Point32Health CEO Cain Hayes says there are “great alternatives” to advance well being fairness in 2023.
Mr. Hayes took the helm of the Canton, Mass.-based payer. in 2021. Point32Health was fashioned in 2021 when Harvard Pilgrim Well being Care and Tufts Well being Plan mixed.
Mr. Hayes sat down with by Becker to speak in regards to the firm’s method to well being fairness, Medicare Benefit and extra.
Query: Well being fairness is one in every of your huge areas of focus at Point32Health. What’s a latest success on this space that you’re pleased with?
Cain Hayes: There are such a lot of that it’s tough to decide on one. As one of many high 20 well being plans in america, well being fairness is a major focus for Point32Health. We’re pleased with the truth that we’re the one well being plan in Massachusetts that gives protection for each section of the inhabitants. For members who’ve Medicaid, Medicare, Medicare Benefit and even the ACA alternate and industrial segments, as a result of we consider that everybody ought to have the chance to get their well being higher. The determinants of well being fairness are so necessary on this regard.
We’re additionally pleased with the truth that we’re the primary well being plan in New England to obtain NCQA Well being Fairness accreditation. It is actually a testomony to all the nice work of so a lot of our colleagues who’re centered on entry and serving to individuals in our communities entry high quality, inexpensive well being care.
Colleagues at each degree actually have this as a major focus. Final 12 months, we launched what we name the Point32Health company well being fairness program. We’ve greater than 70 initiatives centered on well being fairness throughout the group, so it is arduous to select only one. We created this program to actually drive a broader influence to actually drive higher outcomes total.
The way in which we take into consideration well being fairness is that nobody group can remedy it alone. It requires collaboration and public and, frankly, non-public partnerships.
Q: Do you serve any market section? How do you adapt your well being fairness approaches to completely different populations?
CH: We consider that there isn’t any single answer for well being fairness. For instance, in our Medicaid inhabitants, we acknowledge that there could also be extra challenges with the social determinants of well being, which embody secure housing, wholesome consuming, transportation, and language boundaries. For that inhabitants, we actually zero in on actually doing an evaluation of our members to know the place there are gaps and the place their wants are, after which join these members to assets which might be in the neighborhood that may assist serve these wants. Whether or not it is a partnership with the meals financial institution for meals insecurity, whether or not it is just a few examples of how we adapt particular applications to those populations.
Q: What’s the greatest problem payers face in terms of well being fairness?
CH: The largest problem, I might say, is across the monitoring of full knowledge, inconsistent knowledge, associated to well being inequities. That is higher, I’ve to say, as a result of it has been a spotlight for a few years. For a few years, there have been gaps [the data on] entry, price and high quality for sufferers primarily based on race, ethnicity, gender, age, sexual orientation and different demographic elements. These inequities meant that the gaps have been usually not resolved. At Point32, we stay laser centered on persevering with to work diligently and supply up-to-date and in-depth knowledge to our suppliers. We consider it is rather necessary. Information is essential to advancing well being fairness by figuring out well being disparities, and growing interventions to deal with them, and measuring the success of our well being fairness initiatives.
Q: The Tufts Well being Medicare Benefit plan has earned a five-star score eight years in a row How do you keep these high quality requirements, at the same time as CMS has modified its methodology for calculating scores?
CH: The primary is just to proceed to information and empower our Medicare members to reside their healthiest lives. I might additionally say that we need to make it possible for our Medicare members have entry to prime quality well being care advantages and providers. We have to proceed to have sturdy collaboration and partnerships with the supplier neighborhood, and complete applications and initiatives, together with our care administration applications. We need to assist members handle persistent well being circumstances for higher well being outcomes.
Lastly, I might similar to to proceed to supply members with glorious and personalised customer support to assist them navigate well being and wellness on this healthcare system.
Q: Point32Health was fashioned by two plans becoming a member of forces. Different nonprofits have made strikes mix little time Out of your place as a non-profit plan chief, do you suppose additional consolidation is the best way the plans are headed?
CH: No, I do not essentially consider that consolidation is the best way to go for non-profit payers. There are a lot of state and regional nonprofit well being plans throughout the nation which might be doing an important job of offering revolutionary applications and initiatives, and offering nice worth to their members, and to the neighborhood, which is basically key.
Now in fact, by means of the mix of the plan of Harvard Pilgrim Healthcare and Tufts Well being, we’ve created our mum or dad firm Point32Health, and we’re capable of present better worth to our members and the communities we serve. We have had plenty of successes over the previous two years as a mixed group in strengthening our place to supply entry to high quality, inexpensive healthcare to our members in an easy-to-navigate expertise.
Q: What’s the greatest problem in your thoughts in 2023?
CH: From an total perspective of the healthcare panorama, I consider there are a selection of challenges that the trade is dealing with now and can proceed to face. First, the previous couple of years have been extremely difficult for the well being system. Medical doctors, nurses and different clinicians are stretched to the brink. There’s a vital scarcity of employees in well being techniques, and well being techniques are actually compelled to be inventive to fill these scientific gaps for affected person care – outsourcing firms, and so on., that may come to a better price. I anticipate there shall be an total influence on well being care prices in 2023 due to this. Though it’s not near the scarcity of personnel of the well being techniques, we’re nonetheless dealing with some challenges when it comes to open positions all through the nation.
The subsequent factor I’ll say is well being care affordability is a problem. Suppliers are definitely in search of larger charges given the prices of COVID-19. This type of results in the subsequent piece, which is the place I consider that COVID-19 will proceed to be a consider 2023. Like many different healthcare firms, Point32Health has skilled larger medical tendencies in 2023, together with the price of administration of the COVID-19 vaccine, remedy, and so on., in addition to the price of deferred care as a result of pandemic. As you possibly can think about, the influence of COVID is difficult to neglect, however we consider there shall be a seamless influence.
I might say that whereas I do not essentially see it as a problem, however extra of a chance, I consider there are big alternatives to develop new initiatives, applications and well being care measures to advance well being fairness all through the New England area. and, frankly, the nation.