Security Health Plan’s new director of population health, Melissa DeGoede, wants to develop innovative programs for improving member wellness.
As part of Marshfield Clinic Health System, Security Health Plan has about 220,000 members, mostly in Wisconsin. Its lines of business include commercial coverage, Medicare products, self-funded insurance options for companies, and others.
DeGoede says she’s looking forward to working with Eric Quivers, Security’s chief medical officer, to “understand the health and wellness needs of members and develop programs to support their health care needs.”
Quivers says DeGoede’s previous experience sets her up well for this new position.
“Missy comes to Security Health Plan from a similar role at her last employer where she supervised utilization/care management and quality services,” Quivers said. “In her short time at Security Health Plan I have seen her pull the Health Services management team together. She brings a wealth of knowledge and experience to Security Health Plan and we are much better for it.”
While she’s cooking up ideas for new health programs, she’ll also work to better position existing programs to meet the needs of the plan’s customers.
“For example, diabetes is on the rise across the country and really across the world, so we focus on members that have diabetes or could be diagnosed,” she told WisBusiness.com. “We offer educational programs, supporting health care needs in the community.”
She says members can work with case managers and health coaches to monitor health issues — not just diabetes, she notes, but “all spectrums of diseases and chronic conditions.”
“Preventative programs as well,” she added. “Getting screenings done, getting in to see clinicians… these preventative programs absolutely help business clients keep insurance costs down.”
She says Security works closely with businesses to support their financial targets by controlling cost of care, while striving for high quality as well.
“I’ve had the opportunity to spend the last 30 years in health care, and I’ve worked in the care delivery space as well as in the payer space,” she said. “I’ve had the opportunity to understand the science and the delivery of health care, and how it aligns with finances or economics of health care.”
“That exposure has positioned me to understand how to support a member or patient across the continuum of the health system,” she continued.
For the coming year, she says her top goal is to work toward further integration of the financial side of health care with the delivery side to “enhance access to care, and enhance coordination of care,” aiming for less unnecessary utilization and lower costs.
To support this goal, she will analyze population data to identify areas of focus and strategies for the health plan as a whole. That includes increasing support for members with chronic conditions, boosting community-based programs that can help identify potential gaps in service.
Her biggest challenge for this year, she says, is to try and keep up with the rapidly changing national health care system. She points to external factors like national policy, as well as internal changes like evolving delivery models and system acquisitions.
“Everything going on is causing a lot of churn and making navigation difficult these days,” she said. “Health care is in a rapidly changing phase; it’s also a very exciting phase.”
DeGoede predicts the U.S. system will continue to evolve into more of a value-based delivery design where clinicians give more thought to the cost and quality of care, leading to “increased efficiencies in the health care delivery system.”
“That will positively impact quality while decreasing the cost,” she said. “We’re really looking at affordability and quality in health care like we’ve never done before.”
–By Alex Moe