Rob Scruggs

The landscape is changing rapidly and regional payers can no longer hang their hat on being the “local plan option.” Nicholas Kraft inspired me when he said, “we want to look very different from national competitors.” I was thrilled to engage in this exploration of just how different regional payers’ product offerings can be. We have to deliver affordability, access and ease of use, yes. But regional payers can aim higher. We can deliver delight (a tall order for any insurance product). John Hancock partnered with Vitality to launch a one-of-a-kind life insurance product nearly a decade ago. It gives enrolled members the opportunity to directly influence their cost share through healthy behaviors. How could John Hancock do it? By investing in the ability to underwrite on additional variables. For decades, Vitality Group Inc. has been partnering with risk bearing entities around the globe to deliver on this differentiated insurance model. It was such a pleasure and privilege to sit knee to knee with Matthew Gibson, Tanya Little (Budlender), and Health Plan Alliance sales, marketing and strategy leaders and imagine what a “product of the future” could look like if regional payers reward engagement that matters to transform the member experience, offer something truly different in your market, and freeze your population’s health risk by leading members where wellbeing meets care.

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Walmart Exits Healthcare Market: RPM Steps Up to Fill the Gap... Walmart's departure from the healthcare market, including its virtual health care services, will leave a void in care services for underserved communities. While hospitals and primary care providers (PCPs) remain the backbone of our healthcare ecosystem, their resilience is rooted in the trust relationships they've built with patients. This trust is a cornerstone of effective care, and RPM can help hospitals and PCPs extend their reach. RPM uses digital technologies to monitor patients' vital signs, health data, and other relevant information remotely, enabling healthcare providers to deliver timely interventions and preventive care. By leveraging RPM, we can: - Increase access to care for underserved communities - Detect health issues early, preventing complications - Deliver personalized care plans - Reduce healthcare costs - Empower patients to take a more active role in their healthcare As we move forward, RPM can help address the disparities in healthcare access and ensure that everyone has access to quality care, regardless of their zip code or background. Let's harness the power of RPM to create a more equitable and accessible healthcare ecosystem! #RemotePatientMonitoring #Telehealth #DigitalHealth #HealthcareAccess https://lnkd.in/eD7CcaEm

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🚀 The 2025 Medicare Advantage Final Rule brings transformative changes to healthcare! Dive into our detailed blog post to explore how these changes will enhance beneficiary protections, refine quality measures, and ensure program sustainability. Discover how RapidCalim’s AI-driven solutions can help you adapt and excel in this new era. #HealthcareInnovation #MedicareAdvantage #AIHealthcare #HealthTech

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Really strong kickoff to the "Big Six Payor" earnings yesterday morning by UnitedHealth Group and the market loved it as it jumped to an all time high this afternoon and is up 10% since the earnings call. They grew revenue 6.5% to almost 99 billion and below are the key takeaways along with a more in-depth look. 🏥 Optum Performance:  - OptumHealth: Revenue grew by 13% to $27 billion with improved margins. Digital engagement rose from 62% to over 75%, reducing readmission rates by 10%. Finally showing margin growth for a business with a great growth potential in value-based care for the Medicare population. - OptumRx: Revenue increased by 13% to over $32 billion, driven by strong customer response to chronic care solutions and mobile infusions. Adjusted scripts handled jumped to 400 million from 380 million a year ago. 🔍 Medicare Advantage: CEO Andrew Witty highlighted a Milliman study showing a 4% cost saving for Medicare Advantage over traditional Medicare. UNH is focusing on delivering additional value through services like dental, vision, and hearing. 💡 AI Integration: UNH is leveraging AI to drive efficiency and reduce costs. OptumHealth managed a 40% increase in high-risk patients without additional headcount, also driving the enhanced patient engagment. OptumRx saw significant onboarding improvements with 9% less spending than last year due to AI enhancements. Looking to build some AI enabled workflows in OptumInsight to sell to downstream customers which could be great for top line. 🔐 Cybersecurity: Despite challenges from the Change Healthcare cyberattack, UNH is using the incident to innovate and enhance their system security. Some of their customers shopping Change Healthcare to other potential providers is forcing them to innovate internally. 🌟 With strong tailwinds, lower interest rates from the Federal Reserve, AI-driven growth opportunities, OptumHealth showing signs of being able to scale, UNH is well-positioned for a strong 2024/2025. Great kickoff to the earnings season! Below is a more in depth look at their earnings call. #healthcare #ai

