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Lessons from Marketa Wills, CMO for Johns Hopkins Health Plans, on Redefining the Value of Health Insurance through Collaboration and Member-Centric Care.
Marketa Wills, CMO for Johns Hopkins Health Plans, an organization with a mission to provide high-quality health care plans for its members
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.
Today, we're excited to get to know Dr. Marketa Wills, Chief Medical Officer (CMO) of Johns Hopkins Health Plans, who focuses on optimizing clinical and quality outcomes for approximately 700,000 Johns Hopkins health plan members while efficiently managing costs of care.
Marketa previously worked at several national health plans, including United Healthcare, WellCare Health Plans and Centene Corporation. She's also a McKinsey & Company alum (Cleveland Office) where she served a broad range of payer and provider clients on a variety of strategic and operational engagements. She holds an MD from the University of Pennsylvania School of Medicine and an MBA in Finance and Healthcare Management from the Wharton School of Business. She also trained in adult psychiatry at Harvard's MGH/McLean Adult Psychiatry Residency Program.
In this episode we talk about Marketa’s path in medicine, what her role as Chief Medical Officer entails, how she thinks about partnerships with payors, advice she has for founders, and what she is excited about for the future of medicine.
If you prefer listening, here’s the link to the podcast!
Journey into Medicine
From an early age, Marketa had a proficiency in math and science that caught the attention of her parents, who enthusiastically encouraged her to pursue a career in medicine. While Marketa harbored no objections to their wishes, she was not completely certain about a career in medicine.
As she neared the completion of her undergraduate studies, Marketa immersed herself for a year at the prestigious National Institutes of Health, working diligently in a laboratory setting. It was during this time, she thought more about a career in medicine but a different perspective also came into her consciousness—a contemplation of the underlying infrastructure that underpins healthcare systems. This newfound consideration gradually captivated her attention, encouraging her to ponder the intricacies of healthcare delivery beyond the confines of a medical practitioner's role.
"I started to contemplate how funding in the healthcare system is generated, how contracts function in the healthcare space, and the appropriate staffing levels necessary to ensure smooth operations. While I was grateful for the realm of science, I was even more compelled by the ecosystem surrounding it as it was becoming more and more important to me."
Because of her profound interest in comprehending the infrastructure and structural ecosystem of healthcare, Marketa ventured into the application process for medical school. At that time, the University of Pennsylvania stood as the sole institution offering a combined MD/MBA program, effectively merging the medical school with the renowned Wharton Business School. Fueled by the opportunity, Marketa submitted her application and embarked on her studies at Penn Medicine.
However, her academic path took an intriguing turn. Rather than immediately pursuing the MBA program, she chose to embark on a residency in psychiatry. Her decision allowed her to delve deeper into the realm of mental health care, honing her expertise and gaining invaluable experiences before eventually pursuing an MBA.
Calling for Psychiatry
During her time in medical school, Marketa encountered a distressing situation when her mother fell terminally ill with recurrent metastatic breast cancer. Tragically, her mother eventually succumbed to the disease. As a result, Marketa had to temporarily halt her medical studies precisely when she had planned to apply for the MBA program.
After a year-long hiatus, Marketa resumed her studies and embarked upon her clinical clerkships. While on a rotation in the psychiatry unit, she crossed paths with Cabrina Campbell, the clerkship director who eventually became a mentor to Marketa. Dr. Campbell, who has since achieved great success becoming the residency training director at Penn, recognized Marketa's exceptional abilities and specifically praised her aptitude for psychiatry. She commended Marketa for her unwavering dedication to her patients, noting how she consistently stayed late to provide care because of her genuine love for the field.
In the wake of her mother's passing, Marketa discovered previously unrecognized talents through the discerning eye of her mentor.
“I think sometimes we have a path that we think we must take in order for life to work out. And it's just not like that. It's more like a GPS system; taking a wrong turn prompts a rerouting. And that's precisely how I stumbled upon psychiatry—a fortuitous event that I hadn't anticipated but ultimately became one of the most rewarding aspects of my life on multiple levels."
This experience underscored the significance of having a mentor who guided Marketa in the right direction. These influential relationships extended far beyond the four years of medical school, persisting even two or three decades later. Marketa still maintains regular contact with her mentor and had the pleasure of reconnecting with Dr. Campbell during the most recent Medical Alumni Weekend at Penn. They were able to toast Dr. Campbell being awarded a prestigious endowed chairpersonship. Marketa also firmly holds onto the timeless wisdom that as one ascends and achieves new heights in life, it is imperative to extend a helping hand to elevate others through the transformative power of mentorship.
