Bridging the Gap: Payer and Provider Perspectives (ft. Susan Mullaney)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now your host, Ed Marx.

Hey, welcome to another edition of Digital Voices. Super excited about this drop because it's going to be a lot of discussion around the intersection of payer and provider, because our guest Susan Malaney has experience in both. Susan, welcome to Digital Voices.

Ed, it's great to be here. Great to be here with all of you. So thanks for taking the risk for having me on as a guest. Yeah, it's going to be awesome.

This is why, as of today, this is late July, we actually reached the highest we've ever reached. We're number 4 on Apple for Podcasts under technology. So—

Okay. Wow. Wow. Hats off to you.

Excellent. It's not so much me, it's, it's the guests like yourself, Susan, and also our awesome audience that tunes in every week. So just wanted to say thank you for everyone for doing that. And also another thing, I think why is we have no commercials, no ads or sponsors. So I don't know about you, Susan, if you listen to other podcasts, you know, I'll be running and then all of a sudden there's like a commercial. I wanna stop and fast forward through the commercial, you know? I don't wanna—

Yeah, we, we're living parallel lives.

Yeah.

Yeah. That's such a drag.

So we met. Professionally on LinkedIn. And I've been watching you and the different things that you speak about, and I was really impressed. And so I reached out.

Right.

And like I said, and we'll get to it in a minute, you have this great career in terms of you spent time on both the provider and payer side. And I think that is so beautiful because I think that's what's necessary to have the ultimate relationship. And so that's sort of how we met. But Susan, the most important question I have for you during our time together is what songs are on your playlist?

Okay, I'm glad that we're going to cover that critical topic because that hits squarely into the future of healthcare. It's, well, and I am so glad that we're connecting and I love that question. So I don't know if you use Spotify, but I use the Spotify AI DJ and I'll tell you what, I'm so boring. My AI Spotify DJ, I think he's ready to fire me because I just listen to the same stuff over and over and over again. And I can almost hear him with a sigh like, oh, hi, what song is this? So I might be the first person in the world to be fired by this AI DJ. You might be. But I love listening to music when I'm out running, exercising, et cetera. Top stuff on my playlist, I'll go in the Wayback Machine. Sharon Brown, I Specialize in Love. I love that song. My girls are loving it. I've got a 16 and 14-year-old girls Donna Summer, I reached back into the '80s this time, I Know It's For Real. That's a classic, and I'm trying to bring it back. Coldplay, Everglow, beautiful song. The Who, Baba O'Reilly, classic. And I grew up playing basketball to that song. I'll save that story for another day. But then I also, there's this great station called Jazz in the Background, which is exactly what you'd think it would be. So if you're a jazz fan, it's just awesome to turn that on if you're cooking or, and I also love early music, ancient music broke, and I will actually work out to that. So it's a glimpse into my psyche. I hope that doesn't send you running for the hills, but—

No, this is great. And in fact, on Spotify, if you type in Digital Voices, our playlist will come up and your songs will be added to it.

Okay, good. Because I need an introduction to new music. So I'm going to just start listening to that.

Well, it's pretty eclectic, as you would expect after having about 275 guests. So we have a lot of different types of music, but let's jump in. You know, is there a life message or mantra, words that you live by that sort of guide you?

Yeah. Here's my bottom line. Life is fleeting. Life goes by quickly and you have to live with purpose. You have to live with impact. And on the professional side, what's always guided me, Ed, is I have to love what I do. And I have to love who I'm doing it with. Life is too short not to have both. And that's why I got into healthcare. It's so meaningful and so purpose-driven. And all of us, no matter what we, what role we play in the industry, we have a big impact on people's lives from day to day. And so that, that means the world to me and that's what makes me tick.

Yeah. Love it. Let's talk about You, from the beginning, where were you born? Tell us where you were born.

