TCOC: Intro

Introduction to Meritain Health and our approach to Total Cost of Care.

Transcript

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Welcome. My name is Bridgette Cassety from Meritain's broker engagement department. I am thrilled today to be joined by Dave Parker, who is our head of national sales here at Meritain. Today we are going to be discussing how Meritain health is uniquely positioned and committed to lowering the total cost of care for our plan sponsors and our members.  I thought we would go ahead and jump in, and talk about why total cost of care is important as a healthcare organization? 

Thanks, Bridgette. The reality is everybody knows this, healthcare is just expensive. The focus that has to exist, is to drive those costs down obviously, but you cannot just save money through a network discount. It is got to be done looking at total cost of care. As a TPA, I think we have a opportunity, or a unique opportunity to accomplish that more so than than most TPAs as well as other carriers. We have been fortunate because as a TPA we have been able to maintain our DNA which really is built on the foundation of flexibility. That flexibility allows us to pull a lot of components together which will ultimately save our clients and our members money. Again, getting back to that total cost of care, we need to drive that down. That is where our focus is.

 What would you say are some of the unique ways that Meritain helps accomplish that for our customers? 

We really look at it from four pillars. Those areas really are cost avoidance and prevention, access, payment integrity, and actionable data.

Those topics are broad topics and there is a lot packed in there. Why don’t we take a few minutes and chunk each one of them down and maybe talk a little bit more with our listeners about that. Do you want to kick us off and talk a little bit more about avoidance and prevention, and access. You want to tackle those two? 

Absolutely. Cost avoidance and prevention really is about providing the right tools and resources as well as guidance to support our members. Tools such as healthcare blue book, who has been just a fantastic partner for a number of years, they have helped both clients and members save a significant amount of money. Looking at how to keep members healthy and then stay healthy. It is not just about getting them healthy. It is the continuum of care. So, focusing on population health management, healthy merits, our phenomenal wellness product. Or Aetna resources for living. Also looking at meeting the members where they are at. Look at today's market, we are all dealing with COVID-19 and access to care is so important. One of the ways we can accomplish that a lot easier is through telemedicine via Teladoc. Or looking at introducing innovative solutions in our health innovation. Our transformation team has a broad, a number of products to the forefront for us, such as Lavango.  Really driving the right products and solutions for our customers and our members is important. 

Dave, I think you're spot on about that proactively keeping members healthy, it's really foundational to cost containment, and certainly Meritain provides a lot of tools and resources to not only avoid those costs before they're incurred, but then also to ensure that members and plan sponsors are paying that lowest total cost of care when they are. I think that the next thing that you mentioned in your four pillars was access. Do you want to talk a little bit more about that?

 Absolutely. Access is not just about network coverage. Lots of networks exist out there and there are some really big networks. Access is focusing on the strength in network. It is access to pharmacies and strong results from that. Looking not just at a broad access network, but a network that has high quality providers a well value price point. Again, not always the lowest cost provider is the best provider either. So, we want to drive our members to high quality providers that have a good price point, optimizing the network and driving the members to the best value is really critical. Being part of the Aetna and CVS family gaining access to the minute clinics, and the health hubs is so important. The tools and capabilities they have there are just such a major value. Then focusing on care integration looking at the integrated pharmacy solutions and how to offer optional or multiple network configurations again, to accomplish member steerage to the right providers. I think those are that is what access is about it.

 Dave, I agree that when it comes to Meritain certainly innovation and strengths from a network perspective is cornerstone value here. I appreciate you sharing that. Certainly, a client's best network solution is the one that not only offers the most comprehensive coverage, right from a high-quality provider, but also allows for the greatest healthcare savings. It is finding that balance. What else would you say that Meritain focuses on when it comes to total cost of care and keeping that at a low point?

One of the things that gets overlooked is payment integrity, that is an interesting statement, but it really does drive down a lot deeper. We have great access to networks and are focused on driving costs down, but let us look at how we pay the claims. Let us look at how we touch the claims and really edit and audit them, looking at it from a cost management solution perspective. Proactive review, audit claims on the front end, negotiating directly with the riders. We have a dedicated team; this is all they do is bill review and direct provider negotiations. It is really an important aspect. Adding to that, looking at the whole picture from the results perspective again is just an imperative within that. I think payment, integrity is a key component there.

I think there is one more thing that you have mentioned, and certainly we all hear a lot about that and that is around data. Actionable data. Actual data is what we hear a lot in the market. How do we take that information and make it meaningful? Can you talk a little bit more about that? 

You bet. I will sound redundant to what a lot of people will always say, but I firmly believe that data is king, and having actionable data is imperative in today's day and age. It has been for a while, but it's really more important now than ever. We have focused aggressively on an actionable data, by working for our Atlas analytics tool, we have a team of professionals that will just pour through that data and identify various different things that are unique within the plan, and do benchmarking. It is just an impressive process that they go through and that they provide to our clients. The thing that most plans provide standard reporting, we do as well, but what we drive deeper into is that customized reporting, what do we need to focus on? How do we need to focus on it? How do we drive results in member outcomes differently? And that is where that data point really comes into play and that Atlas tool comes into play. We also use data through what we have is called the member experience advocacy team. This is a unique team. Again, another dedicated team that is focused solely on escalated issues. They have taken data and used it to identify those escalated issues for members to approach and challenge claims to help drive those claims in a different direction as well. Important to say that data really is king. 

You’re right Dave and using data with a purpose is a key component for our customers and managing trends, both prospectively and retrospectively. Thanks for sharing that. We appreciate your overview of the four pillars of how Meritain uniquely manages the total cost of care. I want to thank our listeners for joining us, I hope that you found this insightful, and we look forward to joining us in future podcasts that we'll take a deeper dive into this and other topics. Thank you.