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Published in Health Care

Pandemic gives health care industry ‘solid nudge’ to make needed changes

BY Sunday, December 20, 2020 06:16pm

Joan Budden retires Dec. 31 as CEO of Priority Health, Michigan’s second-largest health plan with more than 1 million people statewide enrolled in policies. As she prepares to depart after 12 years with the Grand Rapids-based Priority Health, the last five as CEO, Budden expects COVID-19 pandemic will continue to cause disruptions. That includes within Priority Health, which had to adjust its operations because of state-ordered restrictions, as well as with the broader trend toward increased use of telehealth services, Budden told MiBiz

What major adjustment that Priority Health had to make because of the COVID-19 pandemic will carry over into 2021?

Priority Health has always had a lot of people have an option to work from home, and about 60 percent of our workforce did that at least on occasion. Of course, back in March we went full swing into 99.7 percent of our workforce working from home and we did that really quickly, within a week. Our behaviors, our patterns of how we work, will never return to fully being in the office again, and we will not travel the same and we’ll connect differently. I think there are significant workforce ramifications.

Priority Health CEO Joan Budden COURTESY PHOTO

What changes to the health care industry that were brought on by the pandemic do you expect to see stick around? 

We have been trying to encourage and promote virtual care for several years now, and it blossomed under the COVID pandemic situation, both on the consumer side as well as providers being thrown into it and becoming more accepting of it. A lot of people had experience with telehealth and will consider that more frequently in the future as a potential channel for care and to improve access to care. There’s big ramifications on the provider side, and there’s clearly some accessing (and) convenience improvements on the consumer side as well.

Where can telehealth make the biggest difference?

One of the most promising areas is in the mental health arena where many geographic locations have a shortage of mental health providers. Telehealth in the mental health arena can really get greater access to the care that people need, especially with the extra stress and isolation and loneliness that this pandemic has caused. That can be very positive in the long run.

Does the pandemic accelerate change in health care?

What I find in health care is we talk about it for years before we do it. We’ve been talking about telehealth for years. We’ve been talking about value-based payments for years. And whenever we talk about it we say, ‘it’s just on the verge of happening.’ But I do think the pandemic is going to give us a solid nudge to move us along that continuum.

What’s another example of how Priority Health responded to the crisis that will stay in practice next year? 

What we did in COVID was we identified the highest-risk people in our membership for COVID and we reached out to them to help them proactively understand and get the care they need to maintain their healthiest self. I think you’ll see more and more of that kind of outreach work being done on the health plan side to close gaps in care. 

If you’ve been diagnosed as a diabetic but you’re not getting primary care services, we are going to contact you and help you get an appointment. If you are over 50 and haven’t had your colonoscopy yet, we want you to do that. We think that prevention and early detection is the right thing to do. 

Those are the kinds of things I think you’ll see heightened, and technology and automation and risk-monitoring is going to get more and more sophisticated with more advanced data analytics and more advanced digital capability. That’s a real improvement for the better.

2021 will bring a U.S. Supreme Court decision on a lawsuit over the Affordable Care Act. How do you think the industry will respond to that ruling, regardless of how it goes?

I believe that it will not be struck down. That’s my opinion, not fact. I believe that the Biden administration will build off of the Affordable Care Act. Going back to the Obama administration, they realized at that point that there were flaws in the ACA, and we’ve been working to try and educate the Trump administration on flaws that exist and to try and make what we have better, rather than throwing the baby out with the bath water. I think that’s where we’ll continue to focus as a country.

If the President-elect were to call you and ask for advice on what he could do to make health care better in America, what would you tell him?

I would probably say something on pharmaceutical prices. It’s not lost on me, or probably anybody else in Michigan, that during one of our most expensive and heated political seasons this year, there were only pharmaceutical and political ads on TV. No one else could afford it, and that should tell us something.

The advertising is just one piece of it. I would love to see a world where Medicare and Medicaid paid (care providers) actual costs for medical care for their enrollees, instead of commercial (insurers) picking up the bulk of the costs and subsidizing government programs. I don’t think it’s right that we have providers being so grossly underpaid for the Medicaid population and then having it optional if they actually participate in those programs. Government programs should pay their fair share. 

Read 1159 times Last modified on Friday, 18 December 2020 12:44
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