What the Chief Medical Officer (CMO) does at Johns Hopkins Health Plans
Marketa's tenure at McKinsey exposed her to a wide range of payer and provider clients, offering invaluable experience in strategic and operational work. The dynamic environment at McKinsey, coupled with the opportunity to work alongside brilliant colleagues and mentors, propelled her into leadership roles across various organizations, amplifying her knowledge in both the provider and the payer space. Notably, her ten-year journey on the payer side saw her assume influential positions at United Healthcare, Wellcare Health Plans, and the Centene Corporation.
While Marketa initially held positions within the behavioral health space, she gradually transitioned into the realm of population health programs which stretched her across the entirety of the medical spectrum. Traditionally, behavioral health and physical health aspects of medicine have been compartmentalized, existing as separate entities. However, Marketa values the opportunities of gaining experience in both domains, as it has provided her with a broader perspective and allowed her to bridge the gap that often exists between them.
Given her extensive experience and knowledge, Marketa was recruited during the height of the pandemic as the CMO of Johns Hopkins Health Plans, administrator of provider-sponsored health plans from Johns Hopkins Medicine. Overseeing a vast network that manages approximately half a million lives, predominantly in the mid-Atlantic region, she leads the Health Services division to support four health plans including Medicaid, Medicare, a military family and retiree health plan, and a group plan for Hopkins employees.
In her role as CMO, Marketa bears the responsibility of setting the health plans’ clinical strategy. This encompasses various facets, including the administration of pharmacy benefits, formulary decisions, medical service requirements, protocols for therapy administration, technology implementation for clinical documentation systems, and the measurement of each health plan's quality. Additionally, she oversees provider engagement aspects of the health plans, ensuring effective collaboration with providers on quality-related matters.
"I have the true privilege and pleasure of leading the Health Services team, which comprises approximately a quarter of the associates within the health plan. I would estimate that around 65% of these Health Services employees are clinicians within our organization, including nurses, social workers, pharmacists, physicians, and medical directors, all of whom report into the Office of the Chief Medical Officer. It is both an enjoyable and demanding responsibility, and I consider myself fortunate to have a team of dedicated leaders who report to me and collaborate in partnership, working cross-functionally to advance the agenda of the Johns Hopkins Health Plans brand."
Potential Partnerships with Johns Hopkins Health Plans
In the pursuit of its extensive agenda on behalf of members and provider partners, Johns Hopkins Health Plans actively seeks partnerships with external organizations and companies. Critical decisions must continually be made: should Johns Hopkins Health Plans leverage their core competencies and capabilities to develop in-house solutions, or should they engage with specialized entities or vendors who possess the expertise required to propel their business forward?
Marketa and her team are frequently approached with opportunities for potential partnerships, drawing upon her two decades of experience in healthcare. Over the course of her career, she has participated in numerous pitch meetings, spanning the spectrum from startups to publicly traded companies, exploring various partnership models.
"When contemplating a partnership, my focus always gravitates towards the significant challenges and issues pervasive in the healthcare landscape and their relevance to Johns Hopkins. Simultaneously, I take into account our organization's internal initiatives, allowing me to construct a roadmap. As companies approach me, a fundamental question arises: will this organization fit within our Johns Hopkins Health Plans roadmap and will it yield synergistic outcomes within our organization?”
With this framework in place, Marketa emphasizes the importance of thorough research for startup founders and established companies alike. Understanding the needs of health systems and health plans is crucial, enabling purposeful outreach to specific organizations that align with those needs and can benefit from the startup's offerings.
"Johns Hopkins Health Plans constantly scans the market for components that can seamlessly fit into its portfolio. Equally significant is the alignment of organizational values, ensuring a continued spirit of innovation in our collaboration."
The facilitation of these partnerships varies depending on the organization's size. For small startups, it is typically the founder, technical lead, or clinical lead who initiates contact with Marketa. In the case of larger companies, the sales team takes charge of engaging with Johns Hopkins Health Plans. Consequently, partnerships with Johns Hopkins Health Plans occur at various levels and involve individuals from diverse backgrounds within the organization. When exploring a potential partnership, the health plan involves the vendor management and the legal teams in meetings to ensure engagement with potential vendors is fair and equitable.