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🔍Is your behavioral health treatment strategy reactive or proactive? Starting May 7th, providers and patients can proactively measure treatment and gain insights into symptom severity with our new Behavioral Vital Signs™ report. As a provider, you'll get a comprehensive PDF report via secure message or right in your EHR. This includes trends for clinically validated surveys, actionable self-report data, and even intelligent passive sensing insights for the last 30 days. As a patient you will receive the same report in the Health Rhythms app, where you can share it with your wider care team and securely review them month over month. It's time to improve our mental health measurement capabilities to enhance treatment strategies and improve outcomes. #DigitalHealth #MentalHealthCare #HealthcareInnovation #PatientCare #healthrhythms #bvs #behavioralvitalsigns

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During 2023, Elevance Health and our care provider partners made meaningful, measurable progress towards improving whole health for tens of millions of people we mutually serve. And our second Advancing Health Together report proves it.   I sat down with Dan Salinas, MD chief medical officer for Emory Healthcare, to discuss how data sharing is fueling progress, and how real collaboration is the real key to future success. Bryony Winn Ashok Chennuru Omar Latif, MD Shane Hochradel Vardini Vishwanathan https://lnkd.in/d4Eypa5Q

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Telehealth continues to play a vital role in expanding access to care for patients across Virginia, and licensed providers are increasingly recognizing its value. As a result, the usage of telehealth services is growing steadily, improving health care outcomes for many. Check out the full results from our latest survey: https://lnkd.in/duAuJCt8

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Relevate Health is honored to celebrate 15 years of working with Chelsa Burke , Vice President, Business Analytics & Insights. Among her many skillsets, Chelsa is outstanding in her ability to garner a comprehensive understanding of the complex matrix of healthcare data. As a part of our senior leadership, she oversees our data strategy and insights department, being responsible for providing intelligence across the organization that drives result-producing strategies and engagement solutions. Managing a team who develops data-driven insights, their work is pivotal in contributing to product innovation, client development, and marketing strategy recommendations for client success. We recently asked Chelsa to tell us more about her work: What keeps the fire in your belly to do the intense work you do? A deep passion and drive to understand the healthcare landscape and how we can use data, information, and tools like AI to improve the HCP experience, patient outcomes, and access to healthcare. 15-years is incredible so what keeps you going & growing? Healthcare is such a fascinating and complex space that impacts our communities at many levels. I love being on the front lines of the evolution of healthcare and developing solutions using new ideas and technologies that ultimately drive results for our clients and patients. What does the future of the work you are doing look like? At Relevate Health, we have always focused on using micro-analytics at the community level to produce scalable solutions and national results. Data and technology are ever evolving to help us do this better. We are now able to understand HCPs, their patients, and their consumption of information at a much deeper level. The future looks promising as we evolve our omnichannel capabilities to be able to serve relevant and timely messages to each HCP based on AI and predictive analytics. Chelsa is not all work and no play. She and her family live in a rural area with a hobby farm. Did we say not all work? We take that back. She is working non-stop caring for 4 kids, 2 dogs, 6 chickens, a hamster, and a homestead! They love all things outdoors including kayaking, hiking, camping, and gardening. The whole family enjoys creating things and crafting, which are sometimes sold at local markets or on Esty. You can also check our her latest blog which explores the critical role of tailored communications in addressing health disparities. 🔗 https://bit.ly/4aMURDM So, there you have it. Chelsa is our all things to all people at work and at home.

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We try to leverage technology in ways that superpower our people and help with the scalability of care. This is great advice from Froedtert Health’s Bradley Crotty MD MPH during Reuters #Digitalhealth24 conference. Here’s to superpowering teams and scaling care.

