John Byrnes, Chief Operating Officer at Banner|Aetna

In this episode, John Byrnes, Chief Operating Officer at Banner|Aetna, discusses how the organization is advancing value-based care through integrated technology, strong payer-provider collaboration, and personalized member support. He highlights key strategies driving improved health outcomes and sustainable cost management in Arizona.

Episode Transcript

(00:00):
This episode is brought to you by Veradigm,
the only health care technology company connecting all
corners of care. Some companies deliver clinical data.
Others turn that data into insights.
A few provide point of care tools to
clinicians.
Veradigm does it all at a national scale.
That's why leading health care organizations are part
of the Veradigm network. By enabling smarter, more

(00:21):
connected workflows,
Veradigm helps close care gaps right at the
point of care where it matters the most.
Whether you're a provider, a biopharma company, or
a health plan, visit veradigm.com.
That's veradigm.com
to learn how Veradigm can help you too.
Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast. Thrilled today to

(00:44):
be joined by John Burns, who is the
chief operating officer at Banner Aetna. John, thank
you so much for taking the time to
be with me on the podcast today. Hey,
Jacob. Thanks for having me. Yeah. Absolutely. And
before we dive into everything we wanna talk
with you about, John, can you tell us
a little bit more about yourself, your background
in health care, and what it is that
you're doing today at Banner Aetna?

(01:04):
Sure. Yeah. Happy to. So as you mentioned,
I'm the chief operating officer of
Banner Aetna,
which is a joint venture health insurance company
based out of Arizona.
I stepped into this role in April
after having spent more than a decade with
Aetna
and CVS Health.
And,
in in that role, I was,

(01:27):
really did a number of different functions covering
government affairs, enterprise strategy, product design,
and most recently was in clinical network operations
for about five years for the company,
focused nationally on all of our our various,
network operations across care management, utilization management, and
the like. So, that's where I'm coming from.

(01:47):
In my current role as the COO of
Banner Aetna, I'm responsible for leading the development
and execution of our integrated strategic plan. And
that's really with a focus on aligning our
payer and provider capabilities,
affordability,
enhance quality, and deliver a seamless member experience
for our customers.

(02:07):
And I'm also responsible for oversight of our
day to day operations, which covers everything from
medical cost and network performance, clinical quality, service
operations, and compliance as well.
Fantastic. So you were at CVS for a
long time. Now you're back at Banner Aetna,
which, of course, you you helped launch.
And you're returning to the company

(02:28):
during a time for the industry where there's
a lot of pressure on the traditional insurance
model,
and that really it seems to be across
every market at this point. So talk to
us. What's your perspective on all of this?
What's your vision for scaling the impact,
of Banner Aetna, and what does success look
like right now, in terms of operations

(02:49):
and clinical outcomes,
given the state of the industry?
Absolutely.
You know, I'm I'm really excited to come
back
and work with this business. I think,
you know, from the beginning, Banner Aetna was
built on a clear and compelling vision, which
was
to reimagine the healthcare experience
around the needs of the individual.

(03:10):
And the founding principles that we crafted when
this business was stood up were really designed
to move beyond
transactional health care by delivering
personalized, seamless, and affordable experiences
that empower members to really achieve their best
health.
And at the heart of that strategy is
a belief that
success comes from tightly integrating

(03:32):
the payer and provider capabilities
to deliver those results.
And that's not just in theory, but really
in practice. And I think that this approach
and the business that has been stood up
is really uniquely suited to
Arizona's diverse and dynamic market.
When we think about what that means for
our operational success to date and where we

(03:53):
go from here, we're really focused on four
primary levers operationally to drive efficiency, engagement, and
value for our customers.
And that covers everything from things like real
time data integration. So how do we strengthen
the data and workflow between between the health
plan and the care delivery teams
to improve decision making, reduce administrative friction, and

(04:14):
enable more effective,
care management?
It also covers things like virtual care expansion.
So with our consumer expectations
and seeing how those are shifting in the
market,
we wanna scale seamless
and digitally enabled care options that are fully
integrated into the member care journey so that
members can access care virtually,

(04:36):
or in person depending on their needs, where
they are geographically located and so forth.
And really helping by doing that helping reduce
inpatient utilization
and enhance that access, especially in rural and
underserved communities.
Another thing we're looking at operationally is with
the advent of AI and how much that
has has started to really mature over the

(04:57):
last,
eighteen to twenty four months is looking at
how we can leverage
some of those AI capabilities
to better drive predictive analytics,
help integrate some of those,
AI capabilities into the operations, and really in
doing that, driving better outcomes as well as
enabling and empowering clinicians

(05:17):
to deliver the best care possible.
And then I would say operationally,
the last thing and the fourth lever is
really around
how we think about this from an employer
centric standpoint.
So we obviously have a lot of self
funded
employers of varying sizes across the state
and really thinking about how do we empower

(05:38):
and enable them
to manage
the rising cost of health care for their
workforce
while at the same time empowering
and helping to improve the health of those
members.
And really the success tied to that is
are we able to,
help support enrollment growth, drive administrative efficiency,
and ultimately help the employer to have some

