Hi, everyone. This is Laura Dierda with Becker's Healthcare. Thank you so much for tuning in to the Becker's Healthcare podcast series. Today, we're going to talk about network performance. Joining me for today's discussion are Bob Tavernier, who is a solution executive for Quest Analytics, and Karen Tashian, who is senior director of network regulatory operations at Health Care Service Corporation. Bob, Karen, thank you so much for being here today.
Thank you, Lauren. Thank you very much, Lauren. To get us started, can you please introduce yourselves and tell us a little bit about your work in health care? And, Karen, we'll start with you. Thanks for having us, Laura. As you stated, I'm Karen Tashian. I work for health care service corporation, which is a Blue Cross Blue Shield franchisee.
My job is to make sure that we stay compliant, and so most of my teams work on making sure our networks are adequate and that we're providing enough member access to care. So we manage all of the regulatory filings that are attributed to that. Bob, do you wanna go next? Thank you, Karen. Hi. My name is Bob Tavernier. I am a solutions executive here at Quest Analytics.
My role is primarily focused on client engagement, focusing on on all solution verticals as it relates to network data management, network management, and network monitoring. Super happy to be here today. Thank you. Well, Bob, Quest Analytics recently partnered with Becker's to survey health plan leaders on network performance and related challenges.
What were the most striking or validating findings from your perspective, and why are these insights timely and important for payer executives today? That's a great question, Lauren. Some of the primary focus areas when organizations think about what's most important to them, network performance is hot. It really is. When they think about the top three priorities, lowering administrative costs, improving clinical quality, focusing in on truly member satisfaction, we're those top three.
They know that network performance is truly foundational when it comes to ultimately measuring performance of the network and ultimately helping them with their organizational priorities. What's interesting is they really focused on taking a look at deeper dive at competitive intelligence, focusing in on wanting to know more from the data around not only access to care, but understanding more provider costs and quality. Yet the data that
they have access to isn't good. From a competitive landscape, they actually stated that they do not have any high quality data. When it came to access to care, they actually had moderate level of quality data. So really understanding how do we collectively help improve overall data to get them to the position of where they want to ultimately go with aligning network data with network design, which ultimately helps with organizational priorities. It's very interesting space. It's super hot space
to go in. But, ultimately, when we're focusing in on network, it's not only about where the organizations are at today. It's how do we help them to get to the next level. They not only need to be network adequate, but they want to be able to use the network data to ultimately be competitive in the marketplace, have truly marketplace differentiators, and ultimately help to improve the member's experience.
Well, that's fascinating to hear. And certainly, whatever you can do to get that competitive advantage, in today's health care space makes a big difference. So I appreciate your thoughts there and and is currently what Quastya Analytics is doing, to make a big difference. Karen, in hearing about reviewing the survey findings, which two or three themes resonated most strongly with your experience at HCSC, how is your organization approaching these challenges or
opportunities? And can you share any examples of strategies or initiatives that are gaining traction? Yep. So that is a really, really good set of questions. We have a saying in the payer industry that I'm sure probably will resonate to some of the listeners where we are, data rich
but information poor. And so, especially at HCSC, we have access to all kinds of different types of data, but I think making sure that you are leveraging the right insights in a cohesive manner so that you can have actionable results and strategies, that's really key. You have to know your members, you have to know your provider population, and you have to know what your organization's
priorities are. So certainly for us, we are very much prioritizing, making sure that we are lowering medical cost as much as humanly possible, making sure our members are getting the right type of care they need when they need it, and then also making sure that while doing all of this, we're able to grow in a compliant manner, as we're trying to keep up with different regulatory
expectations that continue to grow. And managing all of that with, you know, different levels of clinical needs is sometimes a challenge for us. So, certainly, I definitely agree with a lot of the survey results. There's a lot more too that we'll be discussing later today, but I know that HCSC is not necessarily a standout differentiator. We share a lot of the same pain points that Bob just spoke to.
That's great to hear and really helpful to have that context in how, you know, you're navigating through today is really a lot of challenges within the health care space and but building and designing the future of health care, what an exciting opportunity that, you know, leaders within the space have today. So as we look toward that future of network strategy, what approaches will best position payers to deliver value and differentiation? How do you both see data and technology
evolving to support this? What innovations are you most excited about? So, one of the wonderful things about being in this juncture is technology is on our side. And so with so many advancements in recent technology, just even in the last ten to fifteen years, data is not only more accessible, but there are more solutions and opportunities to do more with them.
And so I think there is a world of options and different solutions for payers to take on depending on what their low hanging fruit, solutions are or approaches or opportunities they wanna go after as well as some of those, opportunities that take a longer pathway. Excellent points, Karen. I'd love to add that really when you're thinking about network strategy, it's understanding where you're at in the market and where do you wanna be when you grow up. Do you really wanna focus in on
your broadest networks? Do you want to have a high performance network? Are you focused in on tiering? How do you ultimately help to set up the the appropriate networks and product benefit designs that are ultimately helping the member to get to the level of care that they need. It's absolutely critical when you're thinking about data and technology.
It's important that you're considering all avenues, not only the network teams, but clinical quality, customer service product, and that you're able to utilize the dataset that can help a variety of those health care verticals to ultimately work together to utilize the data to make informed decisions to ultimately create the best experience for members. Fascinating to hear, and great to have those types of capabilities.
I I know everything you mentioned, really is, you know, truly top of mind for so many health plan leaders and executives today. Before we wrap up here, I'm curious. Is there anything we didn't cover or final thoughts you'd like to share? And, Bob, we'll start with you. Great question, Lauren. One of the things that's really critical when you're thinking about innovation and really taking a step forward is understanding where you are and ultimately where you want
to go. When you think about competitive intelligence, understanding what the competitors have, being able to break down down that level of information in terms of things about what clinical outcomes, thinking about quality, thinking about costs, thinking about are the providers ultimately following things like clinical practice guidelines? Are they billing for additional services that those members don't need?
The payers are very familiar with this space knowing, working very closely with HEDIS performance measures, star ratings, cap surveys. If you look at those surveys and performance measures, a lot of those are really driven by ultimately the member experience. So it's not only building that that appropriate member experience.
It's also being able to understand what are the key differences in your space and how do you ultimately differentiate yourselves from your competitors with the utilization of network data. That's fascinating. Thank you so much, Bob. And, Karen, what are your final thoughts? I think Bob hit on some really great points. In general, I think it's a really exciting time for payers. Our industry is evolving and growing, and there's more asked of us to serve our members.
And so in general, I'm excited to see how we can leverage any level of data enhancement, if you will, or data filtering in order for us to keep up because, again, that's just what our members require. Well, thank you, Bob and Karen, for your time and insights today. We also want to thank our podcast sponsor, Quest Analytics. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview.com.