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Can payers and providers really be friends? @BenGrabski and @JohnFryer share their perspectives on collaborative value-based care in this new podcast episode from @Lumeris! In this podcast interview, we explore challenges and opportunities in the Medicare Advantage landscape, highlighting the importance of collaborative payer relationships, consumer-centric innovations, and care delivery transformation. Ben and John share valuable insights on leveraging AI, navigating strategic inflection points, and building a win-win model to empower health systems and providers in achieving value-based care. Here are just some of the key takeaways from the discussion: 1. At Lumeris, our North Star is always to improve patient outcomes and provider experience. This will allow us to sustain (and thrive) through multiple market cycles. 2. Many in our industry (our competitors) see changes in risk adjustment as an existential crisis. And they should in those businesses because value-based care isn’t just about coding. 3. We must empower our partners with people, process, and technology (using just technology to solve problems will never be successful). 4. Systems can no longer continue to afford to build new assets and or keep up with their existing physical plant and property within the reimbursement environment that exists today. 5. Building win-win payer-provider relationships is key to success in VBC.

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Health payers are facing daunting challenges—so we asked 150 executives where they're focusing their investments right now to learn more about the state of the evolving industry. That data and our analysis revealed the need for: 🧠 a mindset shift around prioritization ↔ a streamlined foundation for digital member experiences 🔓 a holistic viewpoint to unlock integrated care Download our signature research today to learn more about how a mindset shift—not just tech investment—holds the key to success. ✍ Andy Sordi | Benjamin Baenen | Bryan K. | Dawn Kramer | Kate Kiyosaki | Paul Horner #HealthPayers #FutureOfHealthcare

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In this video series, listen in as Optum Advisory experts @Jeremiah Reuter and @Aaron Jurgaitis share their perspectives on how to adapt to constant changes in health care and leverage data to help care coordination. Watch part 1 here: https://optum.co/wqeyrq Watch part 2 here: https://optum.co/00xw8i #provider #healthcare #OptumAdvisory #Optum #healthcareperspectives #carecoordination #healthcaredata #healthcareconsulting

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The proposed mandatory Transforming Episode Accountability Model (TEAM) would advance the Innovation Center’s prior work on episode-based alternative payment models, including the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models. The proposed model would launch on January 1, 2026, and run for five years, ending on December 31, 2030. Prior to the model launch, all model policies would be finalized through rulemaking. TEAM was designed based on lessons learned from previous episode-based payment models and from input from stakeholders in response to a Request For Information published in 2023.

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Healthcare has made improvements but there's still a long way to go to become truly digital-first. While we've seen advancements in telemedicine, electronic health records, and AI-driven diagnostics, the journey to fully integrate these technologies into everyday practice is far from complete. And the “door” to care – patient navigation – needs a lot of work. If we don't evolve, patient's will find others who do! https://lnkd.in/eSJKiHSR #patientcentricity #digitalfirst #digitaltransformation #patientnavigation

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Walmart takes a step back from healthcare services, closing 51 clinics and virtual care, citing challenges in profitability and operational costs. A stark reminder that healthcare is a tough business ! More about it on Fierce Healthcare 👇 #healthcare #walmart https://lnkd.in/dYpY3pcT

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#ATANexus is off to a great start. Honored to join Helen Hughes in an important conversation about mastering the execution of inpatient virtual care. When it comes to measuring the Return on Innovation, the call to action is clear: 1. Identify, and align, on the problem your program is solving. 2. Quantify data in the current state-you need to measure what your program achieves. 3. Look for partners who are ‘in it’ with you.

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In the evolving landscape of US healthcare, vertical integration has emerged as a key driver of revenue growth. Payers positioned at the center of integrated delivery networks, aligned with traditional pharmacy and provider functions but without capital-intensive acute-care facilities, experienced the quickest revenue gains over the past couple of years. As the #HealthcareIndustry transforms, strategic alignment and integration across payer, pharmacy, and provider functions will likely remain crucial for sustained #RevenueGrowth. #PayerHealthcare

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Optum is proud to be highlighted in the recent HFS report for driving excellence in value-based care. Learn more on how we enable PCPs to drive outcomes, grow revenue and remain independent. https://optum.co/45k5mb #Optum #HFS #valuebasedcare #payer #healthplan #vbc #valuebasedhealthcare

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