Lisa Odom began working in the healthcare industry shortly after she graduated from college. Looking back, she says she had very little awareness of the complexities of healthcare or the requirements and challenges it presents. Odom learned quickly, though, as one of two accountants handling compensation of the clinical staff at the hospital where she was hired.
Odom is now chief financial officer at Springfield, Missouri-based Cox HealthPlans (CHP), the only locally based and provider-owned healthcare plan in the state, and has gained a wealth of experience and expertise during more than twenty years in the healthcare industry, as well as a deep bench of valued business partners, such as EnvisionRx.
“EnvisionRx is a patient-focused, nimble, and flexible company,” says Matt Gibbs, EnvisionRx’s president, commercial & managed markets. “As the pharmacy benefit manager for Cox HealthPlans, we are able to react quickly to market demands, while ensuring members get the medicines they need at a cost they can afford.”
Odom spoke with American Healthcare Leader to discuss some of the challenges she faces, and how the company stays closely connected to the communities it serves in the face of ongoing consolidations in the healthcare industry.
How do you preserve your local focus in an industry that seems to be driven by mergers, centralization, and economies of scale?
Staying local has always been a priority for both CHP and CoxHealth, the parent of CHP. We’re both governed by a community board of directors, so we essentially always have a finger on the pulse of what the community needs. CoxHealth’s president and CEO, Steve Edwards, as well as the medical director of one of CoxHealth’s large physician groups, Mark Costley, MD, are both on CHP’s board of directors, so we’re able to keep the provider and insurance businesses closely aligned.
CoxHealth has also purchased two local hospitals in the past five years. To leverage economies of scale, we’re also part of the BJC Collaborative, whose founders include BJC HealthCare in St. Louis, St. Luke’s Health System in Kansas City, and Memorial Health System in Springfield, Illinois. The nonprofits work together to achieve higher quality of care, reduce costs, improve patient experiences, and implement population health best practices.
What kind of results has the close alignment of the community, CHP, and CoxHealth produced?
Internally, we’ve provided data analytics to the provider side on some of our population health initiatives. For example, we understand where members access care, so we’ve been one of the resources that helps guide the expansion of the healthcare system. By assisting in pinpointing opportunities for expanding access to care, in the past two years CoxHealth has set up new urgent care centers, retail clinics, and has expanded its telehealth services.
CoxHealth’s Center for Health Improvement, an outpatient department of the hospital, is another example. For members with diseases that are particularly costly—like multiple sclerosis and rheumatoid arthritis—the Center offers clinical care and more flexible schedules that can accommodate our members better. Since CoxHealth and its providers utilize the same EMR, we can maintain care coordination while care quality is enhanced through access to the Center. It also provides educational sessions for patients who need information to help manage their illnesses.
Are there business advantages to having such deep local roots?
CoxHealth started out as a hospital in 1906, so we’re a well-known and well-respected name in the twenty-six counties we serve. CHP’s president, Matt Aug, is from Springfield, and Bart Stead, the director of marketing, is too. They know the communities we serve extremely well and have strong local relationships in addition to their healthcare expertise. I’m also a native of the area, but I’ve worked for larger companies, and I can tell you that the healthcare world is a lot smaller here. We’re all neighbors. I know people at the other local health system. I see people I know and work with at the grocery store, school, and at church. That’s a great incentive and responsibility to maintain the highest quality of care, great customer service, and competitive rates. And as long as we do that, our brokers and the rest of the community like having us as one of their options. They want to see us succeed. Our size and focus also means we’re more aware of exactly what the community needs and can be more agile and responsive to those needs than a larger company.
How are you addressing ongoing instability in the insurance markets?
We’re being very proactive and have formalized our approach to enterprise risk management. We created a cross-functional team to compile a complete picture of our concerns and are prioritizing them into categories of high, medium, and low concern. It’s a very holistic approach since each department and individual brings unique expertise and perspectives. It’s also been great at educating everyone on how they contribute to our overall operations. Previously, many people didn’t understand the full scope, for example, of the director of medical services’ responsibilities, or how the IT department ensures that data is being aggregated and reported properly to the Centers for Medicare & Medicaid Services, or how I work with actuaries on pricing throughout the year. A good example of this is the Affordable Care Act’s risk adjustment program—its greatest impact is financial, but it requires everyone to contribute to make it successful.
How have your team members contributed to the financial department’s successes?
They have played a huge role in everything we’ve accomplished, in large part, because they’re all so willing to push themselves outside their comfort zones. Jennifer Keeling, director of accounting, for example, walked into the middle of a very complicated project for an accounts receivable module with our general ledger vendor and helped make it a great success. Tamara Thomas, manager of underwriting, has been an exceptional project manager on a new line of business we’re in the process of developing. And Sandy Hopkins, director of member and provider services, provided critical insights into what members and providers need as part of rolling out a new web portal. I couldn’t do what we do without them.
EnvisionRx is a division of EnvisionRxOptions, a pharmacy benefits and services company and a wholly owned subsidiary of Rite Aid. URAC-accredited for Pharmacy Benefit Management (PBM) and Drug Therapy Management (DTM), EnvisionRx provides affordable and effective prescription drug coverage for employers and health plans. With the options and flexibility needed to truly optimize all aspects of the pharmacy care experience—from full service to à la carte options—EnvisionRx uses its proprietary EnvisionCare model to ensure integration to achieve the very best outcomes for both plan sponsors and patients. For more information, visit envisionrx.com.