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Becker’s Healthcare Podcast
Strengthening Payer Provider Collaboration to Improve Care and Efficiency with Dr. Daniel Elliott
00:12:41
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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 up. We're looking forward to hosting you here in Chicago.
- [00:34]
B
Hello, everyone, and welcome to Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Dan Elliott, Chief Medical Officer, Provider Experience over at the Centene Corporation. Dan, how you doing? Thanks so much for joining us.
- [00:47]
C
I'm doing great, Scott. Thanks so much for having me.
- [00:50]
B
Of course. No, we're going to lean on you for your expertise with a lot of big topics in health care and with, with health plans. But before we do that, I was wondering if you could please share a little bit about your background and your journey in healthcare.
- [01:00]
C
Yeah, no, I appreciate the opportunity. So, yeah, I've been with Centene now for three years. I joined them as the CMO in a local market in my home state of Delaware. Really enjoyed walking through that experience and really learning the nuts and bolts of managed care in a market that I understood deeply. And then for the last year, I've served as the CMO for provider experience at Centene. So getting the opportunity to see the national environment, to work across all of our lines of business, all of our different plans and really exciting opportunity. And prior to that, I spent 21 years with a health system here in Delaware. Had a lot of different roles working with accountable care organizations and sort of really applied health services research and just practical operational and clinical improvements which were wonderful in addition to a long career as a primary care clinician.
- [01:51]
B
Well, thanks so much for sharing that background info, Dan. You know, I've been asking a lot of the speakers from me, speaking at our Spring Payer Issues Roundtable, like yourself, about that, that payer provider relationship and you, I think with you it's an even more kind of, with your role, it's even more unique. So I definitely want to hear what you think and just regards to that relationship and how is it changing as both sides face cost pressure and workforce shortages?
- [02:16]
C
Yeah, it was real issues and real challenges for sure. Well, you know, just a little background, I, I joined the payer side because I had deep experience on the provider side making the changes, doing the pop health improvements and interventions. And I really felt like, and wanted to understand more about what are the levers that the payer side have. And I've always had this vision of sort of a comprehensive ecosystem working well to drive care for members, for patients, whatever your lens or focus is really just taking care of the people who need our health care services. And so what was exciting about joining the managed care side and now having three years of experience on the payer side was what I love to see is that we are all fighting the same fight. You have different tools, you have some different sort of things that you can lean on and bring into play. But fundamentally we're all working to provide a healthcare ecosystem that delivers really honestly the best quality care we can for most affordable outcomes. And that is exciting to be part of. And frankly, our current environment is challenging and it's stressful with OB3 and coverage changes and financial and cost structure changes, we're all familiar with those. But frankly it takes, in my view, a lot of the things that have been underneath. They've been challenges that we've been trying to navigate through. It puts a finer lens on them and it says, boy, if we're going to solve these things as a country, we're going to have to solve them sort of together, right? And starts to, you have to have that view that looks at all of us sort of under that sort of broader need to make the best health care system we can. And so as we from a payer perspective are working with our providers, I think everyone's more acutely aware of the fact that we have to do this together and there's lots of structures, there's lots of ways to do that. But fundamentally I think it's a movement or a moment for us in healthcare to lean in and say, how can we be good partners? How can we. Things that maybe are historically present have been tolerated, they're sort of built into the system. How do we actually now start to find ways to do those things more efficiently so that we can make sure that the money that's being spent in healthcare is going to what we want it to be, which is helping people get the care that they need?
- [04:30]
B
Yeah, I think you're exactly right. I think focusing on that, on that big goal, you know, definitely help both sides work together and find solutions. So I think it's, it's important to keep that goal in mind, like you said. The second thing I want to ask you about, Dan, where do you see the biggest gap today between payer strategy and operational execution?
- [04:48]
C
Yeah, you Know, along the same vein, you know, I, I really think a lot and have the opportunity in my role to just constantly be evaluating how are we working as the most effective partner we can with our provider partners out. And so I think the gap that I stare at sort of face to face every day is saying, how are we being the best partner? Are we giving meaningful information? Are the insights that we're providing? The information we're providing, the support, whether it's care support, care management, care coordination, other aspects, whether it's just being a good partner in terms of paying claims and sort of moving things through the system in the most efficient way, constantly asking, are we being that best partner? And I think we, in fairness, have opportunities to provide more meaningful information. To put it in a way that's communicated, that that leads to clear, actionable opportunities. You know, it doesn't do anybody a lot of service to just say, hey, here's some generic score reports and here's some things that we've noticed. But boy, how do we dig in as partners and say, in your practice, this is what we're seeing. It may or may, you know, may or may not be different than your peers or other things we're seeing in your market. But here's insights. And when I was on the provider side, I really longed for that, some of that broader payer view that sometime when you're from a provider perspective looking out, you don't, you don't necessarily have that broader information. So I see this gap in front of us that we're trying to close of providing meaningful information in a meaningful setting that drives action and starts to solve the problems that members are feeling, that our providers are feeling, and honestly that we as payers are feeling and experiencing as well. So if we can have that conversation meaningfully, if we can support it with operational processes that start to solve those problems and close those loops, I think it just makes everything just go better from that point forward.
