Meritain Health® - In the Booth

Lowering Total Cost of Care with Meritain Health

January 21, 2022 Meritain Health Season 3 Episode 1
Meritain Health® - In the Booth
Lowering Total Cost of Care with Meritain Health
Show Notes Transcript

Join our host, Bridgette Cassety as she interviews Michael Ciarrocchi, Chief Market Development Officer with Meritain Health. Hear his take on TCOC what to expect from Meritain Health in 2022 and beyond 

Speaker 1 (00:00):

Welcome to another addition of in the booth. My name is Bridgette Cassety and I'm head of broker engagement here at Meritain health. Today, we're gonna be focusing on total cost of care and what's next. And I'm gonna be joined by our chief marketing development officer, Michael Ciarrocchi, Michael. It's been a while since we've had the opportunity for you to join us. And I'm excited that you're here today, so that we can talk about the total cost of care, which I know you're very passionate about. And I think everyone can agree that total cost of care is really an evolution. So what I'm hoping that we can do with our time here today is to really get our listeners to hear from you, you know, what has evolved here at addition related to total cost of care and what they can expect to hear more of in 2022?

Speaker 2 (00:43):

Sure. well, first of all, Bridgette, thank you for being welcomed back into the booth. It's it is fun to, to be here and chat and, and to talk a little bit more, share a little bit more about how we are executing on that, on our strategy around total cost of care. You you're right. We have discussed it quite a bit, but it is absolutely an evolution and that evolution is really shaped so heavily by our customers and our brokers and consultants who have really done a great job at helping us both validate the things that are working, but also really point us into the direction to the things they need us to do more of. So as, as we think about you know, there are some things that we've learned that have really been well received, right?

Speaker 2 (01:30):

The things that we do that are uniquely Meritain that are unique to that TPA DNA that helps our customers maximize the, the health of their members while reducing the total cost of care. And right. Those are, those are the things that we talk about quite a bit, number one, access to Aetna's national provider network, which does such a great job of helping on in networks in network costs, but also our heavy focus around what we refer to as payment, integrity, all that's, all those things that we do to that really live and breathe inside our claim process, where we put eyes on claims at a much lower dollar threshold to make sure that the clinical accuracy is there to make sure that the contractual accuracy is there. All the things that we do on it from an out of network perspective that we don't simply just get the claim and send it off to a tertiary contract.

Speaker 2 (02:23):

And send that on that we really have a very detailed approach when it comes to looking at those out of network claims and then even into the medical management components that we use that provide again, another opportunity of making sure that our members maximize their health and reduce that total cost of care. Those things have been really well received by our by our consultants and brokers and customers. But I think as we think about what's next, we've also received some really good feedback that I, I, I think would be defined by our customers as saying, Hey, you're part of this, this huge CVS enterprise. And we would love, we would love to see you leverage. We'd love to see you leverage some of those tools in and, and leverage them to the benefit of our customers. And so that has really con helped us continue on the journey where we've been able to launch at the end of last year. And it'll be a big focus moving into twenty twenty two, two concepts that we call Meritain connective solutions, as well as point solution optimization. So, so Bridgette, those are the kinds of things that you'll be hearing us talk an awful lot about throughout 22, as well as to 23 pioneers as well.

Speaker 1 (03:40):

And Michael, you talked about point solution optimization. I just want to drill into that a little bit more for our listeners. So what exactly do you do you believe that our, our brokers consultants and customers can, can expect around point solution optimization? You know, what does that mean to us here at Marta that people should know more about?

Speaker 2 (03:58):

Yeah. You know, so point have become an interesting buzzword and a catchall for a lot of different things. In particular in the TPA space, right? TPAs in general are very effective at having operating models that allow them to plug and play with a lot of external point solutions. And so Marta obviously had had made a lot of investments in making sure that those data feeds were up and running and that they were effective. However, one of the areas of opportunity that we noticed was that there there's needed to be more to working with external point solutions than simply connecting the data feeds our customers are when they invest in a point solution, whether it is a navigation firm, whether it's a specialty vendor, whether it is whether it is some other type of wellness solution, our customers, when they invest that money, they really need to see a return on, in, on that investment.

Speaker 2 (04:58):

And too often, what we found in the TPA space was that PA sort of stopped at connecting the pipes to make sure that the data flowed back and forth. And what we found really lacking was someone who could act as a curator and help connect the dots from the perspective of information, meaning that, that it was more, it requires more and simply connecting data feeds to go back and forth. It requires investing in the people which we have through a point solution center of excellence. It requires the investment in those people to make sure that the point solutions are able to maximize the value they bring to the customers that data and reporting cetera gets integrated on a way a consultant or a customer can see the benefits of that work without feeling like there is a bunch of pointing fingers at who ought to own that type of data and those types of data feeds.

Speaker 2 (05:55):

So we've really invested heavily to make sure that we have a team that interfaces with those point solutions to, to make sure that the relationship between those firms work well, that there's clear understanding of, of what data obligations exist for each firm, that we are able to integrate those at the, again, at the customer client or, or broker request to make sure that we are providing that that customer with as a unified view of their plan performance as we possibly can. So for us, it's so much more than just data feeds. It's so much more about connecting the dots for our customers, so that, and realize, and maximize the investments that they're making in those point solutions.

Speaker 1 (06:43):

And I think you're right, Michael cause when people are, are purchasing those point solutions, ultimately that's their goal, right? They want to make sure that there's connectivity and that it's maximizing value, which is why they're purchasing these solutions to begin with. So I think that that's good perspective.

