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and preventative care services to the home. By providing clinical care and support services that provide whole person care, we improve health equity, access, and outcomes for the populations we serve. This is Gracelyn Keller with the Becker's healthcare podcast, and we are live at the 2024 fall pay issues roundtable. I am joined right now by Angela Perry, who is the chief Medicare officer at UPMC Health Plan. Thank you so much for being here, Angela.
Would love to have you start off by introducing yourself and telling us a little bit more about your role. Sure. Again, I'm Angela Perry. I'm the chief Medicare officer for UPMC Health Plan and UPMC. We are a payer provider organization. So we have both health plan and several hospitals and physicians. My role there is I'm responsible for the Medicare products division. We have approximately 200 and almost 20,000 members in Pennsylvania.
We focus on both from a Medicare Advantage perspective, non SNP, which is our HMO and PPO products, as well as our special needs plan, our D SNP product. We have about a 140,000 members in our non SNP and about 40,000 numbers in our D SNP product. Wonderful. Well, thank you for being here. Mhmm. And let's start our conversation today talking about
growth goals. So from improving member experience and expanding value based care to controlling costs, Payer executives have ambitious growth goals for the rest of the year and looking into 2025. So in your role, what is your top priority, and how are you planning to get there? Sure. So from a goals and a growth perspective, every Medicare Advantage Plan is looking to grow. And the last couple of years in the post pandemic era has been challenging to say the least.
So our goals continue to be focusing on innovative benefit design. Again, focusing from a quality and and a risk adjustment point of view. So a lot of the policies from a government perspective have changed. And being able to not just comply with some of those changes from quality and stars to risk adjustment, the health equity index that's a part of
that. All of these things are our goals, not just to comply with them, but to really understand how we're gonna better impact the health of our communities. We are primarily in Western and Central Pennsylvania. And so being a regional health plan, we are highly engaged in our communities. And our goals are really to connect people from an access and affordability and a stability point of view. Absolutely.
And going off of that at an industry level, how would you describe the biggest barriers to effectively serving and engaging members? What opportunities do you see for large scale improvements, and how are you applying all this in your current strategy? So I think some of the biggest barriers really come back to access overall. And the pandemic has taught us not only can we use a myriad way of engaging members digitally through telehealth, but also just your regular brick and mortar.
Primary care is central to overall health. And our senior population in Western Pennsylvania and and Alleghany County, which is where Pittsburgh is, Alleghany County has the the 2nd highest aging population behind Miami Dade. So we're number 2 with with our seniors growing older. And from a a barriers perspective, what we've seen in this post pandemic world is that things are much more complicated. And as a result, our our physicians who still tend to be very fee for service focused instead of
really in value models. They're just trying to deal with, enormous volumes and high utilization. And so that doesn't really lend itself to comprehensive evaluations for our seniors. It really is much more episodic in nature. And when you're It really is much more episodic in nature. And when you're dealing with the kind of complexity and acuity that we're seeing, being episodic versus comprehensive tends to make things more expensive, tends to spread things out across the population.
Seniors get frustrated that they're not they're only being seen for maybe their diabetes and not for their asthma or their COPD. They have to come back for a second or third visit. So that creates access issues, which is an unintended consequence overall. So how we're addressing these is really engaging with our physician and provider partners very differently. Having new conversations, not just about risk adjustment and quality, but also about what their goals are.
Because most physicians, frankly, have been burned out in this, again, post pandemic world. They're they're being asked to see huge numbers of people and that doesn't lend itself to good quality care either. So by coming together and trying to solve in a more aligned way, these conversations are the ones that are driving changes in process and changes in focus by both the payer and the provider side of the house at UPMC. Let's shift gears just slightly toward health equity.
So as health equity becomes increasingly centered in payer strategies, how are you addressing health disparities? And can you share specific examples of measurable successes to date? Sure. So at at again, UPMC, we are a regional health plan. So we are very community focused and community engaged.
And one of the things that we've done for years is not just focus on behavioral health or social determinants as a kind of buzzword, But we understand at the community level, at the community hospital level, what's happening in those different neighborhoods. There's rural. There's urban. There's suburban. There's cultural sensitivities that we need to pay attention to and how people choose to access care. So our strategies have been about engaging people where they are.
And not just looking at things like like language or or those kinds of barriers. But instead, looking at at going into churches, we have something called our faith and wellness challenge. It's almost like the biggest loser where different churches, mosques, and synagogues compete to get healthier over, you know, a period of time.
We engage with our our local groceries to have mobile access to healthier foods going into communities that have food, you know, that we look at the deprivation index and there's food deserts and and a lot of communities. So we try to partner with those groceries to bring literally mobile trucks that bring in healthy foods. And then from a benefit design perspective, we have a healthy foods card that's particularly focused on our special needs plan.
So our members can use that card at those those mobile trucks to buy that healthy food. That's just one example. I could go into several. But primarily, we like to focus on the behavioral aspects, on the social aspects, on the community aspects, and make sure that our benefit designs reflect that sense of values for putting people first. Have a hashtag grandma and grandpa centered care.
And that means really understanding what the individuals need and making sure that our community focus is central to all that we do from an operations and a member services execution. And as we wrap our conversation here, is there anything else you'd like to share on the podcast today? I would just say that, you know, there's still a a thought that members are, or seniors or persons with disabilities are not as digitally focused as maybe some younger folks. And I would say at UPMC, we've seen
that not to be the case. That our seniors engage with our flex card. They engage with us digitally. They're very comfortable doing telehealth visits even in rural communities. But even they struggle with different things. So creating tech guides or or doing things that, you know, again, meets that individual where they are.
There's so much fear when it comes to making decisions in the Medicare space that anything that we could do as health plans to better support and engage our members and make things easy for them, have an easy button, that is the way forward. And our seniors really appreciate that and reward us with high retention and satisfaction. Wonderful. Well, Angela, thank you for taking the time to be here today on the Becker's Healthcare Podcast. Again, we are live at the
2024 fall payer issues roundtable. Thanks so much. Thank you.