President of Banner Plans talks running insurance at a hospital

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You won’t be saying “Banner? I hardly know her” for long.

Chuck Lehn has been the president of Banner Plans and Networks since the Phoenix, Arizona-based health system Banner Health launched the insurance company back in 2011.

In fact, he’s been with the nonprofit health system since 1986, originally working on the hospital financial side of the business. Then, after the Affordable Care Act passed in 2010, Banner execs decided to form their own health plan, which has grown to offer Medicare, Medicare Advantage, and Medicaid (including a joint venture with Aetna) options for the 3.5 million patients the system serves annually.

And while it isn’t uncommon for health systems to own health plans, it certainly makes for different work than running just the plan alone.

Lehn spoke with Healthcare Brew about what it’s like to operate a health plan connected to the Banner system and about the future of health insurance with new technology in play.

“The most important thing that we’re trying to do is change the narrative to: How do we get rewarded for keeping people healthy?” he told us.

This interview has been edited for clarity and length.

What’s your day-to-day like?

Main tasks would be a couple of things: One is paying a lot of attention to our members. How do we make sure that we’re delivering services that are useful? We get feedback through formal and informal call centers and survey data, and measure retention.

Second, we’re paying attention to our regulators. On the external side, it’s a little more governmental, with departments of insurance, Medicare, Medicaid, etc.

Then we’re really focused on our provider network. How do we keep them engaged? Doctors always see the value in helping a patient. And when they see they’re doing more than helping just the patient that’s right in front of them, it’s rewarding for them.

Have any recent policy changes affected your work?

A lot of our business goes as the government goes. In the Medicare space, new programs have been launched. How we can reduce fraud, waste, and abuse has been important.

On the Medicare Advantage side, the big change has been how star ratings are measured, how risk adjustments are measured. Being able to manage that has been pretty challenging, but we’re weathering that.

Then, a really big change has been with Medicaid. During the Covid-19 pandemic, we had to work so hard to just make sure people had access, and we stood up all sorts of virtual things. Coming out of that, there was a lot of pent-up demand. How do we still get people into the right care with the right provider, in the right setting, etc.? Now, a lot of people are losing coverage with the redetermination. How do we keep as many people covered as we can, but be compliant?

How do you see the future of AI or other technologies for health plans?

The promise in AI is eliminating a lot of the lower-value tasks and freeing up teams to focus on higher-value work.

The consumer and provider backlash against prior authorization is geared around the administrative hassle of gathering information, submitting it, and then waiting. We have electronic medical records (EMR), we have lots of automation that we’re implementing, so hopefully that heavy work of gathering all of that information and putting it together is automated. It also speeds up decision-making—which is what consumers are looking for—and it lowers cost footprint.

We’ve got AI embedded in our call center to help provide better information, and we’re using AI to identify things that could be a problem. If we’re seeing that somebody is scheduling something with a provider that’s not contracted, maybe we could redirect them so that they wouldn’t get a surprise bill.

How does it compare to run a health plan connected to a system versus one that isn’t?

One is that your access to information improves. You’ve probably got direct access to the provider’s EMR, you’ve got access to scheduling—all sorts of administrative things that you typically wouldn’t have. Hopefully we’re using that information on the member’s behalf.

Two, there’s a real opportunity for coordination of care. If the building says “Banner” on it, [providers there are] going to know something about you, going to be able to help you, and hopefully your care isn’t going to have to start all over again.

There’s also really practical things that happen, like when we do outreach to help people get their preventative care completed. They’re more likely to answer the phone if it says Banner Health [is calling].