Speaker 0: The payer provider relationship has never been simple, but what's happening now is something different. Value based models are maturing unevenly, prior authorization reform is reshaping workflows on both sides, and affordability pressure is intensifying. The organizations that figure out how to collaborate genuinely, not just contractually, are the ones that will set the terms for what comes next. Becker's fifth annual fall payer issues roundtable brings together more than 500 executive level attendees and 70 plus speakers for two days of focused senior level conversation on benefit design, network strategy, transparency, and the financial Hotel Chicago. For the agenda and event details, visit beckerspayer.com and click on the events tab in the upper right.
Speaker 1: Hi, everyone. This is Elizabeth Casselow with the Becker's Payer Issues podcast. I'm excited today to be joined by doctor Alice Chen, chief health officer at Centene. Doctor Chen, thank you so much for taking the time and joining us today.
Speaker 2: Thanks so much for having me, Liz. I'm delighted to be here.
Speaker 1: Of course. And so before we jump in, can you just tell us a little bit more about yourself, your career background, and your current role at Centene?
Speaker 2: Absolutely. So I have been chief health officer here at Centene, for the last almost four years and would say, it is a really unique health plan. I know we all think we're unique, but Centene really is. It is the largest government payer, with currently about 12,000,000 Medicaid members, three and a half million marketplace members, and a little less than a million Medicare members, with a through line of low income Americans. So we really focus on, government programs, and in particular, underserved Americans.
As for me, the reason I ended up here is because my entire career has been focused on, improving access quality, of care to... For underserved populations. So whether that's in the delivery system, as a primary care physician, I still volunteer at a free clinic in San Francisco, in public health, community health centers, public hospitals, philanthropy, government, purchasers. That's been the through line for me. So, Centene is a place that I think has special resonance for anyone who cares about the quality and outcomes for for underserved populations.
Speaker 1: Well, thank you for giving us that overview. I know today we were gonna talk a little bit about an article that you published in health affairs recently on the evidence based prevention continuum. So can you fill in our audience about what that is and how it's differentiated from other frameworks?
Speaker 2: Absolutely. So the Centers for Medicare and Medicaid Innovation, almost a little bit more than fifteen years ago in 2015, established the health care payment learning action network. That is quite a mouthful. We oftentimes call it the HCP LAN or LAN for short. And, the LAN is a collaborative of public and private health care leaders that collectively believe in alternative payment models and accountable care and really thinking about, how do we align all the stakeholders, providers to, payers to purchasers to policymakers around creating more value in healthcare through aligning incentives.
Most recently, the LAN stood up, a series of work groups including this work group around evidence based prevention with the idea that particularly now when there is a real focus on, both affordability and outcomes and the need for prevention, there have been a lot of, new ideas bubbling up around what constitutes, effective prevention. And so in that, context, we thought it was important to create a framework in order for all the different stakeholders to have a common understanding, common language, common reference point around what constitutes evidence based prevention versus a good idea or maybe not even a... Maybe not a good idea in order to more effectively, have a societal discussion about what, merits investment and scaling.
Speaker 1: Can you talk a little bit more about what a good idea might look like and how this framework would help a health plan understand if that would scale?
Speaker 2: I'm gonna give you a little bit of a preview because one of the use cases that the evidence based work group decided to take on is the idea of nutritional interventions. This idea of food is medicine is very compelling because it just makes intuitive sense to people that what you eat affects your health. When I first got to Centene, what I would say is there was a lot of interest in this, but it really was a thousand flowers blooming. A lot of people had lots of different ideas and pilots and programs, that were not necessarily evidence based. And so the idea of food as medicine is one that I think has intuitive validity, and when you delve into it, the evidence base, helps you differentiate between things that are more opinion of...
Informed or emerging evidence versus things that are more evidence based and ready for scaling. And so along that continuum are things like just sending people food boxes versus very targeted interventions around post hospitalization, medically tailored meals for people with diabetes or congestive heart failure. So, again, taking a concept that's that's a good idea and then having the rigor to look at the evidence to say which populations and what specific interventions are likely going to get you outcomes both in terms of potentially cost savings and improved, health. So what are
Speaker 1: some next steps for health plans that are looking at this framework and are curious and wanna dive into this more?
Speaker 2: We would love it, at Evidence based... And I... I'm saying we, the royal the royal we for, the work group because I know we've had a lot of conversations about this. If payers and purchasers would use this framework before they decided to invest significantly in a given intervention in part because it's not to say that things that are on the emergence... Emerging evidence or evidence informed side of things don't deserve investment.
It's that they deserve investment in a different way, which is if you're going to do something, make sure that you set it up in a way where you can rigorously evaluate it and add to the literature and add to our our collective knowledge about work, what works for whom in what settings. And again, I think for Centene in particular as a government payer, we have a very strong ethos that, we are stewards of taxpayer dollars. So every dollar needs to go to its highest and best use, and if it's not evidence based, if it's not something that has a emerging evidence that we can then add to and then decide whether to continue down this path, or if it doesn't work, stop doing it, then we're not doing our our our duty.
