Transcription:

Scott Webb: As a regional provider-owned health plan, SummaCare values the relationship between its members and their doctors. SummaCare has been proud to serve its friends and neighbors since 1993 and was awarded five out of five stars from Medicare for 2023. And joining me today to discuss the benefits of a hospital-owned healthcare insurance company and how SummaCare and Summa Health put the needs of patients first are Dr. Cliff Deveny, he's the president and CEO of Summa Health and Bill Epling, he's the president of SummaCare.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. I want to thank you both for joining me today. We're going to talk about Summa Health, but specifically SummaCare, a hospital-owned healthcare insurance company, why that's unique and whether or not SummaCare can provide better service and quality from your perspectives. So, Dr. Deveny, as we get rolling here, I want to have you speak to that, the uniqueness of a healthcare provider, owning a health plan. Is that relationship unique? And what does it mean for a health plan to be provider-owned?

Dr. Cliff Deveny: Typically, most insurance companies are for-profit and they're owned by investors or they're owned by people who buy the stock or they're privately owned. And so, their mission obviously is to not only provide the service but to maintain a profitability and make a margin of profit and then, that's distributed back to the owners.

The uniqueness of our model is that we're owned by a non-profit health system, which mission is to take care of the community needs, both from a quality of care and access, but also from a stewardship standpoint. So, there's about 6,500 hospitals in the United States, and there's about 150 health plans that are owned by hospital systems. So, it is unique. And really, the genesis came from did it make more sense for the people who were actually providing care to the community to also be good stewards of the dollars that were being spent on the healthcare? And traditionally, providers do their work, they submit a bill, and they don't really have any accountability back to those who are paying the bill. But in this situation, we take responsibility for both the quality of the care and the access opportunities, but also the stewardship and the dollars being spent.

Scott Webb: Yeah, it really does sound unique. So, Bill, where does the mission, the vision for the community align? You know, how do you balance the different business objectives of the two organizations to ensure the community and patients are both adequately served?

Bill Epling: Actually, our objectives are more aligned than you might think, right? Our alignment provides a higher quality of a patient/member experience. You know, SummaCare works closely with the health system to close gaps in care, make sure members are receiving proper well visits and diagnostic screenings. And basically, there's a more focused effort on helping folks maintain their health and wellness in addition to, you know, servicing their acute needs when things happen, right?

So, it just facilitates catching problems or issues early on in the process and moving to proper treatments. We also collaborate to support patients with chronic conditions by introducing health coaching and other resources to introduce unique programs that facilitate a better experience and, quite honestly, what we hope is a better quality outcome for the individual member and patient.

In addition, we play an active role in identifying and addressing social determinants of health. You know, as a health plan, we have access to all the data and information across the entire system of delivery, which is a little unique. And one of the, I think, advantages of being integrated and part of a provider-sponsored organization is that as the payer of the claims, as the financers, we get access to information that, you know, an individual health system doesn't always have because we know that a patient may have gone to another facility for care. We have that information. So, we're able to pull that all together and aggregate that data to assist with overall, you know, quality improvement in outcomes and better serve the populations that we are here in the community to serve.

As an example, Summa performs annually a community health needs assessment to identify those needs for patients and members in our local community. That commitment assessment then leads to, you know, how do we better address the inflationary aspects that everyone is experiencing or the food deserts that might be in a particular location. Individuals that have diabetes and need access to better priced, lower priced insulins, things of that sort. So in our community, it's an aging population, and so we're able to focus our efforts collectively at better serving that population.

We are proud to say that SummaCare is celebrating its 30th year of business. And so, you know, as we continue to provide a mechanism for members to access high quality cost, like the healthcare services in our local community. We have that focus of improving the member and patient experience while helping them navigate what, you know, quite honestly at times can be a very complex healthcare delivery system, and we kind of serve as the navigators for that.

Dr. Cliff Deveny: Yeah, the only thing I'd add to that is we have the privilege truly of providing the right care in the right setting at the right time for the right cost. So, what you see is we constantly are disintermediating ourselves and meeting the needs of the members. And in the end, it really is the members who benefit. It's not about maintaining necessarily what's best for the hospital, what's best for the medical group, or what's best for the insurance company, but what's best for the individual.

Scott Webb: Yeah, the individuals, the members. And Bill, how competitive is Summa Care's service area? And what kinds of challenges does that bring? You know, when you think about the challenges, how has SummaCare responded?

Bill Epling: So good question, Scott, and believe it or not, Northeast Ohio is one of the most competitive health insurance markets in the entire country. As a matter of fact, the Akron area is literally the most competitive Medicare Advantage market in the country. If you're a senior living in Summit County, for 2023, you have 89 different products to choose from. The average senior across the country would have approximately 25 products in their respective service areas. So, Northeast Ohio has become a real hotbed for not only the delivery of services, being in the same market as the Cleveland Clinic and University Hospitals per se, but also it's a very, very competitive market from a health plan, health insurance perspective as well.

So, we believe competition's good. It obviously requires us to remain innovative and on kind of leading edge when it comes to developing products and services for the market. As an example, in 2023, Scott, we introduced a new Medicare Advantage product called Jade with Bene-Flex. It basically allows a senior to build their own supplemental benefits based upon their individual needs by selecting five benefits from three different tiers. It was very unique. It was the first product of its kind introduced to the market, and we had about 15% of our new members for January 1st of '23 select that new product, as well as several hundred others who switched from an existing SummaCare product to one of the new products. So, the breadth of our footprint from a SummaCare perspective goes well beyond Summa. We're currently in about 33 counties in Northern Ohio with about 75 different hospitals and hospital systems and over 22,000 providers providing services to our members across the Northern Ohio footprint.

