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Becker’s Healthcare Podcast
Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA
00:12:34
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- [00:02]
A
This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.
- [00:34]
B
Hello, everyone. Welcome to Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Saria Saccaccio, Chief Medical Officer, ESSENCE Healthcare. Saria, how you doing today?
- [00:46]
C
I am doing well, Scott. Thanks so much for the opportunity to join you today.
- [00:51]
B
It's going to be great. We have a lot of big topics and talking points to get to here, but we're really looking forward to having you speak at our Spring Payer Issues Roundtable in April as well.
- [01:01]
C
Can't wait.
- [01:02]
B
So, before we get to the questions and the topics, Sareya, I wanted to ask just kind of about your background. If you could please share, you know, a little bit about your journey into health care with us.
- [01:11]
C
You bet, Scott. I'm a family physician by training, and I have worked across the gamut of clinical care, whether it was in solo practice, teaching at residency programs and academic institutions. I've served as a chief medical officer in several different health systems and and have been on the health plan side of the industry for the last several years. I so enjoy the work that we do serving our members and ensuring everybody gets the right care, right place, right time, and has the right experience on their journey for health.
- [01:43]
B
Thank you for sharing that. And the first topic I wanted to get to with your perspective is how are your relationships with providers changing? You know, obviously both sides are facing regulatory pressures, but specifically, when you look at cost pressure and work for shortages,
- [02:01]
C
well, first of all, I am so glad that we're starting with relationships. This is the most critical part of the work that we do. And at the end of the day, we're in this together. We are here to provide exceptional care to patients and those who deserve that access to care. And so while perhaps it hasn't changed, there certainly is a palpable shift. And that shift would be a deepening of collaboration. I can't overemphasize just how important that is. And there are a number of ways that we do that in our business and with our partners. First of all, it starts with real time data. Everybody needs this accurate data. This is what I hear asked for the most and the appreciation that we have been able to deliver down to the member level, the data that impacts the career that our health systems and providers deliver in a way that is actionable so that we can impact that health and transparency of strategy. We roll up our sleeves together as partners to address the cost of care of what we do, whether it's determining the appropriate prior authorizations, our pharmacy spend and the challenges there, as we know we've all struggled with that recently, or expanding products within our health planned that is so important to us. And finally, I'll say this is the most important part of this relationship. It's listening first, being curious about the current workflows and expectations that exist with our health system providers so that we can align with the work already being done. Because this is what we know. Whether our health system has 17 different contracts or 27 contracts, we have got to be a part of the solution in developing efficiency and reliability so that care is delivered consistently regardless of who the health payer is.
- [03:52]
B
Yeah, you know, that's really interesting. I've heard from a lot of people on the payer side that that relationship has changed. Like you said, it's gotten more collaborative. I've heard some, some people say it's because, you know, they think that just both sides are up against so many regulatory pressures that both are just trying to figure out a way to get things done. But your perspective is interesting because you think it's coming from a data perspective, a need for both sides to kind of share and utilize data. Is that right?
- [04:19]
C
Well, sure. It's a huge part of the equation here because without information, you can't drive a strategy that delivers results that is critical in the work that we do and the more information available, it's part of our responsibility to make sure it's delivered in a way that we can do something with it.
- [04:36]
B
Sariya, where do you see the biggest gap today between payer strategy and operational execution?
- [04:41]
C
Goodness, there are so many gaps and I'll say so many solutions that have developed. I will say what is most heated at the moment and the two challenges that I'm seeing here is member access to resources that they need when they need it. What I mean by that is, is more ambulatory access. So, Scott, it's rather interesting to me, not surprising as we're all trying to shore up margins these days after Covid, but we saw a significant departure in ambulatory services and access to resources to healthcare so I'll give my mother as an example. She's Medicare Advantage age and has her own plan she works with. And I say, mom, the first thing you gotta do is, is find out where you can receive these services at an ambulatory site, and here's why. It hits the pocketbook of every member and frankly, at every health plan. When services that can be delivered in an ambulatory space is turned around, the lights turned out, literally lights turned out and shifted back to a hospital with a huge parking lot, an overwhelming pathway just to get to the site of service you need with a significant price tag. I do recognize, having been on the health system side historically, that that's where margins are often shored up is in an inpatient facility structure. And we feel the pressure from an administration. We know there's a change. We've got to get to a point where regardless of the site of care, that the service delivered that's the same, costs the same. So that's one piece. The other, I'll talk a little bit specifically about pharmacy gap, the cost of medications and the member responsibility and the health plan responsibility. We have these pressures for the right reasons. I say that because we know this. Medications are too expensive today and they're too expensive for everyone. So those are two gaps that we have got to find solutions for and find them quickly.