I feel like we should be doing this over a glass of wine, but absolutely. So I grew up in Billerica, Massachusetts, and that is a— it was when I was growing up, a blue-collar suburb about 20 miles north of Boston. And so I grew up in a family where we didn't have much, and the whole goal for me was just to go to a college somewhere.

Yeah.

That's where my life began, was in that small community. And, uh, and I learned a lot about having a really great work ethic. What, what really shaped me fundamentally at an early age was my mother was always quite ill and she spent a lot of time in and out of hospitals, which meant yours truly spent a lot of time in and out of hospitals. And, uh, and I didn't think about it in such adult terms at that time, but I'm this little kid and we're in the hospital for one episode of many, and I'm watching these incredible doctors and nurses and the staff at that hospital come together to take care of her and us as a family.

Yeah.

And I thought, okay, I want to be a part of that someday, somehow, some way. These people are a force for good in the world. And here I am, Many years later, and it's been a great ride.

Yeah, that's, that's a great story, which actually mimics mine as well in some ways. And, and so I, I feel you in terms of sort of that catalyst and, and just being, seeing healthcare happen before your eyes as a, as a kid and just growing into it. So you, you go to school and you go to college and then what's next? What, what, what happens? Are you jumping into healthcare directly or was there some intermediate?

You know, I was, oh. As my undergraduate degree is in psychology and sociology, and I actually thought I would want to go on and get my PhD in psychology and do research. And I was so wrong, and I have so much respect for the people who do that work. It just wasn't a fit for me, and I learned that by fortunately doing an internship, going, okay, wow, I'd be horrible at this, and I am mistaking my fascination with the human condition for a career path. So I pivoted from there and I wanted to be doing something where I could have a broader impact. And so, and I've always loved healthcare policy, I've always loved business. And so I decided to go the track of getting a master's degree in public health geared towards the healthcare field. So think MBA geared towards healthcare, but with a heavy dose of healthcare policy thrown in. This was at the University of Massachusetts at Amherst.

Right.

And I was fortunate. And then I went to graduate school with them. The program attracted all these young physicians from all around the world who were there to make the world a better place. It was awesome. So I did that and I was smart enough to know I don't know anything. And so I just said, my program director, Shlomo Barnu, and I love that guy. He said, well, you should apply for a fellowship and that way then you can work directly with the CEO before you're dropped down deep into an organization, you can learn and then go. And they're typically a year long. And so I moved my life up to Madison, Wisconsin. I never thought I'd live in the Midwest. I was offered a fellowship where these people were crazy enough to give this 23-year-old real things to do.

Right.

And I thought, oh my gosh, I'm going to learn so much. It was such a great team. And so I did that terrific experience. Love Madison. What a great town. So I'll plug Madison for those of you who have not been there. Great town for runners too.

Yes.

And then I took a job in Minneapolis and working for what was then the University of Minnesota Hospital and Clinics. And this is the birthplace of open heart surgery and heart transplantation. And I had a blast working in this storied academic health center, these incredible people. And to shorten the story here, I grew up on the healthcare delivery side. I mean, that's really where my home is and heart is. And I'm one of those folks who loves hospitals and all that goes on within them. So I did that for the first part of my career, then actually had a departure, joined a small startup company called Vivius, and it was designed to create a consumer-driven marketplace for healthcare. And I learned so much from that experience because it was me and 30 guys basically.

Yeah.

And every day you just had to make it up.

Right.

It was incredible. I would recommend a startup experience for anyone because you see, you learn how much you can do with so little, and you learn how quickly you can pivot to realities. And so I did that. And then Kaiser Permanente recruited me to come out to the Pacific Northwest and help me build up their healthcare delivery system. And then I eventually went on to be the president of Kaiser Permanente Northwest, running that part of KP in the country. And that was incredible.

Yeah.

And that's where I got to actually bring together all that I knew about the provider side with the health plan side, because we had a very large health plan and it was so gratifying to be able to have all of that together in one somewhat seamless system. 50% of our care was delivered through our network of high-quality providers. It wasn't all Kaiser Permanente physicians and facilities. And now here I am at Blue Shield of California. So it's so far so good. And I, you know, then there was the worldwide pandemic, but that would be a whole other podcast. Honored to serve during that time. That was remarkable. And, uh, and here I am, uh, ready to move us forward during these ever-changing times.