Scott Webb: Yeah, it's an amazing reach, as you say. You just have no choice but to be competitive and it sounds like you are. And Dr. Deveny, what have Summa Health and SummaCare learned? You know, I know it's so important to listen to patients and members, so what have you learned from listening to them and how has it affected how you do business?

Dr. Cliff Deveny: Yeah. And it's a unique situation because, as a provider, you may be hearing about frustrations people have with their insurance companies on access, on copays, on their networks, and you know, who are the choices they have. And then likewise, on the insurance side, you may get concerns from the members saying, "This service wasn't so great. Provider wasn't who I liked," or "I really liked this one." And so, we use that information and we actually have what we call integration meetings where we work together and we can provide that cross information and we can then become better. And so, one of the things that the insurance company got a lot of feedback on was choice and making sure they had enough choice regionally for different members because of their situation having to drive. And so, that then helped drive Bill to design a modified network of providers and so, broaden that. And, in a sense, in the past, it may have been seen as threatening to the hospital. But in the end, it was really what was best for the patients and the members.

And then likewise, Bill will say, you know, "I need this service in the community. I don't have enough dermatologist," or "I don't have neurology that I need or gastroenterology." And that feedback then goes back to the medical group and they put together a business plan. And so, it's really that cross cultivation that really pays off.

Bill Epling: Yeah, Scott, I would just add to that as well another just prime example of trying to meet the needs of the community, and this is more on the commercial space more than Medicare. But a good example is there was a need for small group employers to have access to affordable products. And that is challenging for small groups in particular. So in 2018, we introduced a collaborative product with a Greater Akron Chamber of Commerce to really offer to their members who employers with employees size of two employees up to 50, so small groups. We actually expanded that last year to include sole proprietorship. So if a group has one employee up to 50, and they are members of Great Akron Chamber, we are able to offer them very price competitive products. As a matter of fact, that's been our fastest growing commercial product the last few years. And we're approaching about 10,000 lives in that, again, try to meet the needs of our local community.

Scott Webb: Yeah. And I'm sure it's very gratifying, Bill. You know, you're sort of designing and creating these products because you're, you know, listening to folks and what they want and what they need and you design them and then you see people signing up and switching. I'm sure that's very gratifying, and wondering if there's some benefits. You know, you can tell us about between patients and members, specifically how they're benefiting from you all integrating to businesses.

Bill Epling: A couple examples, Scott, one of the achievements that we're really extremely proud of for 2023 is that SummaCare achieved a five-star status for Medicare Advantage products, which is the highest rating you can receive from CMS. It measures about 34 different metrics related to quality, clinical outcomes, making sure members get proper screenings. And are they happy and satisfied with the level of service and satisfaction from their member experience with the health plan as well as their providers of care?

So, a key component of achieving that status, quite honestly, is related to how we can work together more effectively through coordination of programs, making sure members are getting well visits in their screenings, and just provide a more seamless experience for our SummaCare members and patients. But, you know, further supporting that is just, you know, our retention rate for our Medicare product is 97%. Our products have a net promoter score of 79, and the industry average is 36. So, I think the collaboration integration, our ability to make the process more seamless and help those seniors navigate the healthcare delivery system really plays out in terms of the level of satisfaction and retention that we have at SummaCare as a result of our integration with Summa Health.

Scott Webb: You've used that word navigate a couple of times today and it seems really appropriate and I know I have a couple of seniors in my life, my mom and dad, and navigating all of this is really tricky business. And it sounds like Summa Health and SummaCare really out in front as they always are in trying to help folks do that, you know, really navigate through all of this.

It's been really educational today. I had no idea that SummaCare had been around for so long, 30 years. As we wrap up here, I just want to give each of you a chance to talk about how you seek out the best from your own respective teams and, you know, constantly trying to improve the business, the care, the services, the value. I'll start with you, Dr. Deveny.

Dr. Cliff Deveny: Yeah. So, one of the things that I think very important, is always think about your mission and why you exist and what your purpose is. And I think, you know, the longer you're at this, the more important that becomes. And so when there are tough times or there's pandemics or there's other things that are going on or inflation, you always have to reflect back on why do we exist and what's our role? And so, that makes a lot of critical decision-making and rationalization and pricing and all those things make sense. You know, the beauty of this organization is if the insurance company does well, then those profits can then be reinvested in the community through different services and different, you know, access points and different programs. And so, you know, we really are a community assets. The community are the shareholders of both the insurance company and the health system. And I think that's something that's very unique that you don't see in many communities.

Scott Webb: Yeah, I think you're so right. And, Bill, last word to you today in terms of, you know, getting the best from your teams and just trying to do the best by everybody involved, the business, the care, the services, you know, the whole kitten caboodle, if you will.

Bill Epling: Thanks, Scott. I think just reiterating what Dr. Deveny said, right, it's really about the mission and vision of the organization and recognizing that we are here as a community asset. And, you know, there's just a different level of service and commitment that I think, we bring to the table. So, it's really challenging the teams to make sure that they're recognizing that. I tell the folks at SummaCare a lot that if you've got a member on the other end of the line, you need to treat them as if that was your mother or father on the end of that phone, and you were trying to help them. And I think that's kind of the approach that we take across the system, whether it's helping a SummaCare member or servicing the members' needs or patient's needs from a clinical delivery perspective. So, it's really about communication, transparency, you know, working well together and really staying focused on that mission of the organization that I think really drives us to the success.

Scott Webb: Yeah, for sure. Well, all good stuff today. Thank you both and you both stay well.

Bill Epling: Thank you very much, Scott.

Dr. Cliff Deveny: Great. Thank you.

Scott Webb: That's Dr. Cliff Deveny, he's the president and CEO of Summa Health and Bill Epling, he's the President of SummaCare. And for more information, go to summahealth.org or summacare.com. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.