- [06:37]
B
Absolutely. What's one investment or initiative you believe will most reshape how health plans operate over the next two to three years?
- [06:46]
C
You know, honestly, I think there's a lot of hype out there about AI and technology, but I really do believe that it's going to be a game changer for us. And you know, it's funny, I think often back to sort of the early days of population health and accountable care organizations, and everyone was just hungry for data and we were doing every, everything we could do to get data in any which way. And it was kind of funny times because a Couple years into that process, we were sitting around a table with a number of folks who were in that space and we're like, whoa, what are we going to do with all this data now? Right. And we almost saturated or supersaturated our ability to sort of engage and interact with that information. And so now as we think about technology, we think about AI sort of overlaying on some of these assets that have been accumulated from a data perspective. I'm encouraged by what's possible. I think, I tend to think basic blocking and tackling first with these things. So, you know, how can we improve efficiency of basic services? How can we improve the efficiency of our own workflows internally? Whether you're on the payer or the provider side, we need to get more efficient. And AI starts to provide opportunities to do that by surfacing observations and things that maybe we wouldn't see and then certainly, you know, collating information from different sources. You can think about all the applications within the payer provider intersection where that's needed. Right. We spend so much time exchanging information and trying to, you know, make sure things are in the right format. Golly. To have a technology situ solution that can help us there. I think honestly, it's pretty encouraging to think about what's possible. I do though, want us to really be thoughtful and I tend to think about what are those basic blocking and tackling things that we can do first and get momentum and I think that's the space where we'll see the greatest incremental gains.
- [08:36]
B
Yeah, I appreciate what you said about the, the blocking and tackling there with AI because it's, I think, and kind of what you're saying, it's best as like a thing of, as maybe a long game. Like everyone who was very on board and gung ho with AI right away, they kind of panic when you notice mistakes early on, like, oh, it forgot XYZ or didn't do what I thought it did. So I, I think as long as, you know there's going to be some tweaks that's going to improve, it'll end up helping, you know, everyone a lot, tremendously. Is that kind of what you're saying, Dan?
- [09:03]
C
Oh, 100. You know, it's like with any kind of change management piece, right, there's always going to be speed bumps along the way. And if sometimes if you take too big a bite and you try to overhaul something completely, then that first taste that people get of it, it's got too many, too many speed bumps.
- [09:19]
B
Right.
- [09:20]
C
It's a Little too risky and then people back off quickly. So we're honestly spending a lot of our time looking at what are those, you know, incremental games in efficiency that we can really see that people can feel and that again, a lot of that is internal at this process. We certainly look forward to it having sort of broader implications for our work with providers as well.
- [09:40]
B
100%. If you could change one regulatory or industry practice tomorrow to improve affordability and access, what would it be and why?
- [09:50]
C
It's hard to talk about the provider payer space and not think about the prior authorization process and sort of how um is done. And again, this is a place where, you know, we have a lot of commitments, the AHIP commitments and others about processes and technology to support these things. But I do think feels like just a ripe opportunity in front of us to look at how we have these conversations, how we exchange information, how our skilled teams talk with other skilled teams. How can we make sure that we're applying those resources in the place that makes the most sense, that everyone gets the sort of most benefit out of a conversation like that. What can we move through in automated or a semi automated way of course with all the right sort of precautions and other things that go with it. But I think that's the area where you know, from decreasing friction and abrasion from really helping us be experience each other as partners in this space again we're, we're all about the same thing and that's a place where there's sometimes unnecessary friction. And I'm honestly super excited about what it might look like as again technology as under the current, you know, cost structures and challenges that we're thinking about. We put a real laser focus on this area. I think we can make progress and make sure that we're spending our time spending our resources in the places where everyone's comfortable, that we're getting something out of that investment and I think that'll be good.
- [11:18]
B
And the last thing I wanted to ask you Dan, what issue is putting the most pressure on health plan margins right now and how are you responding differently this year in 2026?
- [11:27]
C
You know, Med x medical expense, the way things are moving, I think that's always top of mind. You're watching, you're seeing where are things popping, what's new this year? What's you know, where are areas that are sort of starting to gain traction. It's just something to monitor. And again we want people to get the healthcare they need. So understanding is it appropriate, is it the right care for the right people. Those are all the questions in the lens through which you look. I think, you know, when we look to sort of the next steps in this process, it's trying to understand how do we now turn that and focus on working with a partner, a provider, a system, a region, and start to take those margins in place or start to take those Medex trends and start to make them real in terms of the members, in terms of the providers, where that care is delivered. And I think, you know, that's a it's a real opportunity and again, one where we're applying technology, AI and other things to start to be more sophisticated and even more nuanced in where and how we see those trends playing out.
- [12:31]
B
Well, Dan, thanks for joining us on the podcast and for a great conversation. Looking forward to working with you in April.
- [12:36]
C
Awesome. Thanks, Scott. Appreciate the time.