RamaOnHealthcare September 20, 2021
The purpose of these written format interviews is to bring action-oriented ideas and inspiration to an industry that is attempting to meet the needs of its customers.
As with the previous interview, COVID remains a persistent topic today. My choice is to continue with another illustration of the diverse demands COVID and its impact within the rural and urban health landscapes. Today, we interview Les McPhearson, President of Dean Health Plan.
The pandemic is certainly widely and greatly disruptive, but we must not allow it to damage our future healthcare system. We must adapt and reenergize going forward. Les can help us understand that obligation to our future and continuing to help others.
Les McPhearson, President of Dean Health Plan, has been helping southern Wisconsin residents make the most of their coverage for more than 38 years. I met Les when we were both leading healthcare innovation efforts in separate organizations and stayed connected as he was driving the United Benefit Advisors. I noted his dedication to the true value of the healthcare system for consumers. Now, Les is leading a health insurance plan, Dean Health Plan, and is the Chair of SSM Health Plan. I wanted to challenge our thinking around consumerism, the viability of value-based care, and the impact of COVID on lives within the context of a rural health plan.
Mohan: Welcome Les to the Mohan Nair interview (frankly more a discussion). My starting questions for our consideration is what is going on with the lack of consumer enablement in the systems we all engage? Where have we failed, or is this dream of placing the consumer in the center of all we do just a buzz term?
Les: It’s a pleasure to join you, Mohan. This is such an important topic to Dean Health Plan. The journey toward real consumerism in healthcare has been an arduous one, and we aren’t there yet. For far too long, the entire healthcare ecosystem took the approach of what we did to the consumer rather than what we could do for them. That dynamic isn’t necessarily helped by so many receiving their benefits through employer-sponsored plans, but that’s not the consumer’s fault. It’s a big part of the system in our country, and it’s our responsibility to navigate it in such a way that makes the experience better. While we’ve seen consumerism take-off over the last 10-15 years in so many other parts of the economy, it has progressed in health care but continues to lag. I don’t believe it is just a buzz term, but there remains much to be done.
While we’ve seen consumerism take-off over the last 10-15 years in so many other parts of the economy, it has progressed in health care but continues to lag.
Mohan: Les, I know you to be a very soulful leader and one who cares deeply about the transformation of the system. How are you making personal changes that direct your teams to find those underlying challenges that still plague consumers in healthcare? For example, how are you addressing inequity in healthcare, social determinants of health impacts, and the like?
Les: As a faith-based, mission-driven organization, we start by trying to do the right things for the right reasons. Yes, we all have financial and operational goals that must be met, but that doesn’t have be mutually exclusive with putting the consumer at the center. While it has been said a lot, we try to meet people where they are. A world-class digital experience, and while a huge step, it is only part of the solution. There needs to be a combination of incentives, engagement in health & wellness, a seamless experience to aid those with chronic conditions, and being easy to do business.
Almost nobody engages with the healthcare system because they want to; it’s usually because they have to. And when they enter the system, it’s often accompanied by fear, uncertainty, confusion, and concern for themselves or a loved one. Recognizing that helps us meet people where they are, on any part of the spectrum. We no longer take the “you can have your car in any color as long as it is black” approach, but try to facilitate the process rather than dictating the process.
We are also investing heavily in population health and addressing social determinants of health (SDOH). With the former, we aim to help patients get the right care at the right time and in the right place. That is better for everyone. We also believe preventative health, such as childhood and adolescent immunizations, breast cancer screenings, and colorectal cancer screenings, is critical. And of course, promoting health, activity, and healthy diets is a critical aspect to improving the overall health of a population.
Far too many people have barriers that prevent them from achieving their optimal health care outcomes. Whether those obstacles are housing, transportation, socioeconomic, or food insecurity, they are real and impact too many people. Dean Health Plan works closely with our members, employer clients, and community partners to provide solutions in each of the communities we serve.
Far too many people have barriers that prevent them from achieving their optimal health care outcomes. Whether those obstacles are housing, transportation, socioeconomic, or food insecurity, they are real and impact too many people.
Mohan: As a leader in the region on diversity and inclusion imperative for our society, what are you engaging in, as example, that others can emulate or learn from?
Les: We’ve made significant progress in Wisconsin and look forward to continuing that journey. This is one of the most important priorities Dean Health Plan has. Some examples of what we are doing at Dean Health Plan:
- As we advance COVID vaccinations, we are using our Applied Analytics capabilities along with publicly available race and ethnicity data to identify geographic areas concentrated with the largest populations of unvaccinated and vulnerable members. We then collaborate with our care delivery partners to take our mobile vaccination clinics to those areas. We meet them where they physically are.
- We’ve conducted COVID vaccination clinics in county parks, schools, after Spanish mass at a local church, and at Mexican restaurants.
- Dean Health Plan has partnered with the Urban League of Madison on virtual job fairs and to conduct COVID vaccination clinics at minority-owned barber shops.
- In addition to the Urban League, we’ve partnered with the Department of Veteran Affairs, the Wisconsin Department of Workforce Development, and Chrysalis (a Madison organization that provides employment services for individuals with disabilities) on job fairs and hiring opportunities.
- Within our organization, we are one of the first ministries to formalize a Diversity and Inclusion Council and over the past year have conducted virtual cultural awareness events such as an Irish Pub concert, investing in Latinx Talent, a Japanese drum performance, and raised over $4,000 for Second Harvest Food Bank.
Mohan: The underserved are everywhere, and yet we have not served them well yet. Give us a framework for how we can identify, address, and serve the underserved.
