NBTH — Guiding Greater Health from the Top: Mike Tuffin & Pat Geraghty

What will it take to make health care more integrated, accessible, and patient centric? It starts with collaboration, innovation, and technology, say AHIP President and CEO Mike Tuffin and Pat Geraghty, chair of the AHIP Board of Directors and president and CEO of GuideWell and Florida Blue.

Tuffin and Geraghty sat down with us to talk candidly about their responsibility to deliver the best, most convenient, and most affordable care and coverage to the people they serve. They also opined on what keeps them up at night — and shared a rare peek from the C-suite on the amazing things that happen when health insurance providers come together at AHIP to drive change, employing the most promising tools and tech on the market for delivering top-notch care in our country.

Listen in for their thoughts on the next steps in health care transformation.

Episode Transcript:

Mike Tuffin

What I've been struck by in every conversation I've had with a business leader, with a clinical leader among our companies, they all want to be part of making the system work better.

Pat Geraghty

But really the mission here is about affordability, access, quality, and equity.

Robert Traynham

All right, first of all, welcome. It's good to see you both.

Geraghty

So nice to see you.

Traynham

I'd love to start this conversation with an icebreaker. And little birdie told me that you're both sports guys. So tell us a little bit more about that.

Geraghty

So guilty as charged on the sports guy. I'm a New York giant football fan my whole life. And now I'm in Jacksonville, Florida, been there a long time. So I absolutely picked up the Jaguars but the Giants are my first love.

Traynham

Has sports been a part of your life, from the beginning, Pat?

Geraghty

Absolutely. Grew up playing football, basketball, and baseball. Loved all of those sports. Learned a lot from, team sports. And, learned that allegiance to the Giants from my father. My brother and I were very dedicated to, following the Giants throughout all the ups and downs, mostly downs, but, but, loyal fans.

Traynham

Mike, same question.

Tuffin

So the two most painful sports moments of my lifetime were both delivered by the New York Giants-

Traynham

Ah.

Tuffin

... when they beat my beloved New England Patriots in two Super Bowls so-

Geraghty

Ah, yes, I remember those fondly.

Tuffin

So those were, those were dark days, but yeah, sports is a big part of our life. My, my dad first took me to Fenway Park when I was six and I've been a lifelong Boston Sports fan. And even though our family now lives in Metro D.C., I have our kids fully indoctrinated as Boston Sports fans.

Traynham

Very nice. Allow me for a few moments, gentlemen, to keep this analogy going, with sports teamwork, a coach, rowing in the same direction, literally and figuratively. I want to use that and carry that through this conversation with respect to how you got into health care. Pat, let's start with you.

Geraghty

So for me, getting into health care was an interesting journey. It really was about, helping people. And the critical nature of health and health coverage, is something that really appealed to me.

Traynham

Mike, same question for you.

Tuffin

Yeah, sure, Robert. Thank you. Always been, my whole life, a policy junkie, advocacy, the political realm, all of it. And there's really no place you can apply those interests and have more impact than in the health care system in the U.S. And with all the challenges we face, all the opportunities we face. So I've always been really drawn to that.

Traynham

Pat, we are so fortunate to have you as our new board chair, but you also have a full time job. You wear a different hat and that is CEO of GuideWell. Walk us through your vision, for your not for profit organization.

Geraghty

Yeah. Thanks, Robert. You know, GuideWell and Florida Blue, which is the, the main, Blue Cross Blue Shield company under GuideWell and SSS, which is the, most recent acquisition from Puerto Rico. They're both not for profit companies. They're focused on dealing with the health and well being of the people in Florida and in Puerto Rico.

GuideWell also does things to serve people across the country, bringing health services to, to folks. But really the, the mission here is about affordability, access, quality, and equity. And really, that equity piece is so much more in focus than it was in the past. And I think it really speaks to the diverse populations that we're taking care of and really thinking about how do we bring quality health care to everyone that we deal with and really allow people to live their best life.

So our mission as a company is to help people and communities achieve better health and working on that each and every day with a great team of people is what we're about. And so, that, that drives me every day. I'm passionate about that mission and the ability to make that difference in the, Florida and Puerto Rico markets. And as chair of AHIP, I see a real convergence of those, priorities and really thinking about how do we bring affordable, quality, accessible, equitable care to everyone in the country.

Traynham

Mike, you, this is almost like back to the future. You were at AHIP for many, many years as Executive Vice President for Public Affairs, left, and now you're back as our new President and CEO. What brought you back to AHIP?