"It's often a cross-functional team, even in the early stages of partnerships. We also involve our IT partners to ensure eventual seamless integration of the product or service into our IT roadmap, considering the uptake for our health plan members. We prioritize the member experience and aim to avoid a scenario where members need to access multiple platforms for different solutions, causing confusion. Keeping the member experience at the forefront, we integrate new solutions into our offerings or form partnerships with a focus on providing a cohesive experience."
Why A Freemium Model Does not Always Appeal to Health Plans
At times, an organization finds itself at the forefront of an innovative concept or idea, brimming with excitement and potential. Yet, large health plans often require additional evidence of outcomes and results from other health systems and payers before taking the leap to integrate such solutions into their comprehensive insurance offerings. The hesitation stems from the risk associated with early-stage startups, a risk that large health systems and plans are not always willing to bear.
To address this concern, many startups adopt a freemium model when engaging with insurance plans or health systems. By offering their services or products free of charge, they aim to secure buy-in from health systems and gather valuable data, while also gaining traction among patients, providers, and other stakeholders. However, Marketa emphasizes that this approach is never truly free. It entails costs related to IT integration, implementation, and time, not to mention the opportunity cost for health plans that could invest in more established organizations known for their track record of delivering exceptional quality and service.
When startups approach smaller organizations or payers, they can measure health outcomes and collect critical data points. By demonstrating success and scalability through robust evidence, they are then more attractive to more mature and larger health plans.
"I believe that having those critical data points from smaller payers is an important consideration for our organization. We prioritize demonstrated health outcomes and quality outcomes above all else. Additionally, we evaluate whether there is a sensible financial return on investment. These factors guide our payer-side selection process when choosing vendors to partner with. If a solution is not free, that is perfectly acceptable because we value paying for exceptional outcomes over receiving something for free that offers subpar features or outcomes for our members.”
The Johns Hopkins Health Plans Focus on Being Member-Centric
In healthcare, the utmost priority is always the well-being of each individual. However, it is evident that the consumer or patient experience within the healthcare system does not always match the seamless and satisfying experiences provided by companies like Amazon or other renowned consumer-oriented businesses.
When it comes to ensuring quality and positive health outcomes, the significance of patient experience cannot be overlooked, even within the healthcare realm. The focus remains on placing the patient or member at the center, meeting them where they are, and providing resources in a manner that aligns with their preferences and needs. This holds particular importance when serving diverse communities, as the aim is to create a welcoming and trusting experience. Johns Hopkins Health Plans is committed to considering this aspect at every step, encompassing both their network and technological offerings.
“The question of how members will access a product or platform and how they will feel while using it is constantly on our minds. At Johns Hopkins Health Plans, significant efforts are underway to surpass industry standards and identify valuable apps and portals for our members. To achieve this, member advisory councils play a crucial role in helping us understand their desires and priorities. By placing members at the core of our solution-building process, we leverage tools, techniques, and strategies akin to those used in marketing and sales, enabling us to enhance our clinical offerings.”
As a result of this patient-centered approach, interventions such as remote-patient monitoring, initiatives to address workforce burnout, and same-day appointments have been implemented. The challenges associated with appointment wait times, particularly within the Medicare and Medicaid space, are acknowledged.
“You know, waiting for or securing an appointment can be quite challenging. I have personally observed this, particularly in the Medicare and Medicaid space. One aspect that fills me with pride is the Johns Hopkins OnDemand Virtual Care available to all our members across our various health plans. This service allows them to access telemedicine within an hour. What's particularly remarkable is that it was developed in collaboration with professionals from our delivery system. As a result, once these virtual visits are concluded, the medical records seamlessly integrate into the EMR system used by many of our primary care physicians affiliated with Hopkins. This achievement has allowed us to create a solution that bridges the gap between payers and providers."
The on demand virtual service offered by Johns Hopkins Health Plans was established through a partnership with an external entity, namely Teladoc. Teladoc provides a convenient and affordable means for individuals to engage with licensed doctors 24/7 through phone or video calls, addressing a variety of common health issues.
Through their collaboration with an external partner, Johns Hopkins Health Plans has expanded access to telehealth services, a modality that many members find beneficial. Member feedback regarding the Teladoc experience has been overwhelmingly positive. Users appreciate the flexibility of fitting appointments into their schedules without the need to visit the emergency room or urgent care centers. In situations where their regular doctors are unavailable for same-day appointments, Teladoc offers a seamless tool with an easily navigable interface. Members feel well taken care of by the physicians and find comfort in knowing that their own doctors will receive the information and have access to their medical records.