Yeah. Talk to us a little bit about sort of the unique perspective then that you have, because a lot of times, right, we were sort of single-tracked. And you are actually triple-tracked, right? You did a startup, but you've also served on delivery side and the payer side. And so what sort of perspective does that give you?

Well, first of all, we exist in a healthcare system. I'm going to put that in quotation marks. I mean, there's really not a healthcare system in this country, right? But we live in this system that's grown up over time where Payers and providers are really pitted against one another. And that is not good for anyone, right?

Yep.

And my opinion is those days are over because we have to solve for the affordability crisis that we're in, in healthcare. And we've talked about that since I've been in healthcare, but it is getting very real right now. I believe that we're at the tipping point where we cannot become more expensive. And we have to embrace innovation and improve the quality of care. I mean, look at all that's happening in the biotech realm, for instance. That's the future. That's a big future for care and cures. And so there's a lot that we have to figure out. And I'm here to tell you, a statement of the obvious, I'll be Captain Obvious, payers are not going to figure it out on their own. Providers are not going to be able to solve for that on their own. So we have to come Together. It's easy to say, it's hard to do. But, you know, Ed, what I've learned over my career is that organizations collectively move at the speed of trust. Blue Shield of California is such a great organization that is so mission-oriented. We're in it to make life better for our members, to create a healthcare system worthy of our family and friends. And let's support and partner with the incredible providers who take care of those people, right?

Sure.

We're not the ones taking care of those people. And so, You have to come together in a very different way, and it starts with a shared view of reality and the goal. It's powered by data and technology, and that's actually really going to help accelerate this now. But, you know, we're in the people business, and we're forever going to be in the people business, and we've got people who take care of people and save their lives. And so how do we use data and technology to bring us closer together, support The terrific doctors and nurses and pharmacists that exist out there, all for the common goal of reducing the total cost of care, improving quality, and making healthcare simple and easy. I mean, could it be any harder? No. And we have to change that. So where there's a will, there's a way. I'll say this though, you could have all the technical capabilities to bring together a partnership. But if you don't have that trust and that willpower and that drive to make it happen, forget it.

Yeah.

So as a payer, we think about that at Blue Shield as how can we be the most trusted health plan for any provider in the great state of California to link arms with and work with? Because we all, I think, are recognizing at this point in time what got us here is not going to get us there. And we have to— we have 330 million-plus people In the United States of America who are counting on us to figure it out. So, yeah, we're, we're fired up to do just that.

Yeah. That's why I think, again, your career trajectory is inspirational, and I think it would be helpful if there were more executives like yourself who've had the experience on both sides, right? Because sometimes that helps too, because we kind of grow up in this lose-win, you know, and we're, we're not thinking win-win and like each other's the bad person and it's not the case. And when you get the chance to work on both sides, you kind of figure that out. So based on your perspective, what's one thing, and then I'll ask the reverse of this as well, but what's one thing you wish providers knew more about payers?

Yeah.

So the majority of the audience, probably 70%, will be from the delivery side and they don't know what it's like. And so, you know, what's one thing that you might share?

The most important thing that I'd share is to know that Everybody who works in the payer world, they care as much as you do about taking great care of patients and members. That's what I want all of you terrific leaders in healthcare delivery to know about us on the payer side, and that we would jump at a chance to work with you to make it all better for our patients and for you. I mean, you've got the hardest jobs around. My opinion. And that, and that feeling is there and it's real. And, uh, and so that, that's what I'd want the audience to know.

That's, that's good. And that's powerful. The same perspective, but from the other view, what is one thing you wish payers knew more about delivery side or provider side?