Speaker 1: What other advice do you have for industry leaders as they think about this framework, and what are you excited about as a team right now more generally?
Speaker 2: I would say, I would encourage, my peers to have frank conversations with companies that come to solicit, business and partnerships. And for us at Centene, we typically have three out of the gate criteria. One is particular to us because of our size and scale that we don't wanna be any company's first relationship. We want an established organization that's kinda worked out the kinks already. That may not be true for a small plan or a regional plan, but we really want to be able to identify things that work in scale.
Secondly is develop your intervention for our population. Nothing is more disappointing than an, an intervention that's been developed for a commercial population with a lot more resources, with different barriers to care, and then the group wanting to pivot and looking at the TAM and Medicaid and saying, oh, this is a great population to go after, without accounting for, issues of literacy and language. Some of the, constraints that our members may deal with that aren't true for potentially you and me. And then lastly... And this tags back to the evidence based prevention framework, which is, have real data.
I can't tell you how many decks they've seen where, there's this just straight line of, like, benefit, going right up to the upper right corner. And when you dig into it, it's, you know, 50 people with no comparison cohort. And so it's really hard to hang your hat on that. So in terms of payers, particularly in the government space, really looking rigorously at the level of evidence, making sure that the interventions are for your population, and have, been actually implemented in real life before taking it on.
Speaker 1: Do you have any advice for vendors on the flip side of things that might be eyeing Centene but are still in those, like, early stages? I know our audience is mostly payer executives, but there are some vendors who listen too. So I'm curious.
Speaker 2: Those would be my three, recommendations. Like, no... Before you approach a payer, understand who they're serving. Make sure that you're solving a problem that they actually have because I think the health care system all too often has solutions in search of problems. And in order to do that, you have to deeply understand again both who the plan is serving, what problems those populations have, and, ideally, have some proof points.
Speaker 1: I love the solutions in search of problems point. I feel like I see that across industries.
Speaker 2: And they're so shiny. They're so tempting.
Speaker 1: Absolutely. No. I totally get that. Do you have any final thoughts as we wrap up, doctor Chen?
Speaker 2: I would say, my hope is this continuum sparks a conversation about the importance of prevention, because it is something that is being rightfully raised to something we under invest in. And the way I think we get to it is by being rigorous about what level of evidence there is, but also not stopping just because it isn't on the far side of the continuum. But again, being clear eyed and frankly collaborative in terms of sharing the data that each of us actually generates when we when we pilot something that's more on the evidence informed or, emerging evidence side so that we can inform the field so
Speaker 1: we can move forward collectively. Doctor Chen, thank you so much for taking the time to chat with us today.
Speaker 2: You're so welcome. Thank you for having me.
Speaker 1: Of course. And to our listeners, if you'd like to hear more podcasts from Becker's Healthcare, you can visit beckershospitalreview.com. Thank you.
Speaker 1: Hi, everyone. This is Elizabeth Casselow with the Becker's Payer Issues podcast. I'm excited today to be joined by doctor Alice Chen, chief health officer at Centene. Doctor Chen, thank you so much for taking the time and joining us today.
Speaker 2: Thanks so much for having me, Liz. I'm delighted to be here.
Speaker 1: Of course. And so before we jump in, can you just tell us a little bit more about yourself, your career background, and your current role at Centene?
Speaker 2: Absolutely. So I have been chief health officer here at Centene, for the last almost four years and would say, it is a really unique health plan. I know we all think we're unique, but Centene really is. It is the largest government payer, with currently about 12,000,000 Medicaid members, three and a half million marketplace members, and a little less than a million Medicare members, with a through line of low income Americans. So we really focus on, government programs, and in particular, underserved Americans.
As for me, the reason I ended up here is because my entire career has been focused on, improving access quality, of care to... For underserved populations. So whether that's in the delivery system, as a primary care physician, I still volunteer at a free clinic in San Francisco, in public health, community health centers, public hospitals, philanthropy, government, purchasers. That's been the through line for me. So, Centene is a place that I think has special resonance for anyone who cares about the quality and outcomes for for underserved populations.
Speaker 1: Well, thank you for giving us that overview. I know today we were gonna talk a little bit about an article that you published in health affairs recently on the evidence based prevention continuum. So can you fill in our audience about what that is and how it's differentiated from other frameworks?
Speaker 2: Absolutely. So the Centers for Medicare and Medicaid Innovation, almost a little bit more than fifteen years ago in 2015, established the health care payment learning action network. That is quite a mouthful. We oftentimes call it the HCP LAN or LAN for short. And, the LAN is a collaborative of public and private health care leaders that collectively believe in alternative payment models and accountable care and really thinking about, how do we align all the stakeholders, providers to, payers to purchasers to policymakers around creating more value in healthcare through aligning incentives.
Most recently, the LAN stood up, a series of work groups including this work group around evidence based prevention with the idea that particularly now when there is a real focus on, both affordability and outcomes and the need for prevention, there have been a lot of, new ideas bubbling up around what constitutes, effective prevention. And so in that, context, we thought it was important to create a framework in order for all the different stakeholders to have a common understanding, common language, common reference point around what constitutes evidence based prevention versus a good idea or maybe not even a... Maybe not a good idea in order to more effectively, have a societal discussion about what, merits investment and scaling.
