Newsroom | Collaborative Care

Q&A: Supporting Members and Delivering Value

A conversation with Dr. Hannah Alphs Jackson, chief medical officer and vice president of network for government and individual markets

Dr. Hannah Alphs Jackson went to medical school planning to be a practicing physician and trained as a resident in urology at Northwestern Medicine, an academic health system based in Chicago.

But then she left that clinical path to explore ways to make a broader impact by helping health care providers change how they practice through innovative payment arrangements with Medicare and other payers. Last year, she joined Health Care Service Corporation (HCSC) and serves as its Government and Individual Markets (GIM) chief medical officer and vice president of network.

"There are just so many aspects to health care that are so complex to navigate and really require everybody working together for the betterment of our members."

In this interview, she discusses bringing insights from her experience across the delivery system, first as a clinician and then as a value-based care leader, to enhance HCSC’s position serving Medicare, Medicaid and individual plan members and network providers.

How would you describe what you do at HCSC and why it matters?

I made the leap to join HCSC because I could see there is a real commitment from the organization to grow and optimize our government programs portfolio. And supporting these populations is an area that continues to be ripe for a lot of positive disruption and innovation in the health care industry.

When I think about my role as a clinical and network leader, the opportunity is really about helping realize the promise of the “Quadruple Aim” and ensuring that we have a clinical strategy and a network strategy that align to improve quality, reduce costs and improve member experience. What this ultimately means is ensuring our members have access to the highest quality providers and meaningful clinical programs to support their clinical needs and address social determinant of health.

Why did you pivot from clinical care to health care administration?

The Affordable Care Act (ACA) was passed while I was a resident completing my clinical training at Northwestern Medicine. One of the things that was so apparent to me as I got closer and closer to being a practicing physician was the lack of preparation throughout my training, medical school and residency, for truly understanding the broader health care landscape and the impact of health policy on medicine and health care overall.

I had exactly one combined lecture on Medicare and Medicaid throughout my entire four-year medical school education. Even in residency, I didn't get any real or meaningful in depth exposure to health care financing and reimbursement — commercial insurance, billing and coding, physician compensation. So the ACA created a lot of unknowns about the future, especially for the generations of physicians ahead of me in their careers.

With all of the dialogue around changing the way health care is paid for, I found myself really interested in understanding payment as a lever to improve care. I recognized that I just didn’t have the depth of knowledge to truly understand the complexity, so I decided to go back to school and get my master's degree in health care policy.

After finishing my degree, I decided to stay at Northwestern, but in an administrative role using my clinical background to work with clinicians and health care leaders to think about value-based strategy at an academic medical center.

What did you learn from your early experience on the administrative side of medicine?

The first projects that I got involved in were around the CMS Innovation Center’s Bundled Payments for Care Improvement initiative (BPCI).

I lived through developing that clinical transformation, leveraging Medicare claims data to build predictive data capabilities to identify patients at risk for bad outcomes; managing patients after hospitalization through the post-acute continuum; and developing a quality-based network of ancillary providers committed to working more tightly with our hospital and physicians.

This experience was so fun and so rewarding, but it also solidified an understanding of how much opportunity there is to improve how health care is delivered. From that time, I haven’t looked back. There is so much work to do!

What appealed to you about pursuing these goals from the payer side at HCSC?

First, the scale is just much broader, so there’s an opportunity to impact more of our population. Also, when I think about HCSC and the populations served in all of our markets, it is a really good cross-section of the challenges experienced across the U.S.  broadly.

But second and more importantly, having led Northwestern Medicine’s value-based portfolio for almost a decade, I also truly believe that value-based reimbursement is one of the most powerful tools to transform the delivery system. So from that perspective, I do believe the payer community has a tremendous opportunity to help better align incentives with providers and the opportunity to do it in a way that minimizes administrative burden to get to the heart of what everybody’s trying to do, which is improve the value of health care.

How can we collaborate with providers to accomplish that?

A lot of this comes from the way that we design and structure our value-based programs. But then it’s also how we support that program and leverage insights through data and analytics to drive additional provider transformation and enhance the coordinated experience of care for our shared population.

Reducing administrative burden on both sides, payer and provider, is key as well. HCSC has been a leader in making investments on the data side — creating connectivity between providers and payers to minimize some of the manual processes that are often required to support value-based agreements.

I experienced this partnership from HCSC while I was at Northwestern and really saw the potential for trying to make data exchange seamless and ultimately get at: How can we actually use this data to support our members? How are we partnering together and using insights about gaps in care delivery that can actually drive improvements?

We are only at the beginning of this work and there is a long way to go. Not all of our providers are in the same spot when it comes to population management and value based care, so balancing the current state with the promise of the future is the challenge we have to tackle.

How do our own clinician employees contribute to better health outcomes — especially in areas such as maternal and infant health where there are significant disparities?

When it comes to population health — and when it comes to a challenge as large as health equity — we all have to be rowing in the same direction. Social determinants of health play a huge role in the health inequity faced by our members and our communities. These social factors are deep-rooted in the fabric of our society and are such that no one provider, no one payer, or even the federal government can solve it alone.

And in this way, our care coordinators, our medical directors, our many other key clinical team members on the HCSC GIM team, absolutely play a huge role in addressing social determinants of health. They are another essential part of the ecosystem to support some of our most vulnerable members.

What has been so rewarding for me in my first few months at HCSC is to witness firsthand the collaboration between the clinical teams on the ground and our team for some of the most challenging members and situations. There are just so many aspects to health care that are so complex to navigate and really require everybody working together for the betterment of our members.

Health Care Service Corporation, a Mutual Legal Reserve Company.