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Q&A WITH PROVIDENCE HEALTH PLAN'S CEO ON BUILDING THE HEALTH PLAN EVERYONE WANTS
Jakob Emerson - Friday, October 14th, 2022
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Don Antonucci has been CEO of Providence Health Plan since 2021. He sat down
with Becker's to discuss how he's working to get away from the buzzwords heard
all too often in healthcare. As he puts it, he's walking the talk by delivering
health plans members actually want — not just need, or choose.
His company, the insurance division of Renton, Wash.-based Providence, covers
630,000 members across the West Coast, including 63,000 Medicare Advantage
members. Those numbers are expected to grow, as the company is launching its MA
plans in parts of California and Washington state for the first time next year.
With those expansions, Mr. Antonucci is clear that he's focused on truly knowing
the communities Providence is about to serve, all while balancing continued
efforts around care quality and cost.
Question: You're expanding Medicare Advantage plans in parts of Washington and
California in 2023. What led you to this decision?
Don Antonucci: Providence Health Plan has a focus on quality, and we've been a
four-plus-star plan for the past decade. We've been primarily based in Oregon
for Medicare Advantage. With the strength of having our own delivery system in
an integrated fashion, the next steps that made sense were places like Orange
County, Calif., and the three additional counties in Southeastern Washington.
It's an important line of business for us, and there's a lot that we believe we
bring to the table there.
Q: Major payers saw their MA star ratings decrease for 2023, including at
Providence. How does this rating change your strategy moving forward?
DA: It doesn't change it at all. Star ratings are important because it's what's
best for members and patients. Star ratings have declined across the United
States in part because of the methodology changes. All that means for
Providence, and all the other payers out there, is that we've got to make sure
that we stay in tune with how the star ratings work, but never waver from the
focus that we have on quality for our members and patients. At Providence and
Providence Health Plan we share the same promise, which is to really know, care
for and make things simple for our members. At the end of the day, we start
there.
Q: Before your current role, you led membership growth at Blue Shield of
California. How does MA fit into your growth strategy at Providence?
DA: What I really took from Blue Shield of California was some great leadership
values in terms of how the organization walks the talk. I also learned to make
sure that I'm always growing as a leader and focusing on our own employees,
which we call caregivers at Providence. By starting with the focus on our
members and patients and our own caregivers to be able to deliver the service
that you would want, that I would want for myself or for my family and friends —
I think that's the biggest thing I took from Blue Shield.
Also, working in the California marketplace. It is a significantly more
competitive and complicated marketplace — probably the most competitive that
I've worked in my career, and I've worked in a lot of them. With us going into
Orange County with Medicare Advantage, it made me realize the importance of
always acknowledging the community that you're part of or that you're going
into. That's going to be the difference. The good news for us is that we have a
presence there already with Providence, and that partnership helps us take that
next natural step in providing a great health plan with Medicare.
Q: Some payers are now offering incentives or reimbursements for Medicare
Advantage members who have family members come and act as caregivers. Do you
believe that's a viable solution to help health plans get better care outcomes
among their older members?
DA: It's interesting — I think anything that comes back and improves
affordability, quality and experience for actual members is a good thing. It
sounds like that really lines up.
When I think about the promise of knowing, caring for and easing our members'
way, approaches like that can be really valuable and important. The nice thing
about Medicare Advantage is because it's grown so much across the country, it's
very competitive and it starts to create some interesting innovations that are
cutting edge. It's really exciting to see approaches like that come to fruition.
Q: Where is Providence Health Plan innovating in MA?
DA: Some of the basics for Medicare Advantage are $0 premiums, $0 copays for
in-network primary care and specialty visits, and $0 medical and prescription
deductibles. We've also got nonemergency transportation services, post-discharge
meal services through Mom's Meals, and over-the-counter spending and dental flex
cards.
We're also doing quite a bit around home and community-based care at Providence.
We're always looking to figure out what's the best combination and partnerships,
whether that's for remote patient monitoring, new digital services and point
solutions — we want to integrate into our current offerings. We've got a
significant partnership with Virta Health that's starting with our commercial
business, which is focused on complex diabetes care and management. And we've
gotten actual results — members and patients that have used that service have
actually been able to lose weight and lower their blood sugar.
I think what makes us a bit unique is that we're looking at these things from a
health plan perspective and through the view of how does this interface with or
make things easier for our own providers? So that's how we approach everything,
and we're very picky about wanting to make sure that there's a return on
investment for those types of opportunities, meaning improving care quality,
cost and experience.
Q: What do you believe still needs to happen for widespread adoption of
alternative payment methods?
DA: This industry has been talking about this for a long time and at some point,
talk is cheap. We've got to continue to work together, with providers, with
employers, and with members to move away from fee-for-service.
The good news for Providence Health Plan is that we already have a big focus on
value-based care and those approaches. Across our lines of business, 75 percent
of our Medicare members are in a value-based arrangement. In Oregon for
Medicaid, we have 100 percent in value-based arrangements.
Our focus now has to be on commercial, where we've got about a quarter of our
members in value-based arrangements. There's some real opportunity to pick up
there and we're really intentional about pulling that together. Again, it goes
back to what would I want for my family or my friends, what would you want? High
quality, affordable care from a health plan that knows me.
Q: What do you believe is the most important insurance trend that executives
should be keeping an eye on?
DA: There's five major trends that I think employers especially need to be aware
of and know: value-based care, virtual care, behavioral/mental health, health
equity and primary care.
With virtual care, we saw that significant rise during the pandemic, so there's
a place for virtual care that adds to access and quality. With behavioral health
and mental health, we've seen the pandemic exacerbate the need for those
services and we know there's not enough providers out there today. On health
equity, this industry is not equitable today. We must constantly focus on ways,
big and small, to drive health equity.
And then primary care — actually having a robust focus on primary care, not just
on the percentage of primary care out of total services or claims. Good primary
care can point you to the right specialist and can really know you as a member
and patient.
Those are the big trends that I'm focused on day in and day out. I believe that
the industry is focused on them as well.
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