Yeah, I guess, I guess I'll be redundant. It's, it's the same thing. And, you know, walking a mile in someone's shoes is worth its weight in gold. So I'd actually advise Every payer who's listening to this, I want you to schedule a time with the providers who take care of your members and go spend a day with those great teams and see what it takes to take great care of real people day in and day out, and then leave there thinking, how can I help? That's what I would want.

Yeah, I think that's a great idea and something that I'm sure if you approach any of your partners, payer partners, provider partners, that they would say, yes, of course, that's a fabulous idea. So let's talk about the time in life when you first discovered you were a leader. Was there a moment where you're like, this is part of who I am?

You know, I'd have to say that my life early on, well, and I guess it still continues to say, it was really shaped by athletics. So I'm lucky in that I've got fairly good hand-eye coordination. So I was really deeply into basketball and volleyball. my whole life and played in college and coached to actually pay for graduate school at the UMass Amherst women's team. And it was really on those courts, the basketball court or the volleyball court, leadership just came naturally to me. And I think it's because I really see the value of the collective team. I am not— okay, and I want to state this for the record.

Yeah.

I don't believe in that old paradigm of, you know, the hero leader.

Yeah.

And certainly not in healthcare, right? It's way too complicated. And it's all about a great team with diverse skill sets and points of views where you've got this open environment where you can put it all together. That's where the magic happens. And that's just how I always was since I was a little kid. That's when it all started for me.

Yeah, no, that's great. Yeah. Athletics is a great place for all of us to sharpen our skills and yeah, whether it's—

Plus you learn so much about self-leadership, right?

Oh yeah, for sure.

Yeah. That's like half the battle.

So going back on the leadership, what, what are one or two things that you're most proud of? Like maybe from your payer experience, although you could go back on the delivery side as well, but as a leader, you know, bringing together teams, what are one or two things I'm sure the best is still to come, but you know, what are one or two things that you're—

Thank you for that. You know, um, well, I'll use two, two examples. So Blue Shield of California, after years of hard work by this incredible team that said, hey, pharmacy care should be, will be reimagined. Let's get all the middlemen out of the way and bring the lowest cost drugs directly to real people who today can't afford to spend all the money we're asking them to spend on drugs. And so we created a program, Pharmacy Care Reimagined, where we did just that, where we've created a transparent pharmacy model that really gets the PBMs out of the middle to a great extent so that we can bring the net price of drugs directly 2 members. And it was a very complicated, high-risk, very bold, visible effort, right? The whole country knew about it because it was on the front page of the Wall Street Journal. So pressure's on, you better get that right. Wow, the team hit the ball out of the park. We went live January and it could not have gone better. I'm really proud of the incredible work that the team did to Pull that off. And now I'd say we're at the starting line of the work that we need to do to actually make drugs affordable. And we're here to figure it out because that is such an explosive growth area that you have to figure out how do we get people on the highest quality drugs and at the lowest price available, because we've got, you know, the biosimilar market's going to be exploding, et cetera, et cetera. So I'm super proud of that. In a prior life, I had the opportunity to build a hospital net new from the ground up, and I'm a big culture person.

Yeah.

And I did this with a team. They were incredible. And there's a lot that goes into building a hospital from the ground up, and people could actually die if you don't get it right. So you better get it right. And the best thing about the whole thing is that We doubled down on the— we have to have a world-class culture to have a world-class hospital. And we want every person working here to function as an owner, not a renter.

Yes. Yes.

And that's, and that's what we created with the thousands of people who work there. And when the— from the moment we opened the doors to that hospital, it was tops in the country for quality, patient experience and cost, lowest cost. It was remarkable. And it was just so fun to be a part of creating something that special that has such lasting power. Very meaningful.

Yeah.

Love it.

Yeah. And that's a unique opportunity to do a greenfield hospital for sure. That's cool that you got a chance to do that. What would you say, Susan, to aspiring leaders? So, you know, a good portion of our audience are managers, directors, and they They listen to you, Susan, and they listen to other leaders and they're like, wow, I want to be like her. What are one or two skills that you think aspiring leaders really should hone in order to get to that next level? Or like moving from D to A1, you know, up the ladder.