Tuffin

Well, I think, Robert, many of the same themes that, that Pat touched on. When I think about the fact that our members serve more than 200 million people. That's in the commercial market. That's in Medicaid. That's in the marketplaces. That's in Medicare. The opportunity to contribute to that at a time when the health care system is facing both really daunting challenges, but we've also got some momentum and we've made a lot of progress in, in certain areas.

So, I'm thrilled to be back and as I've reflected on, my first time at AHIP, I think about the implementation of the Medicare drug bill. I think about the advent of the Affordable Care Act and guaranteed coverage for all Americans. And, I see a lot of opportunity working with our chair and our broader membership to, to build on those accomplishments on, on behalf of the sector.

Traynham

Question for you both. I want to go back to, to Mike's earlier comment around some of the challenges in the health care industry. What keeps you up at night? What is that one or two big things, like, "Oh crud, we need to figure this out on behalf of the hundreds of millions of Americans we serve"?

Geraghty

You know, what keeps me up at night is the affordability question, particularly given all of the pressures that we're facing. We've got a major pipeline of specialty drugs coming at us. Those drugs offer a lot of promise but they're very expensive. And so, how do we bring these drugs into the system and yet deliver on our promise of affordability? That's one of the biggest drivers. We're also in this post pandemic world where we find a lot of pressure from the provider community to sort of make up for, some of the economic shortfalls or challenges that have developed as a result, like in labor shortages and the pressure that our provider partners are having in that space.

So when you're trying to balance that whole equation, it's tremendous pressure to really deliver the affordable care that you're trying to deliver to your members. So that's really one of the things that keeps me up at night. One thing that isn't keeping me up at night is that we were able to bring Mike Tuffin to AHIP. So I can sleep very comfortably knowing that Mike is on the team and we're working together on this mission.

Traynham

Same question for you, Mike.

Tuffin

You know, I, I think about, all the, markets where people get coverage. Progress in all of them, but also threats ahead. Emerging threats to the ERISA framework that has provided affordable, stable coverage to tens of millions of Americans for generations need to keep that strong. The tax policies that have helped millions of people find affordable coverage in the marketplaces, those expire at the end of next year, need to be extended. 33 million people who've made the choice of Medicare Advantage for their Medicare coverage, need to make sure that coverage is going to stay stable for them.

And Medicaid, a big learning out of the pandemic is redeterminations of Medicaid eligibility resume. We have to make it as simple and easy and seamless for people to stay in Medicaid coverage if they are eligible. And if not, to get them immediately into new coverage.

Traynham

Pat, From your perspective, what else have you seen, throughout your health care career just in terms of the innovation or the evolution of health care?


Geraghty

You know, Robert, we are always deploying new technologies. And new technologies have helped us in a variety of different ways to be better, to be more efficient. We've seen artificial intelligence that has really helped us automate processes. Now, that banner of artificial intelligence includes ChatGPT. And there's as much concern as there is optimism. And so, our challenge will be how do we bring that new technology into play in an effective way, in a prudent way so that it benefits our customers and doesn't compromise our customers?

That is a significant challenge. It's the next wave of any technological advancement to have something that has upside and has downside. Look at social media, look at television, look at all these things that we've all embraced as a society. There's upside and downside to each of them. And it's incumbent upon us to try and emphasize and really focus on how do we bring the best of the new technology to bear and limit or mitigate the risk side of that equation.

Traynham

Mike, did you want to answer that?

Tuffin

So much emphasis, appropriately so, on AI in particular and, and frankly, a lot of skepticism about the potential role of AI in health care. We need to make sure we have space for innovation here and we allow AI and other technologies to flourish we're not going to fulfill the promise of equity unless we max out the appropriate use of these technologies because they're going to enable us to reach people in new ways. And, of course, there have to be safeguards, consumers have to be protected. Stakeholders have to be involved, but we have to be really careful that the baby doesn't get thrown out with the bathwater when it comes to regulating the use of these technologies.

Traynham

Can we unpack this a little bit more? You, you mentioned equity, also affordability and accessibility, and obviously AI. Simple question, are we rising to the challenge? Are we, is this our moment to be able to meet these challenges?

