Florida Blue Focuses On Whole Health In Tight Medicare Market

Image

Florida is a competitive market for Medicare Advantage. Florida Blue’s strategy is to know its members and tailor services to their needs.

Parie Garg  and  Camille Harrison

12 min read

Camille Harrison’s career has come full circle. She started off as a customer service representative on the night shift helping seniors. Twenty-nine years later, she is Executive Vice President of Medicare and Chief Innovation and Experience Officer at GuideWell, the parent company of Florida Blue. In between, she held leadership positions focused on customer service at Blue Cross Blue Shield plans in Minnesota and New Jersey.

Harrison joined Florida Blue in 2011 as Chief of Staff to Patrick Geraghty, President and CEO of GuideWell and Florida Blue, and continued an upward trajectory to her current position at GuideWell. That career journey provided insights across the entire business that serve her well as she oversees the company’s Medicare Advantage business in one of the nation’s most competitive markets.

“I saw this huge opportunity to make meaningful change in our organization around how we serve members end-to-end,” she told Oliver Wyman’s Parie Garg. “My member experience that gave me an opportunity to do something special. It’s a gratifying career journey that also took me into responsibilities for our shared services capabilities — digital and innovation. I'm really trying to meet members where they are.”

This is a two-part interview series exploring Florida Blue Medicare’s strategy for doing just that, meeting members where they are. In this interview, Garg and Harrison examine Florida Blue’s Medicare Advantage strategy. Part two will explore efforts to embrace value-based care. The following is an edited transcript.

Garg: You lead Medicare in one of the most competitive, challenging markets in the US. What are some of the challenges you face and what’s top of mind in terms of making the business successful?

Harrison: The senior market continues to grow, and nowhere is this more apparent than in Florida. Baby boomers will finish aging into Medicare by 2030 and every insurer is trying to capture as much of that market as possible – and in Florida, we feel that more than the rest of the nation in part due to our snowbird population. One of the challenges we face is how supplemental benefits are expanding to include assistance with utilities, rent, mortgage, and pest control. Those things might seem like nice add-ons when you talk about vulnerable populations but they lead us further away from providing actual healthcare to members. If individuals aren’t careful to understand what’s being offered, they could end up in catastrophic financial situations when they need healthcare. At Florida Blue Medicare and across all of GuideWell, we firmly believe that the whole person matters — but we are also cognizant that supplemental benefits should be complementary to healthcare and must be sustainable. That is a difficult balance for us to strike given the sheer richness of benefits that are being contemplated by the competition.

Another challenge we face is the regulatory environment. And, when you combine regulatory changes with a market like Florida, it results in a different level of challenge. Take risk adjustment as an example. At Florida Blue, 50% of our Medicare members have two or more chronic conditions; 36% of them have five or more chronic conditions. Changes by the Centers for Medicare and Medicaid Services to its risk adjustment model could unintentionally impact some of the most vulnerable in our population. These members are very sick and interact with the healthcare system often. Decreasing the weighting of diagnoses codes may impact the level of intervention these members get. We understand the motivation for the changes, we just want to be careful that providers will not be hampered in their ability to provide quality care. We must get the approach right and leverage the data correctly to make sure there aren’t unintended consequences that cause quality of care to suffer.

The last challenge that I’ll talk about is provider consolidation. Hospitals are purchasing provider groups and there’s additional consolidation of provider groups on top of that. It’s becoming more difficult for our members, their patients, to find a doctor who through a value-based arrangement provides value to the patient first and then shared value between the payer and the provider in pursuit of our affordability and quality goals.

When you add up everything I've described, Florida is certainly a challenging environment for Medicare. Having said that, we are committed to continuing to serve our seniors and do right by them across the sunshine state.

Garg: How do you define and measure success as you manage the organization through those challenges?

Harrison: The first indication of our success is member retention. If people are staying with us, we're providing a product or service that they perceive can't be beat by someone else. We want our members to be Blue for life and carefully track how we retain our members across years and lines of business.

The second thing we look at is member satisfaction, which is, of course, is linked to retention. Our members tell us how they feel in many ways — through our Consumer Assessment of Healthcare Providers and Systems survey, through our net promoter scores, and through our provider visit surveys. If members are happy with the services we are providing, we know we are doing a good job.

Third, and perhaps more important than either retention or satisfaction, is the quality of healthcare. We make a promise when someone signs up — a promise that we're going to be there when it matters the most. Our members’ health outcomes demonstrate if we're doing that successfully. That includes aligning incentives with providers to ensure members are getting the quality of care that they need and expect.

We believe in whole person health. When you think about mental health, for instance, we want to ensure that people can access care in a way that's helpful. Sometimes you find out that a person who has chronic conditions isn't complying with their care plan because there's a mental health challenge that's not being addressed. Those barriers need to be addressed at the primary care level.

Success for us is also about getting local and understanding what’s needed at a community level and delivering against our promise. We look at things down to a zip code level. As an example, we don’t provide benefits in a rural area where care is difficult to access without addressing the issue of transportation. We are not going to pat ourselves on the back for simply rolling out telehealth — if a member doesn’t have Internet access, it doesn’t matter. It’s about understanding who your member is and making sure your products and offerings meet them where they are.

And lastly, of course, there’s always a financial piece. Do we have profitable growth? Are the financial targets being met? Those are also ways that we measure success since our financial health and sustainability are what support the company’s community mindset and mission.

Garg: Florida Blue has made a very significant commitment to improving access to mental healthcare as part of its overall strategic agenda. What types of services are you offering members?

Harrison: The most important thing we did at the outset of the COVID-19 pandemic was take majority ownership of Lucet, our behavioral health company that focuses squarely on mental health. That allowed us to provide access to all our members virtually or in-person, and to accelerate their ability to get an appointment.

We also have social workers in our Florida Blue Centers across the state. There are activities in the centers that allow people to have social needs met. And we have partnerships that allow someone to visit a senior in their home and help them with chores or get them to the doctor or just be a companion. That gives us a window into the home to look at social needs and other considerations that may be exacerbating our members medical conditions.

We are very cognizant about how the mind and body are connected, and how our mental health impacts our physical health — as evidenced by our commitment to and investment in Lucet and these other services that we pride ourselves in providing to our members.

Garg: In context of some of the challenges you described, how would you like to see Florida Blue’s Medicare Advantage business evolve by 2028 or 2030?

Harrison: As I said, we want members to be Blue for life. Across years, across lines of business and across our strategic partners to “harmonize the experience” for our members.

Looking out five years from now, when people talk about Florida Blue Medicare, I want them to know that we understand the needs of our members and that we have products and services that meet those needs; that we’ve made an experience that is so intuitive they don't have to think about how to navigate this complicated healthcare ecosystem, and that we know them as a person, which means leveraging a deep understanding of our members and available technology like artificial intelligence to personalize their healthcare journey.

When providers talk about us, I want them to view us as a partner, not an obstacle to their relationship with patients. I want members to perceive us that way, too. The communication and objectives should be the same so members feel supported by all of us.

As an industry, we need to get past the disruption and the competition and recognize that we all have a seat at the table to drive down healthcare costs and to engage the patient in their healthcare journey.

To learn more contact Matthew Weinstock, Senior Editor, Health and Life Sciences.