(06:00):
long term retention
with their employee base.
So that's operationally how we think about kind
of where we go from here. I would
say from a clinical standpoint,
we will continue to demonstrate that the integrated
care of this joint venture
can outperform the traditional models and fee for
service,
and that really results in better health outcomes

(06:20):
at lower costs.
So for this, we're focused on a few
different critical pieces of it clinically.
One is around chronic condition management. You know,
we've already seen some really great outcomes in
diabetes reversal through our partnership with Virta Health,
both on the A1C reduction side as well
as,
a substantial reduction in diabetes medication,

(06:42):
and then just overall weight loss. And I
think
that has been a real,
use case and some of the demonstrated proof
points around that that has given us,
an opportunity to build from as we think
about the momentum and looking at other conditions
like kidney cardiovascular disease, and how we better
support and and help members manage those conditions,

(07:03):
with with this arrangement.
I think preventative care and early intervention
is another one where we're really focused clinically
on how do we increase screening rates and
timely interventions
for members, making sure they're getting in to
see a primary care provider, making sure that
they are, avoiding
unnecessary hospitalizations
and really take advantage

(07:25):
of the full suite of services that are
available to them. And then when we think
about hospital utilization,
we're also looking at it from the standpoint
of
when a member goes into those care settings,
how do we make sure that we're wrapping
around them with the right level of care
and support? So everything from proactive care coordination,
to post discharge follow-up.

(07:47):
How do we make sure that we reduce
those unnecessary ER visits and that when a
member leaves a care setting, they're equipped with
the right level of education, the right level
of care support, and follow on care to
be able to avoid an unnecessary readmission.
And that's particularly true for for high risk
populations.
Absolutely. And, you know, John, we've heard from

(08:08):
several banner Aetna leaders in the past.
I'll always point into your your value based
integrated model as a key differentiator
in the market. So
talk to us about why you think Arizona
is such a uniquely strong market for the
type of transformation you just described, and can
you expand a bit for us about how
you're leveraging
those local dynamics to push this model even

(08:30):
further?
Yeah. Absolutely.
I I mean, if you look at Arizona,
it it really represents
a uniquely fertile environment for value based integrated
care. And I think Banner Aetna is purpose
built to lead that transformation.
It's obviously not the only player in this
space, but the way it has been configured

(08:50):
and just the opportunity of these two large
organizations
is in a lot of ways unparalleled.
But if you look at the state's
health system landscape broadly, it's highly consolidated
among a handful of hospital systems,
Banner being one of those. But then you
have HonorHealth, Mayo,
Abrazo and others.
I think this concentration

(09:11):
of
system of health systems in the market
and with Banner alone commanding nearly 50% of
inpatient volume, within Maricopa County, it really creates
a perfect scale for the integration
and data sharing around these aligned incentive models
and what we're going after.
The other piece of it, if you think

(09:32):
about the uniqueness of Arizona, is
the demographics
of the state, relative to the population.
And, you know, Arizona has 49%,
roughly of its residents that identify as Black,
Hispanic, Asian or Native American.
And with that comes the need for culturally
tailored and personalized care that is accessible across

(09:54):
the state.
And so when we think about that relative
to our business, you know, Banner Aetna was
physically designed to take advantage of these dynamics,
as a joint venture
between the national scale of Aetna as a
health plan
and then Arizona's,
health system with Banner
and the breadth and depth of that system.

(10:15):
We're not simply coordinating care. We're really integrating
it. So this model breaks down the traditional
barriers between the payer and provider
to deliver that more connected accountable experience across
the continuum.
This means that we can act faster on
the insight insights that we have for our
members,
to more effectively align those incentives to meet

(10:36):
members where they are. And whether that's through
things like digital navigation tools for members,
and our work with ninety eight point six
and and virtual care, whether that's some condition
specific programs like Virta Health and the partnership
we have there, or whether that's community based
programs that we offer through our Get Active
program or the banner at the kitchen,

(10:56):
and then even personalized care management through the
the banner,
the banner care team. You know, we have
a suite of services
and ways of engaging and tailoring those offerings
for members that really meets them where they
are and and the unique needs that they
have.
And then I would say with that,
the unique advantage that Banner Aetna has in

(11:16):
Arizona, if you look at things like the
performance network that we offer, is the cost
savings associated with that for commercial plan sponsors
and the broad access that's provided across key
Arizona counties, which really reaches the majority of
the state's population,
with those banner facilities,
it is really unparalleled.
And I think that combination of

(11:38):
local access to care
combined with the national scale and track record
of,
a national payer like Aetna,
really comes through in in the results that
we've seen where, you know, we have three
times higher than industry average member engagement, and
we're positioned to lead the market in really
delivering that integrated and value based care.

(12:00):
The last thing I'll say on this is,
you know, we wanna push this model further,
and that really means we wanna embed those
value based principles
into every facet of our operations, whether that's
clinical programs, member experience, or even employer engagement.
It's really
around
making sure that we're able to quickly adapt
to
Arizona specific needs and address

(12:23):
gaps in care for rural populations, be able
to tailor solutions for those diverse communities,
and then really partner with employers to improve
the health of of their employees.
So in a nutshell,
we're not trying to rep retrofit value based
care into a legacy system. We were built
for it, and I think Arizona is the
ideal market for this type of model.

