Medical Management with Meritain Health

In our latest In the Booth podcast discussing Medical Management, we are pleased to have Bridgette Cassety from Broker Engagement,  and Tina Etzler, a senior strategic consultant from the product team. 

Transcript

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(00:05):

Welcome to another edition of in the booth. My name is Bridgette Cassety, and I'm the head of broker engagement here at Meritain health. And today I'm thrilled to have with me, Tina Etzler, who is one of our senior strategic consultants on our product team. And Tina, I'm glad to have you with us today because I always learn so much from you when we get together and have an opportunity to talk about our products and specifically today on medical management. So when we talk about medical management, there's a plethora of things for us to discuss. So I thought we'd go ahead and jump in so we can give our listeners as much information as possible today. Can I thought the best thing to talk about when we kick off our conversation is, you know, what is our approach to medical management here at Meritain? So if you were to give me a high level overview, how would you respond to that?

(00:51):

Sure, thanks, Bridgette. I think of our approach to medical management at Meritain as really being there for members to support them on their journey through their lives, towards optimal health at any given time. So I think of it as being there for a reason, a season or a lifetime, and I'll explain those really quick in terms of our products. So I think of utilization management, which most people think of as prior authorization, you know, we're making sure that services are being done that are appropriate for the member at that time, that everything else has been done up to that point to help meet their needs or that they're not in the hospital any longer or any less time than they should be. We're kind of a secondary double-check for that. So we're there for in their life for a reason. The next one would really be a season.

(01:38):

I think of that more as case management, right? So someone's optimal health may not be in place. They've had an injury, an injury or an illness, something that's going on for them. That's going to be a temporary setback that they could use the support to get through it. And we're really there to offer education, help them adhere to their medication, you know, and make sure that even when we can, we're connecting them with community resources like daycare and things that they may need in order to be living their best life at that time where they are a little compromised. The last one is really the category of being there for a lifetime. And for some people that includes having an ongoing illness, you know, a disease state, that's not just going to go away. And so really we want to help them live as best as they can with that in their life.

(02:22):

And, you know, we have about nine disease states and our disease management program that we cover with a lot of breadth. And again, focus on education and engagement, you know, helping them do everything that they can. And then really that, that lucky category, that fourth category of wellness is those people who are living really healthy. And we want to make sure we have programs in place to support them on their journey through life as well. So, and keeping in mind that we have to balance out as well, you know, what is the threshold for the desire for cost containment versus the advocacy for the member? And so given that we're advocates for healthier living, you know, we're, we're typically looking at it from that member view and making sure that we're accountable for the cost containment measures that our clients and brokers want to see put in place the teen.

(03:06):

I think you've covered a lot of territory when you talk about Meritain approach to medical management. That my key takeaway to that is that philosophically it's about member centricity, meeting members where they're at and making sure that their needs are that their needs are being met. And I think that that's a great way to transition into, you know, what's the value proposition of Meritain medical management and I'm sure there are brokers and consultants are out in the marketplace that understand why the value proposition is important. So how would you describe that here at Meritain? You know, Bridget, I think of it in four different categories or pillars, if you will. They're really, and I talk about them with four PS. So our platform, our people, our performance and our possibilities, I'll, I'll dive into the platform first. So that one's really important. And, you know, I think of that as the foundational underpinning of everything that we do to create programs and to execute them.

(04:04):

So our platform is a multi-million-dollar investment, its proprietary for us. So we have complete control over it and what we do with it. We use it as our accountability systems to be able to manage and measure everything that we do, but really the value in it is it allows us to be transparent about that and to offer really best in class reporting to our clients and brokers. We have some standards that we do relative to that, but we're always open to what is the information that our clients and brokers are. So looking forward to understand what's going on with their members and their programs and in the programs that we do that through our platform. And I think Tina, when you talk about information, certainly data analytics is a key component for plan sponsors, brokers, and consultants. When we talk about medical management.

