James Beem has nearly 30 years of healthcare experience at a diverse mix of Fortune 100 organizations including CVS/Aetna, Humana, Walgreens and IBM. He recently joined Socially Determined as Vice President, Government Markets, National Accounts and Channel Partnerships. We sat down with James to learn more about his background and his new role.
Socially Determined: You spent the better part of the past three decades in healthcare, at several well-known organizations. Can you tell us a little about your career and how you got here?
James Beem: I’ve been fortunate enough to work at a wide range of organizations, and in various roles that have helped me understand the complex world of healthcare through many different lenses--all involving data and analytics. Generally, I think about my career path as three different chapters focused on healthcare cost, quality and experiences.
I started my career in medical economics, actuarial and underwriting for managed care providers. That was basically the first third of my career where I held roles at organizations including Aetna and the University of Michigan Health System. My longest tenure was at Humana, where I spent eight years and eventually became Market CFO, responsible for a $300 million health plan.
When I left Humana, I shifted to the quality side of healthcare by taking a role as Senior Vice President of Outcomes at Walgreens. The deep experience with analytics and business intelligence I gained at Walgreens and other organizations set me up for the position I took at IBM. I was an Associate Partner at Watson Health at a very exciting time when AI and machine learning were starting to be introduced into healthcare. In that role, I worked with artificial intelligence, blockchain, cloud technology and analytics to address the challenges providers and payers face navigating the value-based care environment.
The third chapter of my career, focused on healthcare experience, started at J.D. Power, which most people know for their consumer ratings systems. I joined to help launch a new offering focused on delivering healthcare consumer intelligence. We took enormous amounts of consumer data and used it to rank satisfaction at payors and providers nationwide.
As the industry moves more into the value-based reimbursement world where improving cost, quality and experience are the major goals, my experiences have put me in a great position to understand how they all intersect.
SD: What brought you to Socially Determined?
JB: I’ve been working with social determinants of health data for nearly five years, largely under AI machine learning and risk prediction projects. When I began to really understand the influence of social factors, I started looking for solutions to address them. That’s how I came across Socially Determined and was absolutely fascinated by the company’s ability to generate individual risk scores.
There’s an overwhelming consensus in healthcare that social factors are a primary driver of cost and outcomes. But when it comes to understanding the actual social conditions that a member of a health plan or patient of a health system faces at an individual level, there’s a very weak signal.
Socially Determined is a game changer because it can give organizations the ability to look at a health insurance member or healthcare patient beyond just their clinical or healthcare morbidity. This is crucial for payors and providers to understand if they want to confidently take action to influence better outcomes by removing social barriers.
The problem is, if you can't understand the signal because you don't have data to understand who a health insurance member is, or how they look from a social risk perspective, you have trouble marshalling resources to the right people, at the right time, to produce the right intervention.
Under value-based care rules, healthcare is heading towards a place where payors and providers are reimbursed on clinical events that have not yet occurred because an intervention inhibited that event. That’s what makes Socially Determined so compelling. For larger incumbents in the market that hold responsibility for the total cost of care, Socially Determined can bring a unique level of intelligence that helps identify specific needs of people and communities to design interventions to address them.
SD: A large part of your role at Socially Determined will be focused on growing government accounts. Where do you think the biggest opportunities exist for applying social risk analytics in the public sector?
JB: From an actuarial perspective, when you look at morbidity or healthcare risk nationwide, the plurality of the risk sits in government programs including Medicaid, managed Medicaid, Medicare Advantage and traditional Medicare.
The way forward for any provider or health insurance plan interested in mitigating or inhibiting risk is to focus on the bell curve. The highest point in the bell curve is where the highest risk is, and in this case, it's in the government programs.
We have the opportunity to support the government programs that are being more aggressive, ambitious and innovative around social determinants of health and health equity to get resources to the people with the highest risk.
When you look at something like Medicare Advantage, there’s a higher risk being enrolled in MA products now than traditional Medicare. MA recently surpassed 50% market penetration and there are now 10,000 Americans turning 65 every day, with half of them choosing MA plans.
While MA is a government sponsored health insurance product, it’s sold and distributed at the individual level by private health insurance plans. And now, these plans are onboarding much higher risk than they did ten years ago.
From that perspective, Socially Determined has a crucial seat at the table to help them find risk that they traditionally haven’t had insight into. We can fill a lot of gaps in their understanding of who the new Medicare Advantage members are, and what risk sits at the community and individual level.
SD: You’ll also be leading efforts to develop and strengthen relationships with channel partners. What are you looking for to build a mutually beneficial relationship?
JB: We're forging these partnerships with health IT related organizations that want to bring more value to their offerings by going deeper into the social determinants of health realm.
We're focused on tech enabled healthcare partnerships where payors and providers are relying on third-party analytic companies to support their measurement of quality, cost and healthcare improvement.
Through these partners, who already have deep, working relationships with payors, providers and government organizations, we'll be able to help the markets understand where the risk is, and what social barriers exist for patients and members.
We can add tremendous value to any solution in the market that is looking to produce favorable health and business outcomes because we can enrich their offering with a deeper level of data at the individual level. We can give them a wider view of who the population is, and whether the intervention they're producing is going to be impactful. if there are social determinants of health barriers to accessing tailored benefits and solutions, we can help identify and eliminate those barriers.
Over time, we'll be more instrumental in adding value to other organization’s analytic platforms. For instance, if you think of a value-based care platform, and if the thesis is that greater than 60% of the influence of a risk score is due to social determinants of health, having social risk data to help drive decisions is a critical component.
Today we’re already working with a number of analytic partners, including several AI machine learning parties that are interested in leveraging our data for things like risk prediction. We’ll continue the path that we’re on, focusing exclusively on social risk data and investing resources to go deeper into these domains so we can enhance our offering and in turn, help partners enhance theirs.
SD: On a personal level, tell us a little bit about yourself and your passions outside of work.
JB: I grew up in the City of Chicago, and now I live in Nashville, with my wife and two children. Outside of my family and my work, which are my two biggest priorities, I enjoy outdoor activities and travel. I try to focus my spare time on great experiences, which could be hiking and camping around Nashville, or travelling across Europe.