- [06:48]
B
In terms of finding solutions, what's one investment or initiative you believe will most reshape how health plans operate over the next two to three years?
- [06:58]
C
Well, I'm going to shift gears and think more global when it comes to an overall investment. And as a family physician, I'm going to think population health first. And Scott, this is what we know. More people die of heart disease than any other condition, both men and women. We know this. And in the spirit of February is heart month, and we are in February. Cardiometabolic investment is critical to the future and the quality of life for all Americans. So it's not just the medications. That's a piece of it. We know a driver of cardiometabolic impact is obesity. It often starts there. In fact, it's starting in the pediatric space and where it used to be in adulthood that we had to be concerned. So across that age span, we have got to be thinking about the investment of lifestyle benefits. Do people have safe places to walk? Is it part of the workplace, the employer space? How are we involving behavioral health? We know when people are less active, when they have chronic conditions such as diabetes, heart disease, heart failure, they are more likely to suffer from depression Anxiety and other mental health challenges that make it even harder for their overall health to improve. And then finally, those medication barriers. First, one that usually comes to mind for folks are those GLP1 agonists. And that is because they help reduce the weight, but they also increase the cost of care. Addressing the barriers in all of these spaces, investing in a comprehensive approach is something that we have to do in partnership across the entire industry.
- [08:45]
B
If you could change one regulatory or industry practice tomorrow to improve affordability in access, what would it be and why?
- [08:54]
C
Well, I hinted at this just a moment ago. In fact, it was probably more than a hint and it was an obvious nudge. Site neutrality is what's frankly best for our patients and for overall Americans. Receiving the same care at the same price, regardless of the address, really matters to people and really matters to the increasing cost of care that we see today. The other is pharmacy flattening the cost. How do we identify those biosimilars for these fantastic new life saving and life changing drugs for these diseases where people have struggled for so many years, we've got to be quicker to provide those biosimilars for generics to be available and for specialty cost drugs out of the gate, we have some therapies now that cost $1 million a year. Now as we know, fewer and fewer people will have access to health care and more people will be uninsured. In 2026 and onward, there will be more people who cannot afford that million dollar therapy. Again, that can be life saving, life changing. So those are the two things, site neutrality and pharmacy flattening of cost. And we would see a healthier America 100%.
- [10:09]
B
And there's certainly a lot more work to do with pharmacy costs as you're alluding to another thing is going to be a big topic at our Spring Parent Issues Roundtable. The last thing I wanted to ask you, what issue do you think is putting the most pressure on health plan margins right now and how are you responding differently for 2026?
- [10:28]
C
Well, for us at Essence and for me as a clinician, it always ends with quality, quality of care. So I think of star performance, there's a tremendous amount of pressure to maintain where we are. We're a four and a half star HMO plan. In fact, in all of our markets where the highest rated plan. Very proud of that because that is the care that our members are receiving and can rely upon that they will receive by our providers. It's because that strong relationship and collaboration we have with our partners. Now that being said, the bar will continue to rise in a good way. I remind folks of this all the time. We should not be practicing medicine the way we did five years, 10 years ago. We should get better year after year after year. What will continue to challenge us are the social conditions that people are experiencing. Less money in their pocket, less food on the table that's healthy for them in a way that people can afford these medications and their nourishment. That's really important. And the investment in services that close up all of those gaps in care. So, so many folks forget that STAR includes the gaps in care, the. The operations of a business, the improvement year over year, and finally, the experience. I mentioned my mother a moment ago, and I always consider, what would Mimi do? How would Mimi feel if she was in a situation, needed help to health care, and did she have someone to hold her hand through the process? And that's what we're here to do. That's what we should all be doing, is holding the hands of our patients and ensuring they have an exceptional experience and know that they're taken care of and can receive the highest level of care again, regardless of location. Because at the end of the day, this is what we do and we do it together in healthcare.
- [12:22]
B
Saria, thank you so much for joining us on the podcast and for a great conversation. And again, we're really looking forward to you speaking with us in April.
- [12:29]
C
Thank you, Scott. This is important work and I am grateful to do it every day.