(04:54):

So that definitely resonates when you talk about it in terms of key information, you know, the next one, for instance, that I think about is really about the people. So information is important and it's critical to the mission, but really there's a lot that goes into the people that are behind executing the programs that we have in place, which, you know, our products. So, you know, I think of it that we go out and we hire really experienced nurses. And we do that with a specific reason. In mind, we look for nurses that have tremendous depth of experience within given subspecialties within medical management. So, you know, you're talking about the different things, but really what we're able to do then, because we have the depth of experience is we can match the nurses with those experience, with the cases that are coming in from our members.

(05:50):

And so I think of that as what I call the magic in the match. So having someone on the phone who is going to be speaking with the member who is knowledgeable about their specific condition. So I'll tell you, Bridgette, I went through an accident myself and was really, really needing case management, not living my optimal health at that given time, because I was injured and to have a nurse on the phone who, after explaining so many things to so many people, then there's one of the phones says to me, yeah, I wasn't, I was an ER nurse for, you know, in the trauma unit for 15 years. So I really do know, you know, a little bit about what you're going through and I can help. It's such a tremendous connection point. And it's so uplifting that really that magic and the match is what drives engagement, you know, with our members.

(06:39):

And we have really, really good engagement numbers. And we've got a 97% rate of the members that we're able to reach, engage with us. And it's really, really because of the people that support and execute these programs. So, Tina, I know you, you mentioned that you talk about our value proposition to Meritain medical management piece, but when you talk about the people I wrote down three E's from what you were discussing and that's really empathy and experience that drives engagement, and those are all critical elements. I think when we talk about value and medical management, right? So then you start thinking about what is it that these people who are executing the programs, you know, what are they able to achieve? And so I kind of frame that with the word performance. So, you know, we've got a great platform, we've got good people executing our programs, but what's our actual performance.

(07:34):

And so there are some different things in the industry about how people look at that kind of the most common denominator is ROI or return on investment. So we do have measurements for all of those that we make available across all of our products. That's really important. We hold ourselves accountable to that. And not only do we hold ourselves accountable, but we do a five-year look back. So our rates that we publish really aren't just the most recent year or the good year that we had a couple of years ago. It's really what we're able to do, given even what the changes are in the market. Kind of here's what you can expect from us in terms of our ongoing performance.

(08:12):

Okay. I think

(08:12):

You're right, because so many times that people talk about medical management, that the purview of which they look at it, and it's such a short window, but what I hear you saying when we talk about the value of American's medical management, is that it's really ongoing and that there's process improvement to drive better ROI on the journey. So we're running a marathon, not a sprint when we talk about it here. Absolutely. And I've got a great example of us doing that with our UN products, for example, and developing a model approach to that, that at least 70% of our clients have accepted our guidance and advice about how we do that. And that's really you know, seeing a good ROI in our interview and products. The last thing I really want to talk about is probably the possibilities that one's the most exciting, right?

(08:58):

It's like, what are all the different things that we can do? And the reason we can do that is because we have a strong platform and we have a knowledgeable experience, great people who are executing our programs with the support of that platform and, and having a good performance to stand on, knowing that we're what we're doing and we're doing things right on a regular basis really allows us to be flexible. That's exciting. We can customize things to meet the needs of specific clients or certain ways that a client may want for us to execute a given program. You know, the world out there is changing and we know how it impacts medical management and, you know, understanding kind of flexibility with our programs is really, really critical. And so we've got to maintain that performance. We've got to support our people who are awesome and then, you know, do it all and measure it through our platform.

(09:52):

So all together, I think Bridgette, it really, really makes a statement that, you know, we are not afraid to think outside the box because we've got the strength of things behind us that we're able to do it competently. And I think that sets us apart from other entities that are providing medical management. So really wrapping it up. It's all about that platform, our people and the performance that they have and what the possibilities are of the things that we can do to be creative and flexible. Well, can I appreciate your time today? I think for our producers and consultants and plan sponsors that might be tuned in today and listening to medical management that you've done a great job of giving us, you know, the approach as advocates for healthier living, keeping the member at the center of everything that we do, and also giving us some things to think about with your four pillars of approach as far as the value proposition. So thanks for sharing that with our listeners. Thank you for joining us today for our discussion. And we hope that you tune in for another edition of, in the boat.