Les: We start at Dean Health Plan by being deeply rooted in our communities. With a 38-year history in South Central Wisconsin, we live, work, and play alongside those we serve. I’ve mentioned how we identified areas of concentration and need for COVID vaccinations using applied analytics. Additionally, we are committed to serving the health insurance needs of everyone in our community. Our first customer was the Wisconsin’s Employee Trust Fund that provides health coverage for State of Wisconsin employees. That’s a partner we still proudly serve today.
The Medicaid population is a big part of fulfilling our mission to provide care to the poor and underserved. Serving the Medicaid population allows us to work more closely and in creative ways with our provider partners and the State to address care gaps with adults and children. We also address other areas, such as racial disparities in birth outcomes through innovative quality improvement programs where we partner with community doula providers.
The nation’s largest carriers opted out of the individual ACA exchange years ago, and a few are considering re-entering the market. In the early days of ACA, it was sometimes difficult to rate the population accurately. Many plans took losses and left the Exchange. We are committed to the access provided by the ACA Exchange. Dean Health Plan entered and has never left. It’s part of our Mission. Margins are thin on some of our offerings, but we want to serve the community overall because it’s the right thing to do for the right reason.
Mohan: It is always refreshing not to run to technology to excuse a solution when our business models insult true transformation. What is your technology mandate to your community?
Les: Internally, our focus is to use the power of data and analytics to create a differentiated consumer experience, to achieve optimal clinical outcomes, and to be the easiest to do business with (for members, providers, agents & brokers, and employer clients).
For our external communities, it’s as you asked in your first question – it is about the experience. While regulations have established mandates for transparency and the ability for others to use their data better, we had begun this journey before Interoperability and the No Surprises Act came into play. Answering the question “how much is this going to cost me” is fair. Health care is complicated and while you and I both over our careers have worked extensively on the member experience, simply expecting there to be an “easy to understand” button for consumers is naïve. Transparency will be accompanied by a massive education and communication effort. In the end, this will likely lead to a better experience for consumers, but I wish it had been more industry-led as opposed to legislated. And I think the jury is still out on whether it will impact costs materially.
Health care is complicated and while you and I both over our careers have worked extensively on the member experience, simply expecting there to be an “easy to understand” button for consumers is naïve.
Mohan: Why do you want to lead a health plan? Personally, I’ve enjoyed my stay in health plans and have worked with many good people there, yet there are other ways to serve.
Les: I have committed the majority of my career to health plans and health insurance and have no regrets. I didn’t graduate college saying I want to go into health insurance, but once I found my way there, it has been so rewarding. It is an industry ripe for innovation and disruption, so we look to where we can do that ourselves and more broadly, who can we partner with. There are also significant operational challenges – we answer over 75,000 calls a month, process half a million claims a month, and work with insurance commissioners in 4 states plus the federal government. We also see significant technology opportunities and challenges that come from having to replace decades-old legacy systems and simultaneously ensuring we are building for the future. But my 3 biggest loves in Dean Health Plan are:
- Serving our members
- Leading our 875 employees
- Hoping that in some small way, we are making a positive difference as people navigate some of the most difficult times of their lives
Mohan: If you had one thing this year that you want to be remembered for what would it be?
Les: In the year of the greatest employee disruption we are likely to ever see, that we promoted a culture of engagement, performance, and inclusion.
Mohan: If there is one thing you want to forget and let go this year what would it be?
Les: I would be ok with never having to wear a mask again.
Mohan: How do you find inspiration? And what do you with it?
Les: My inspiration starts with my faith and expands to my family, my colleagues, and our team at Dean Health Plan. I hope that I can be a vessel through which my faith and the gifts I have been blessed with are used in service to others.
Mohan: What would you encourage your fellow leaders to do today for the sake of our customers?
Les: What has worked for me is to listen and look for reasons to say “yes” to opportunities rather than “no”. Each customer has a story. I can’t appreciate the stories of all 500,000 of our members, but for the ones that do come my way, I owe it to them and our organization to listen.
Mohan: Uncomfortable question but required. What makes you angry about the way healthcare is provided to your community? What can you do today to change this to joy?
Les: Healthcare still remains too much of a zero-sum game. It doesn’t need to be this way. I believe the transformation to value-based care will be the biggest step yet toward aligning incentives between payers and providers, but until then, the consumer is too often caught in the middle.
Healthcare still remains too much of a zero-sum game. It doesn’t need to be this way. I believe the transformation to value-based care will be the biggest step yet toward aligning incentives between payers and providers, but until then, the consumer is too often caught in the middle.
Mohan: I have been asked what I want to be remembered for several times and I really don’t like to answer this question. I would like to ask, what would you like others in your organization to be remembered for?
Les: I would like Dean Health Plan to be known for and remembered for doing the right thing for the right reasons.
Mohan: Les, I have always found you a soulful and introspective leader not seeking the limelight and that is why I ask for your attention in this interview. Too often, people listen to the people they always expect to listen to and I want my audience to listen to the quiet voices that labor everyday (I do not mean to imply that loud voices don’t contribute!). You are one such voice that labors, everyday in healthcare, in service of others. I want to amplify what’s really going on at ground level and change is from that level because high fliers seldom land. Thank you for your contributions, and let’s get this system reconfigured for the better of generations to follow.
About Les McPhearson
As President of Dean Health Plan (DHP), Les McPhearson is responsible for ensuring the continued growth and successful operations of DHP, including development and implementation of strategic plans, successful introduction of new programs and services, membership growth, operational, financial, and service excellence, and continued improvements in clinical quality.
About Mohan Nair
Mohan is CEO of Emerge Inc, about all things business transformation. He is a 3-time corporate executive, 3-time emerging business executive, 10-year Innovation Officer and 3-time author. He is Edmund Hillary Fellow for Aotearoa New Zealand and is Medical Innovator in residence for MOVAC Capital, the largest New Zealand venture fund.