Geraghty

Well, I think if we're being candid, we haven't risen to this challenge as a society. And now, we have a greater opportunity. There's more clarity around the gap. There's more clarity in the data, what needs to be done. And we should be driven by the passion of doing the right thing. So, I think we have this great opportunity. If you think about something like AI that we were just discussing, think about rural health care. Rural health care has been way underserved. But if we can make sure that every clinician has all of the available medical data at their fingertips through their phone, think of how much different the distribution of health and health care can be in a rural society than it is right now.

Think about underserved urban communities, where we're arming people with the very best information. That's only a piece of the equation, but it's certainly a big piece of the equation. So I'm optimistic that the new technologies can be one of the tools we deploy to get at this, gap in equity.

Traynham

You know, when I think of AHIP, I think of a community of large and small, for profit, not for profit, rural and urban. And the future is really bright based on that community. what does that look like for you, the vision of AHIP

Geraghty

Well, I think the vision of AHIP is to really allow all people in the United States to live their best life. And if we think about it that way, we're really thinking about how do we invest ourselves in keeping people well in the first place. It's what do we do on the front end? How do we make sure people have access? How do we make sure people have transportation? How do we make sure they have, nutrition? The ability to have early childhood learning so that they're ahead of the curve?

You know, this is something we do in our company. We've da- identified six zip codes in the state of Florida. And with partners, we're going deep into those zip codes to change those communities. I think AHIP has the power to do this all across the country. So, we should think big. We should have a large vision for what we want to do, not alone, but with partners. With our partners in the delivery system. Because collectively, we have such power and such ability to change the lives and the communities in which we work.

Traynham

Mike, your vision, for AHIP?

Tuffin

In my early months, in the role here, I've had the opportunity to, touch base with leaders from across the industry. And as, as you noted, we have, companies large and small, regional, local, national, different models serving different marketplaces. What I've been struck by in every conversation I've had with a business leader, with a clinical leader among our companies, they all want to be part of making the system work better. They all want us at the table driving solutions, get everyone covered, make the system more sustainable, finally get at health equity in a, in a meaningful way. And so, the opportunity we have to coalesce, our sector, and then as Pat said, be at the table with others and actually make progress, that's, that's the vision.

Traynham

The name of this podcast is The Next Big Thing in Health. So my last question for you both is, top of mind for you, what is that next big thing in health? You kind of alluded to AI, you kind of alluded to, how that's the big promise in terms of accessibility and affordability, but love to hear any final thoughts you have on that.

Geraghty

You know, Robert, I think AI is a tool, and it's part of where we're going collectively. But in my mind, we have this incredible opportunity to bring an integration of the health care system, this way too long fractured system that we operate in. So within my plan in Florida, as an example, we are now partnered with delivery system. So we have over a hundred primary care offices that we either own through joint ventures or own outright. We have emergency medical facilities. We have at home health care.

So when you talk about a plan like ours, you can't just call us a insurance company. You can't just call us a plan. We're actually integrating health care for our customers. And I think that's what our customers are looking for. They're looking for affordability.

You have to be integrated into that part of the process. Then you have to make it work from a customer perspective. And so, we very much spend our time putting ourselves in the member's shoes. What does this look like? What does it feel like? Each of us have our own personal journey in health and health care. And we know when it's broken or fractured, it doesn't work for us as individuals. It doesn't work for our members. So we've got to be taking on our member's perspective and thinking about how do we make that work so that it's coherent, so it's cohesive.

And so that's really the next generation in my mind. It's not this big rocket ship. It's making it work so our customers say, "I love the experience of navigating my health and my health care with you as a partner.”

Traynham

It sounds a lot like guiding greater health.

Geraghty

Yeah.

Traynham

Mike?

Tuffin

Next big thing, Robert, one of the next big things, I think our country, we're going to look back 10, 20 years from now, and we're going to be in a very different place when it comes to site of service. All the challenges we're talking about, people in rural communities, underserved urban communities, we need to innovate and get people care in, in the way that meets their needs. Think of a parent with a, a child that likely has strep throat.

Do we really need that parent to take a day off of work, drive their child to a physician's office and then on to the pharmacy, et cetera, et cetera with all the costs, all the inconveniences? We need to get to modernizing site of service. We need, care in the home for people, who currently aren't being reached by the health care system. So, a lot of exciting innovations, coming to bear on the site of service front. And I think we'll look back a decade or more from now and, and really be in the midst of a transformation.

Traynham

Thank you, gentlemen.

Geraghty

Thank you.

Traynham

Thank you very much both.

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