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Now here's the episode. - Welcome everyone, to the Becker's Healthcare podcast series. I'm Mariah Mohammed, writer and moderator with Becker's Healthcare, and I'm absolutely thrilled
to have with me today, Tom Groat, CEO of Banner, Aetna. Tom, it's very nice to have
you on the podcast today. To get us started, would
you mind please introducing yourself and telling us a
bit about your background? - Sure, I'd be happy to.
Thanks for having me on. Um, so I'm Tom Gro, uh,
CEO of Banner, Aetna. And by way of background, uh, banner Aetna is a 50 50 joint venture
health insurance company, um, half owned by Aetna CVS and half owned by Banner Health, the largest health system here in Arizona. Um, we just celebrated our
seventh anniversary since we launched back in 2017, and, uh, have grown to, um, in
excess of 450,000 members as of the end of last year. Um, and as far as my
personal background, um, originally started with
Aetna back in 1987, so quickly approaching my 37th year since I started with Aetna. Um, originally I, uh,
worked in small group sales, middle market sales,
national account sales, and then I ran the Ohio
National Account Team for, uh, about seven years. And then after that I moved over to the Mid-Atlantic Marketplace,
um, Maryland, DC Virginia, and had a number of roles there
from general manager to head of sales to the, the market president. And, uh, had the opportunity
where I was there to help, uh, form Aetna's first joint
venture with a nova. It was called Innovation Health. And, uh, got to oversee that
for the first couple of years of its existence. Um, a little over eight
years ago, I moved, um, to the Arizona marketplace,
uh, to run the market and be the west region head and had the opportunity
to help form Banner Aetna. And I've been running, uh, banner Aetna since we
launched back in 2017. - Wonderful. Thank you
so much for giving us that background on you
and the organization. Um, to jump right into
our conversation today, first thing I wanted to ask you is where is your organization
growing, uh, this year, and what is the strategy behind that? - I think one area that we continue to see growth in is in
the individual exchange, and the marketplace has seen
significant growth over the last few years, and especially last year with all the Medicaid redeterminations. Um, and, and the marketplace
in Arizona has become more attractive as the pricing
has stabilized much more than it has in the past. Uh, you know, we've been
well positioned, um, for the individual members, um, as we have a strong network
from an access perspective and, uh, it is well positioned
to deliver efficient and high quality care to
individuals here in Arizona through our market leading discounts and the clinically integrated network. So we've had, um, you know, significant growth over the
last, um, 13, 14 months in that individual exchange marketplace. - Got it, got it. Thank you so much for giving us that insight. From where you sit, what do you believe are the
biggest challenges facing health plans today? And also where are some of
the biggest opportunities? - Yeah, from a challenge perspective, I think it's been well documented that health delivery systems are, are really struggling right
now from a cost perspective due to inflation staffing challenges and payer mix shifts, uh, to lower paying government coverages. And, uh, the issue with that is the answer just
can't be passing along. Larger unit increase is to the more lucrative commercial deals as there'll be a breaking
point at some point where, um, healthcare costs will become too expensive for employers to provide. So, so just passing it along
to the commercial business, um, it, it can't be the right answer. And so we need to continue to promote value-based care
options to reward providers for delivering more efficient care. Um, I think our JV is a
really prime example of that. You know, for instance, on our
fully insured business, if, you know, through our efforts
with Banner, we are able to avoid a, uh, potential hospital stay. Um, banner might lose, you know, the potential revenue
associated with that, um, for the hospital stay, but it will reduce the claim
expense on the insurance company and they in essence will get half of those savings back. So it's a true reward for
really managing the population. And, uh, and there's direct savings back, back to Banner for that. So, you know, from our
perspective, that's the truest form of value-based care, and I think it's important,
um, to help make sure that, um, you know, we're working
collectively to, to deliver the best and most efficient care for our members. We do have outside the jv, uh, a number of other value-based care arrangements that provide incentives
to deliver more efficient and higher quality care, uh,
to reward those providers for doing the right thing. And so I think, uh,
continue to promote that is, is really critical, uh,
to help address some of the challenges that
we continue to see on, on the cost end for, for
the delivery systems. As far as opportunities are
concerned, I think engagement is always, you know, the
holy grail in healthcare. And, um, we are about to launch a, a new program for our most
vulnerable members called the Banner Aetna Eco. And it's basically a community approach to bringing together those
members who have, um, the highest risk they may
have, um, done gone through our diabetes reversal program, uh, participated in our banner the kitchen or participated where with
our care advocate team. And so what we're doing is
trying to bring them together to help support their
ongoing healthcare needs and, and a new approach that's more
community-based, more fun, um, and a real hands-on approach. So, you know, taking them
to do outdoor activities, teaching them to garden
and, and other things, but connecting these members
together to help each other, um, reach their, their greatest potential. Um, we've also introduced welcome calls to our new members in the last year, and it seems a bit archaic to be making phone calls these days. Um, but we had a great success connecting with about half of the members
that we outreached to, um, that are, that are new members. And, um, you know, it's an
opportunity to, to welcome to the plan, uh, see if
their doctors in our network and if not set up a
transition of care plan, um, help them enroll on the member and portal and check to see if
their current RXs fall, where they fall on our formulary, um, to get them the best guidance. And it's really just a great opportunity to connect them right
outta the gate, um, with, with their health insurance plan and help, you know, guide their
transition into our program. So, and I think it's a,
a great opportunity to, to improve engagement and, and answer questions
right out of the gate. - Yeah, that definitely sounds
so amazing to be able to do. Um, Tom, before I let you go,
the lack thing I really wanted to ask you is what technologies
is your organization using to enhance the member experience? - Yeah, in the, in the,
in the past year, one of the things we did launch
is frictionless billing. And, uh, the billing process,
you know, historically is, is very challenging in healthcare. Uh, members will receive
a, a bill from the hospital that says, this is not a bill,
so I'm not sure what it is. And then we'll get an EOB
from the insurance company and they have to, on their
own, try to figure out how do these align with one
another and what do I really owe and when do I owe it, and so forth. And so that has been a historical problem. Um, so we worked with both, uh, banners, accounts receivable area,
as well as Aetna to, um, streamline that process and implement this program, which called Frictionless
Billing, which replaces the bill and the EOB with one
statement, one source of truth that will, uh, better
explain to the member where they are in the billing process and what they actually owe. So it's, um, it's a way
to really bring together, you know, both sides
under one umbrella and, and streamline it for the members. Um, on the, we are also, um, building out a virtual
assistant program, uh, to, to also support those welcome calls. And so using text-based, um,
interactions with the members that we can't get ahold of on the phone, and, uh, trying to go
through that same process with those members to help onboard them. So another way to, to
connect with the members. Some people prefer text, some
people prefer, um, the phone. Uh, so, so we're trying
to make sure we're, we're covering our basis on that front. Uh, I think one other
area that, um, we are, uh, also have been for a long time, uh, working on is, is exploring
other technologies to help streamline the
pre-authorization process. It continues to be a major
pain point for our members and providers, and we're
currently in the process of evaluating, uh, a couple
of options in that area to help really automate it,
streamline it, make it easier for the providers, make it
easier for the members, um, to really try to alleviate one
of the greatest pain points in the healthcare arena. - Got it. Got it. Thank you so much for those final thoughts. Tom. This has definitely been an amazing and informative discussion. So again, I wanna thank you so much for coming on Becker's Healthcare. I look forward to connecting
with you again soon. - Thanks again. I appreciate
you helping me out. - It's so important for leaders
at the top of organizations to keep learning, stay
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