act faster on the insights that we have for our members to more effectively align those incentives to meet members where they are. And whether that's through things like digital navigation tools for members and our work with 98.6 and virtual care, whether that's some condition specific programs like Virta Health and the partnership we have there, or whether that's community based programs that we offer through our Get Active program or the Banner at the kitchen, and then even personalized care management through the Banner, the Banner Care Team. You know, we have a suite of services and ways of engaging and tailoring those offerings for members that really meets them where they are and the unique needs that they have. And then I would say with that, the unique advantage the Banner Aetna has in Arizona, if you look at things like the performance network that we offer is the cost savings associated with that. For commercial plan sponsors and the broad access that's provided across key Arizona counties, which really reaches the majority of the state's population with those Banner facilities, is really unparalleled. And I think that combination of local access to care, combined with the national scale and track record of a national payer like Aetna really comes through in the results that we've seen where we have three times higher than industry average member engagement and we're positioned to lead the market in really delivering that integrated and value based care. The last thing I'll say on this is, you know, we want to push this model further. And that really means we want to embed those value based principles into every facet of our operations. Whether that's clinical programs, member experience, or even employer engagement. It's really around making sure that we're able to quickly adapt to Arizona specific needs and address gaps in care for rural populations, be able to tailor solutions for those diverse communities, and then really partner with employers to improve the health of their employees. So in a nutshell, we're not trying to retrofit value based care into a legacy system. We were built for it. And I think Arizona is the ideal market for this type of model. Absolutely.
- [12:46]
Jacob Emerson
Well, I appreciate you breaking down those local dynamics for us. That all makes a lot of sense. And beyond improving outcomes and lowering costs for your patients and your membership, on you touched earlier on elevating that member experience, we've heard from leadership at the company in the past about things like frictionless billing. So what's your perspective? What does this look like in practice for Banner Aetna? And how do you balance human centered care with that push for operational efficiency?
- [13:15]
John Burns
Yeah, that's a great question. You know, it's funny, I think in a lot of ways when we talk about these different concepts, whether it's health outcomes, costs, medical cost management, or member experience, they're often talked about as competing goals. And I think the way we view it as they are interdependent goals to one another. Our model is not built to only lower medical costs, or only improve health outcomes, or only elevate the member experience. It's really built around those three principles being of equal weight and of equal importance. And by integrating Banner's patient centric clinical care with Aetna's deep operational rigor and digital capabilities, we're able to really deliver against those three imperatives. So for, you know, commercial plan sponsors, this means that we're creating a healthcare experience that helps their employees Stay healthy, be productive and be supported in their healthcare journey. But it also gives those employers better control over cost and outcomes. So it's both meeting the member where they are and making sure that we're caring for them and the various health needs that they have, but then also equally able to demonstrate the rigor and operational excellence needed to be able to manage a health plan at scale for an employer of any size. I think from a member experience standpoint, when we think about that and your question around frictionless billing in particular, you know, we want to take off those points of friction where they exist. And when this business was set up, a lot of what we looked at was what are those critical pain points that a member experiences when they go into get care, when they have that healthcare journey experience. And when we look at that and tackling things like frictionless billing and how we can simplify that, we look at it across the whole ecosystem. So we want to simplify how members are able to access care. We want them to understand their healthcare benefits simply and we want them to be able to navigate the system in a way where there aren't barriers to care and there aren't barriers to understanding that the care that they're getting or paying for that care. And we've invested in a lot of the solutions around that. So things like proactive care advocacy, providing digital front doors, providing more of an integrated customer service model that's powered by real time data and then shared accountability between our payer and provider teams. I think what makes again this arrangement unique is the ability to combine the empathy with the efficiency, the empathy and understanding for the customer, whether that's a plan sponsor or the member, as well as the efficiency of being able to deliver those business results in a way that's really going to be meaningfully valuable to that customer. You know, Banner brings a long standing commitment to that relationship based, community anchored care. So it's rooted in trust. They have the local presence, the deep clinical expertise, things like same day appointments, providing culturally tailored behavioral health programs, having embedded care teams. In primary care settings, the emphasis is always on meeting the member where they are and then treating the whole person as part of that. And then conversely, Aetna as the payer brings the operational backbone to make that scalable. So from things like precision analytics and coordinated care management to streamline digital tools that reduce administrative burden for the member and provider, you know, we don't view operational efficiency as a trade off to human centered care. Instead we see it as the engine that enables it. And when processes are efficient and data flows seamlessly. Clinicians can spend more time with patients and members and ultimately the experience is more personalized, timely and effective.
- [17:06]
Jacob Emerson
Absolutely. Well, benarettna is very clearly on the forefront of that value based integrated care model, John. So we really appreciate you sharing your insights on where the company will continue to go under your leadership. But before we go today, are there any final thoughts you want to share with us? Share with our listeners, our healthcare leaders all over the country, any final bits of advice you'd want to share with them?
- [17:30]
John Burns
The only thing I would say is, you know, I'm incredibly energized to step into this role. Coming up on four months now, and I think this is a really defining moment, not just for value based care, but the health care industry broadly. When you look at market dynamics, what's going on, you know, in the regulatory environment and otherwise, I think it's an exciting time. There's a lot of challenges and the challenges are real, but so is the opportunity. And you know, I firmly believe in the model of this business and what can be delivered ultimately in bringing value to customers and members and making healthcare simpler. And I'm confident that we can and will continue to build something that really is unique in Arizona. And I'm excited for the future of where this will go.
- [18:18]
Jacob Emerson
Fantastic. Well, John, thank you so much for taking the time to sit down with us and for sharing your thoughts with our listeners. We really appreciate it.
- [18:25]
John Burns
It. Thanks, Jacob. I appreciate it.
- [18:27]
Jacob Emerson
And to our listeners. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.