Speaker 2 (06:57):

you're so right. I think the rush right to, to play in a crowded world of point solutions I think that a lot of customers and brokers feel not just confused, but almost that there's chaos and right as, as we look to, many of those point solutions are brought in to maximize a, a specific component or optimize a specific area of their benefits plan that they believe needs some assistance. But if you simply string together in a, almost like a Daisy chain fashion those point solutions without sort of connecting the dots, you can just end up with a bunch of that chaos. And so what our, our mission is to take it a step further and try and present a much more compelling overall view of what's happening to their plan so that customers can, can realize the value from them rather than that chaos are confusion that can result if they're just sort of strung together.

Speaker 1 (07:56):

Absolutely. You know, it's always our goal here at Mary to, and not overwhelmed, but to make strategic decisions with our, with our partners. And, and along those lines, Michael, you also mentioned when you started talking about Meritain connected solutions, I wondered if you could expand a little bit more about that and, and maybe how point solution optimization plays into the Meritain connected solutions.

Speaker 2 (08:18):

It, it was another great example of, of just tremendous feedback from our, from our broker consultant community who really helped remind us of the, some of the tremendous assets and sort of thoughtful solutions that CVS was bringing was bringing to market. And one of the things that was sort of our aha moment was so many, any of those solutions in essence can be utilized almost like a point solution and given Meritain infrastructure is so well designed to maximize those point solutions. As we talked about before, it became clear that there was a whole scope of solutions that we could provide through what we now call Meritain connected solutions that give our clients all the benefits of working with a TPA, all of the flexibility and customization that they are used to from us, but now for us to be able to pull in some of the CVS assets and, and really helps to, to share that greater vision for CVS of creating that omnichannel healthcare experience.

Speaker 2 (09:22):

And so what, what does that look like? Right? Those are, those are buzzword, but they do mean something very intentional. So for us, for instance, the ability as, as we are saving clients’ money from a pharmacy perspective and as we are making access to care much more much more local, we have the ability for instance, for customers to integrate minute clinics and health hub visits into their benefits plan. And that enables cus not only does it enable something of value for their members, right, to be able to go and access that care with either a low cost or no cost copay at, at the minute clinics and health hubs. But it also creates an environment where the member starts to re to utilize CVS that local, that local resource they're able to utilize them for far and get more comfortable with those retail lo for help, for being more helpful in helping them get access to care.

Speaker 2 (10:20):

And so, as we continue to, as, as, as CVS continues to evolve that mission and continues to expand those health hubs and minute clinics to more and more geographies, it again, provides an additional access to those levels of care. And, and we're not just stopping there. So we are, are leveraging we are leveraging additional solutions this year when it comes to virtual primary care, we are leveraging, we'll be leveraging some additional in-store solutions as well as those as those become available. And the great thing about this is we have piggybacked with our, our, our parent of Aetna and CVS to utilize their integrated value guarantee so that as our customers decide to engage in more and more of those CVS assets, they will they will have get additional guarantees in terms of fees and claim targets that we will be able to provide be based upon those different services.

Speaker 2 (11:19):

So, of course it was really, really important for us to make sure that by bringing these assets, they were, they were seen as something additional. They weren't something that we were taking away from. So again, these are not required. These are not mandatory. Our customers are, our brokers will absolutely continue to have all the flexibility they always had with regard to all the different solutions we have, but we really realized and heard from our customers that they like to see us bring some more of those CVS assets to the family. And so that's something that we have really offered to do over the last part of 21. And the fruits of that will really pay off in 22 and 23.

Speaker 1 (11:56):

So, Michael, I, I think that our listeners will be excited to hear about the, the evolution that we're taking and how we're leveraging some of the CVS and Aetna assets that they can take out to their customers to provide, you know, unique value propositions and solutions in the marketplace. So just talk to me a little bit more before we end our time here today. And why is it important for plan sponsors and brokers to be thinking about the CVS and Aetna assets that are part of Meritain connected solutions, as well as point solution optimizations? Why are those things valuable to them?

Speaker 2 (12:30):

So I, I I'd say two, two things that strike me immediately on that, Bridgette, the first is the uniqueness of Meritain connected solutions. There is no other TPA that is able to integrate those CVS solutions whether they're in the retail environment, minute clinic, health hubs, et cetera, there isn't anybody who's able to, to, to sort of wrap flexible infrastructure around those industry, leading assets then, then meriting Meritain is the only TPA that can do that. So there, number one that presents something unique for brokers and consultants to be able to talk about to their, to their customers. The last is the second part is that we mentioned a little bit about this before, but I think other TPAs can, can connect the pipes to point solutions, but we're going to be the one who helps connect the dots that our solutions that are not simply when we're working with an external point solution, you'll still have all that flexibility, but will we really intentional about making sure that we understand the, the, the investment that's being made by your customer and how we can make sure that the, the operational workflow is effective, that the data flow is effective and that we're able to synthesize the data in a unified approach so that consultants can give good counsel to their clients based upon how their total plan is performing and not have to worry about the piecemeal that's so free comes from other types of point solution connections that other TPAs are, are, are capable of.

Speaker 1 (14:03):

So, Michael, a, a takeaway that I have, and from listening to our conversation, our a few critical things. One is, is that our brokers and plan sponsors and customers can definitely take advantage of the investments that are being made from an as perspective by CVS and, and Aetna. And that's a unique experience that we can provide. And I think you said in your conversation, Hey, this is additive. So you don't have to do it, but it's available if you want it, we're responding to the market and making that available that we are definitely evolving our total cost of care into new areas based on the market feedback that we've heard. And we're focused on sort of minimizing. There's a lot of noise out there, but to help our brokers and plan sponsors and customers make strategic decisions that we can connect the dots as you say, and provide high value. And so those are sort of the themes that I heard in our conversation today. And I want to thank you for taking some time with me and for our listeners for joining us to have a conversation about total cost of care here at Meritain and where we're headed in 2022. So thank you and have a great day.