That's a, that's a good analogy. Hey, my advice to everybody, number one, believe in yourself and have a big vision for your life. That is the most important thing.

Yeah.

And you are capable of doing so much more than you think you are. So that's a basic premise. And I want everybody to feel that. Number 2, things are changing so rapidly. Think about how you get 15% better every year. How are you constantly evolving? And I'm not saying 5% better. I'm saying 15% better. What new skills and experiences are you adding to your portfolio so that you achieve that? So think about that. And then last but not least, it's not about IQ, it's about EQ. And being a leader means that you're able to create followership and a sense of purpose. And how do you bring that to life every day for the people who turn to you? for direction, um, would be the main things I'd encourage everybody to think about every day.

Yeah, those 3 are great. Susan, you're this amazing executive and you have 2 teenage daughters at home. You are active and I know you run, maybe still play some of the other sports that, uh, you played in college. How do you recharge? How do you sort of reset, rebase so that you can bring, you know, that all of you into the workplace?

Yeah. You know what's so critical, Ed? And I think, you know, you and I are kindred spirits this way. I think that you're uber athlete. I'm not quite there at this point in time in my life, but those daily habits where you're reinvesting in yourself, and for me, that's exercise. I love my morning exercise routine that, you know, it starts with coffee and then I do a ton of weight training at the gym. And, you know, that is so grounding. for me that allows me to be my best me. And then to recharge, I have a ton of fun. I've been coaching my daughter Gloria, my 14-year-old, for a volleyball team at the Boys and Girls Club.

Fun.

And oh my gosh, what a blast to help these 14-year-old girls become more of who they're meant to be. And we've had a lot of fun this past season with my mantra with them is I want, I want you to get alpha. I want to see that inner alpha out on that court. And that has been a blast. So I have loved doing that. I also too, one last thing, I serve on the board of trustees for Seattle Children's Hospital. So we're in the top 10 in the country, number 4 with NIH research, amazing place. And I chair a quality committee. Hey, if you want to be inspired and get recharged, You walk into that hospital and you see what these amazing people do for these families facing really tough situations. And, uh, and it's nothing short of remarkable. So.

Yeah, that's a great way to recharge, giving back and also taking care of yourself. Like you were just describing. And yeah, shout out to Seattle Children's. I was just there a couple of weeks ago and the leadership there spent, you know, a couple hours there walking through all the floors and meeting some of the nurses and physicians. It is a fantastic place. Yeah. And I, and I meant to mention that about your board service as well. Uh, you're, you just give a lot of yourself, which is, uh, really remarkable. So Susan, we talked about so much, everything from music and then, uh, just about how you were formed and shaped to become the leader that you are and how you grew up and were there for your mom throughout her illnesses. And then just how you created your career, made things happen, and And you provide an awesome perspective on the— from the payer lens, because sometimes I know, because I've spent most of my journey on the provider side, that we don't really understand. And so, it's helpful for you to share. And then, we talked a lot about leadership, what it is to be a leader, the 3 things that everyone should really, no matter where they are in terms of their leadership journey, should hold onto. And then, again, just how you sort of recharge. What did we miss, or is there anything you want to double down on? I'll give you the last word.

Oh, I love having the last word. You know, we all need to be leading with optimism and energy.

Yeah.

You know, there, there can be a tendency to default to, gosh, here's all the stuff that's wrong and not working. And yet I see a bright future ahead. It's going to be a lot of hard work and teamwork to pull it off, but we have a lot to be grateful for and we're just getting started. We've got incredible things ahead. And I hope that we're all leading in that way and that our, that our great Well, Susan Mullany, thank you for being our guest on Digital Voices. Well, thank you, Ed Marx. It's really a pleasure to be here and thank everybody for indulging me for 30 minutes. So I appreciate that.

Time well worth spent. Commercial-free.

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