Johns Hopkins Health Plans leadership takes great pride in this solution, as it has effectively improved wait times and enhanced member experiences when addressing urgent healthcare needs. Simultaneously, it has contributed to reducing the overall cost of care by minimizing visits to the emergency room or urgent care center. This mutually beneficial arrangement has proven to be a win-win situation for all involved parties.
Harnessing Pilot Testing for Program Rollouts
When it comes to implementing new solutions, healthcare plans and systems often face the choice between a full-scale implementation across all business lines or conducting a pilot phase to test the waters. Johns Hopkins Health Plans, their preferred approach is to begin implementation within one of their four health plans before expanding the offering to others.
“Privacy and security hold significant importance in the insurance industry, and the military sector sets even higher standards than other business lines due to the stricter Department of Defense security clearances. So this typically makes us start with our military health plan because we know it will have additional work.”
In certain instances, Johns Hopkins Health Plans may opt to pilot initiatives in other lines of business, such as Medicaid or Medicare. Through these pilots, they gain valuable insights from any mistakes made and use them to inform the rollout to the remaining business lines, ensuring a smooth implementation process that considers the pilot's results.
What Excites Marketa for the Future of Medicine
Marketa is a passionate advocate for the transformative potential of artificial intelligence (AI) and big data in healthcare. Within the clinical space, she sees a remarkable opportunity to harness AI for quality measurement work, enabling the identification and recognition of outstanding medical care provided by doctors. Currently, the process of reviewing medical records to address care gaps is labor-intensive, relying on a dedicated team of nurses within the quality department. Marketa envisions AI technology seamlessly scanning electronic medical records (EMRs) to efficiently identify evidence of closed care gaps, such as completed colonoscopies or prescribed statins. The integration of AI in this area holds immense promise for advancing healthcare standards.
AI in utilization management is another realm that ignites Marketa' enthusiasm. She recognizes the substantial potential for AI in utilization management, which is the area that focuses on ensuring medical necessity for clinical service requests and reducing wasteful practices. As AI continues to evolve, the analysis of medical records will become more streamlined, supported by machine learning algorithms that aid in making decisions regarding medical necessity. The integration of AI and machine learning in the healthcare landscape, particularly within health plans, offers extraordinary opportunities for enhancement and optimization.
Addressing equity concerns holds personal significance for Marketa. She firmly believes in exploring strategies to deliver culturally tailored care to diverse communities and environments. Driven by this conviction, she urges founders to develop flexible solutions that can adapt to different contexts, fostering inclusivity and improving healthcare outcomes for all individuals.
Lastly, Marketa places a strong emphasis on driving behavioral change and promoting wellness. She recognizes that the healthcare system often incents treating illness rather than proactively encouraging healthy lifestyles. Consequently, she advocates for empowering patients through tools and technologies that promote and pay for wellness and positive health outcomes.
Be a Trailblazer, Not a Follower
Marketa advises others to prioritize being a trailblazer rather than a follower when it comes to their careers. Instead of imitating the paths of others who have gone before them, she encourages individuals to carve out their own distinctive journeys. She firmly believes that each person's career is an opportunity to express their unique passions, innovative ideas, and purposeful contributions.
“Everyone possesses the ability to break new ground and shape their careers according to their individual aspirations. Rather than solely seeking inspiration from others, people can tap into their own experiences, leverage their unique gifts, and showcase their exceptional talents to make a positive impact.”
With a genuine commitment to supporting others' career development, Marketa provides guidance and assistance to many mentees throughout the country. She recognizes that life presents numerous questions and critical decision points. She advises individuals to make choices based on their core values, personal backgrounds, and exceptional qualities that set them apart. While drawing inspiration from accomplished individuals can be valuable, Marketa encourages individuals to chart their own paths, seeking mentors who can ignite their inner drive and propel them towards unexplored opportunities.
Choosing to be a trailblazer instead of a follower requires resilience, courage, and a willingness to step beyond comfort zones. Marketa firmly believes that the rewards of forging one's own path outweigh the convenience of imitation. By daring to be different, individuals can authentically showcase their unique brilliance, experience personal growth, and unleash their passion in ways that leave a lasting impact on the world.
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