Preston Renshaw Writes a Prescription for Change

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As a business and finance major at Doane University in Nebraska, Preston Renshaw had no plans to enter medicine until football injuries changed his career path. Two torn ACLs, first as a sophomore then as a senior, forced him to deal with the complexities of the healthcare system firsthand.

His experiences gave him insight into how the healthcare industry gets “people back on their feet and pointing them in the right direction,” Renshaw says. Realizing how critical the rehabilitation process, both physical and mental, were to a person’s recovery “set me on a path to pursue and understand more about my options in health sciences.” He switched his major to premed, a decision that would eventually lead to his current role as chief medical officer at Avera Health Plans.

Renshaw earned an MD in family medicine from the University of Nebraska and began his residency, which he describes as the most rewarding experience of his life. “You learn so much in those years about the complexity of medicine,” Renshaw says. He started thinking about the business side of healthcare, including finance, marketing, legal, compliance, information technology, revenue cycle, and claims management.

“For providers to be successful, they need to understand not just how we take care of patients, how we treat patients, but how all of the components work within healthcare,” Renshaw says.

A holistic understanding of the healthcare system is also important for patient care. Renshaw has seen how catastrophic heath events affected patients, some of whom faced medical bankruptcy. He believes that making someone better physically shouldn’t come at such a steep price. “If we’re able to understand how all the components interact, maybe we can find better solutions to making healthcare affordable and still have the great clinical outcomes that we all want for our patients,” Renshaw says.

At Avera Health Plans, an integrated healthcare delivery system that brings together providers, financing, and insurance under one umbrella, Renshaw is uniquely situated to influence both patient care and cost management. Since joining Avera nineteen years ago, he has worked to improve patient outcomes and keep care affordable. “Lower health insurance premiums, co-pays, and deductibles allow people access to the right preventative care so that they don’t end up with massive healthcare bills that they can’t afford,” Renshaw says.

Renshaw oversees clinical, pharma, risk adjustment, quality, accreditation, and utilization management. Most recently, he’s taken over Avera’s provider relations and network management. In that role, he provides value-based programs to members by finding common ground and bringing insurance coverage in line with clinicians’ diagnoses and ordered care.

“We want our members to have accessible, affordable care,” Renshaw says. “That means contracting with the provider community and making sure their goals are aligned with ours. As much as we can actively develop program strategies together, we need the clinical community to be active partners.”

“Dr. Renshaw leads with purpose, ensuring Avera Health Plans delivers outstanding care through a model that truly prioritizes patients,” says Joe Mangrum, a principal at ECG. “It’s inspiring to collaborate with such a forward-thinking executive, and ECG is proud to play a role in supporting Avera Health Plans’ continued success as an industry leading provider-sponsored health plan”.

Healthcare insurers are traditionally viewed as a barrier in patient care, Renshaw says. But if insurers can find creative ways to lower their financial burden, they’ll improve patient outcomes.

For example, the medical community has been debating the use of biosimilar medications, cheaper alternatives to brand-name biologic drugs like Humira. While insurers push for cost savings, providers worry about compromising patient outcomes. Renshaw has worked with providers to determine which biosimilars are effective and which fall flat.

The stakes are high. The worst thing a provider and insurance company can do, Renshaw says, is force a patient to switch to a different drug. “That’s when we risk potentially worst clinical outcomes,” Renshaw says.

Avera has been working with its provider communities and exploring the use of biosimilars. Its goal is to keep the cost of treating diseases low while ensuring biosimilars deliver the same clinical outcomes as the brand-name products. And its efforts have been successful. “We moved over 98 percent of our members and patients over to the biosimilars without sacrificing clinical quality,” Renshaw says.

“It’s no surprise that Dr. Renshaw is working with providers on strategies to lower costs while maintaining clinical integrity. That kind of collaboration is indicative of his leadership style and something the Scripius team have experienced firsthand,” says Eric Cannon, general manager of Scripius. “In the year we’ve been working together, our relationship has become symbiotic—we value each other’s expertise and trust that we will all do the right thing for members and patients,”

As a leader, Renshaw, who is in the process of earning an EdD in leadership, surrounds himself with individuals who share his and Avera’s mission, vision, and values. He helps them develop their skills by not just managing them but by teaching them, the theme of his doctoral dissertation. “I’m developing them for the future opportunities that will come before them. None of us will be here forever,” Renshaw says.

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