(12:45):
Absolutely. Well, I appreciate you breaking down those
local dynamics for us. That all makes a
lot of sense.
And beyond improving outcomes and and lowering costs
for your for your patients and your members,
Sean, you touched earlier on elevating that member
experience. We've heard from leadership at the company
in the past about things like frictionless billing.
So so what's your perspective? What what does

(13:06):
this look like in practice,
from for Banner Aetna, and how do you
balance human centered care with that push for
operational efficiency?
Yeah. That's a great question.
You know, it's funny. I think in a
lot of ways when we talk about these
different concepts, whether it's health outcomes,
costs, medical cost management, or member experience,

(13:27):
they're often talked about as competing goals. And
I think the way we view it as
they are
interdependent goals to one another.
Our model is not built to only lower
medical costs or only improve health outcomes or
only elevate the member experience.
It's really built around
those
three principles

(13:48):
being of equal weight
and of equal importance.
And
by integrating
Banner's patient centric clinical care with Aetna's deep
operational rigor and digital capabilities,
we're able to really
deliver against those three imperatives.
So for, you know, commercial plan sponsors, this

(14:09):
means that we're creating a healthcare experience that
helps their employees
stay healthy,
be productive, and be supported,
in their health care journey, but it also
gives those employers better control over cost and
outcomes. So it's both meeting the member where
they are and making sure that we're caring
for them and and the various health needs
that they have, but then also

(14:30):
equally able to demonstrate the rigor and operational
excellence needed,
to be able to manage a a health
plan at scale for for an employer of
any size.
I think from a member experience standpoint,
when we think about that and your question
around frictionless billing
in particular,
you know, we want to take off those

(14:50):
points of friction where they exist. And when
this business was set up, a lot of
what we looked at was what are those
critical pain points that a member experiences when
they go into,
get care, when they have that health care
journey experience?
And when we look at that and and
tackling things like, frictionless billing and how we
can simplify that, we we look at it

(15:11):
across the whole ecosystem. So we want to
simplify how members are able to access care.
We want them to understand their health care
benefit simply, and we want them to be
able to navigate the system
in a way where there aren't barriers to
care and there aren't barriers to understanding that
the care that they're getting, or paying for
that care. And we've invested in a lot

(15:32):
of a lot of the solutions around that.
So things like proactive care advocacy, providing digital
front doors, providing more of an integrated customer
service model that's powered by real time data,
and then shared accountability between our payer and
and provider teams.
I think what makes,
again, this arrangement unique is the ability to

(15:52):
combine
the empathy with the efficiency.
The empathy and understanding for the customer, whether
that's a plan sponsor or the member, as
well as the efficiency of being able to,
deliver those business results in a way that's
really gonna be meaningfully valuable to that customer.
You know, Banner brings a long standing commitment

(16:12):
to that relationship based community anchored care. So
it's rooted in trust. They have the local
presence, the deep clinical expertise,
things like same day appointments, providing culturally tailored
behavioral health programs,
having embedded care teams in primary care settings.
The emphasis is always on meeting the member
where they are and then treating the whole
person as part of that. And then conversely,

(16:34):
Aetna,
as the payer, brings the operational backbone to
make that scalable.
So from things like precision analytics and coordinated
care management
to streamline digital tools that reduce administrative burden
for the member and provider. You know, we
don't view operational efficiency as a trade off
to human centered care. Instead, we see it
as the engine that enables it. And when

(16:54):
processes are efficient and data flows seamlessly,
clinicians can spend more time with patients and
members, and, ultimately, the experience is more personalized,
timely, and effective.
Absolutely. Well, Ben Aretna is very clearly on
the forefront of that value based integrated care
model, John. So we really appreciate you sharing
your insights on where the company will continue

(17:16):
to go under your leadership.
But before we go today, are there any
final thoughts you wanna share with us, share
with our listeners, our health care leaders all
over the country? Any final bits of advice
you'd wanna share with them?
The only thing I would say is that,
you know, I'm incredibly energized
to step into this role,
coming up on four months now, and

(17:37):
I think this is a really
defining moment,
not just for value based care, but the
the health care industry broadly when you look
at market dynamics, what's going on, you know,
in the regulatory environment and otherwise.
I think it's a an exciting time. There's
a lot of challenges, and the challenges are
real,
but so is the opportunity.
And, you know, I firmly believe in the

(17:58):
model of this business,
and what can be delivered
ultimately in in bringing value to customers and
members and making health care simpler. And I'm
confident that we
can and and will continue to build something
that really is unique,
in Arizona. I'm excited for the future of
where this will go.
Fantastic. Well, John, thank you so much for

(18:20):
taking the time to sit down with us
and for sharing your thoughts with our listeners.
We really appreciate it. Thanks, Jacob. I appreciate
it. And to our listeners, if you'd like
to listen to more podcasts from Becker's Healthcare,
you can visit beckershospitalreview.com.