Speaker 1: Can you talk a little bit more about what a good idea might look like and how this framework would help a health plan understand if that would scale?
Speaker 2: I'm gonna give you a little bit of a preview because one of the use cases that the evidence based work group decided to take on is the idea of nutritional interventions. This idea of food is medicine is very compelling because it just makes intuitive sense to people that what you eat affects your health. When I first got to Centene, what I would say is there was a lot of interest in this, but it really was a thousand flowers blooming. A lot of people had lots of different ideas and pilots and programs, that were not necessarily evidence based. And so the idea of food as medicine is one that I think has intuitive validity, and when you delve into it, the evidence base, helps you differentiate between things that are more opinion of...
Informed or emerging evidence versus things that are more evidence based and ready for scaling. And so along that continuum are things like just sending people food boxes versus very targeted interventions around post hospitalization, medically tailored meals for people with diabetes or congestive heart failure. So, again, taking a concept that's that's a good idea and then having the rigor to look at the evidence to say which populations and what specific interventions are likely going to get you outcomes both in terms of potentially cost savings and improved, health. So what are
Speaker 1: some next steps for health plans that are looking at this framework and are curious and wanna dive into this more?
Speaker 2: We would love it, at Evidence based... And I... I'm saying we, the royal the royal we for, the work group because I know we've had a lot of conversations about this. If payers and purchasers would use this framework before they decided to invest significantly in a given intervention in part because it's not to say that things that are on the emergence... Emerging evidence or evidence informed side of things don't deserve investment.
It's that they deserve investment in a different way, which is if you're going to do something, make sure that you set it up in a way where you can rigorously evaluate it and add to the literature and add to our our collective knowledge about work, what works for whom in what settings. And again, I think for Centene in particular as a government payer, we have a very strong ethos that, we are stewards of taxpayer dollars. So every dollar needs to go to its highest and best use, and if it's not evidence based, if it's not something that has a emerging evidence that we can then add to and then decide whether to continue down this path, or if it doesn't work, stop doing it, then we're not doing our our our duty.
Speaker 1: What other advice do you have for industry leaders as they think about this framework, and what are you excited about as a team right now more generally?
Speaker 2: I would say, I would encourage, my peers to have frank conversations with companies that come to solicit, business and partnerships. And for us at Centene, we typically have three out of the gate criteria. One is particular to us because of our size and scale that we don't wanna be any company's first relationship. We want an established organization that's kinda worked out the kinks already. That may not be true for a small plan or a regional plan, but we really want to be able to identify things that work in scale.
Secondly is develop your intervention for our population. Nothing is more disappointing than an, an intervention that's been developed for a commercial population with a lot more resources, with different barriers to care, and then the group wanting to pivot and looking at the TAM and Medicaid and saying, oh, this is a great population to go after, without accounting for, issues of literacy and language. Some of the, constraints that our members may deal with that aren't true for potentially you and me. And then lastly... And this tags back to the evidence based prevention framework, which is, have real data.
I can't tell you how many decks they've seen where, there's this just straight line of, like, benefit, going right up to the upper right corner. And when you dig into it, it's, you know, 50 people with no comparison cohort. And so it's really hard to hang your hat on that. So in terms of payers, particularly in the government space, really looking rigorously at the level of evidence, making sure that the interventions are for your population, and have, been actually implemented in real life before taking it on.
Speaker 1: Do you have any advice for vendors on the flip side of things that might be eyeing Centene but are still in those, like, early stages? I know our audience is mostly payer executives, but there are some vendors who listen too. So I'm curious.
Speaker 2: Those would be my three, recommendations. Like, no... Before you approach a payer, understand who they're serving. Make sure that you're solving a problem that they actually have because I think the health care system all too often has solutions in search of problems. And in order to do that, you have to deeply understand again both who the plan is serving, what problems those populations have, and, ideally, have some proof points.
Speaker 1: I love the solutions in search of problems point. I feel like I see that across industries.
Speaker 2: And they're so shiny. They're so tempting.
Speaker 1: Absolutely. No. I totally get that. Do you have any final thoughts as we wrap up, doctor Chen?
Speaker 2: I would say, my hope is this continuum sparks a conversation about the importance of prevention, because it is something that is being rightfully raised to something we under invest in. And the way I think we get to it is by being rigorous about what level of evidence there is, but also not stopping just because it isn't on the far side of the continuum. But again, being clear eyed and frankly collaborative in terms of sharing the data that each of us actually generates when we when we pilot something that's more on the evidence informed or, emerging evidence side so that we can inform the field so
Speaker 1: we can move forward collectively. Doctor Chen, thank you so much for taking the time to chat with us today.
Speaker 2: You're so welcome. Thank you for having me.
Speaker 1: Of course. And to our listeners, if you'd like to hear more podcasts from Becker's Healthcare, you can visit beckershospitalreview.com. Thank you.
