The Exec: How Don Antonucci Scales Multi-State Health Plan Operations

"For us, the approach is change management through growth as we continue to expand into new markets," says the Providence Health Plan President and CEO.

“We’re changing our entire operating model to serve members in new geographies and markets.”

The “we” is Providence Health Plan (PHP) and its President and CEO Don Antonucci. Since joining PHP in 2021, Antonucci has helped PHP expand enrollment to more than 600,000 members. How? Through multi-state operational transformation, change management, and a commitment to volunteerism that pervades the organization and its health equity efforts.

That’s not easy in a complex organization.

PHP offers medical insurance plans in Oregon, Washington and California. In Oregon, PHP also operates Medicaid and Dual Eligible Special Needs (D-SNP) plans for those who qualify. PHP is part of Providence, a faith-based, not-for-profit network of hospitals, health plans, physicians, clinics, home health, and affiliated services operating across seven states: Oregon, Washington, California, Alaska, Montana, New Mexico, and Texas. 

HealthLeaders: How do you define value-based care, given that Providence is a payvider organization?

Providence Health Plan President and CEO Don Antonucci: My working definition of value-based care is coordinated, high-quality care that is affordable and accessible — ensuring that all incentives are aligned for providers, patients, members, and the health plan. The goal is optimal health for individuals with necessary services delivered when needed.

But value-based care alone is also not a silver bullet.

HealthLeaders: It’s surprising to hear someone in the industry say that. Can you elaborate?

Antonucci: Party, it’s because value-based care has gotten a bad rap. The word “value” equates to cheap for some, and people inside industry have different definitions.

There are other issues, too: provider burnout, the continued impact of COVID, the administrative aspects of care. We have a unique advantage as a payvider organization. We can deliver integrated care more efficiently, including preventive services which work better when they are integrated versus disconnected. Having strong local roots helps, too — the ability to see the local market from an enhanced perspective.

HealthLeaders: Speaking of local, Providence Health & Services now operates in seven states and the health plan in two. What is the organization’s approach to growth and how are you achieving it?

Antonucci: For us, the approach is change management through growth as we continue to expand into new markets within the larger Providence footprint. For 39 years, PHP operated primarily in Oregon, but we’re now changing our entire operating model to serve members in new geographies and markets.

HealthLeaders: What are some examples of those operational changes?

Antonucci: The two major areas are technology and operations to enable new market scaling. This involves reassessing our claims systems, call centers, and understanding the regulatory environment. Our Ops focus involves having the right people in the right geographies.

Note: Beginning January 2024, Providence Health Plan has also eliminated referrals for in-network specialists. This change applies to all PHP Medicare Advantage plans in Oregon and Washington and all of its Marketplace plans.

HealthLeaders: How does that change as you scale?

Antonucci: We have to administer in a way that’s cost effective. We start with some level of presence and people, but that level is not the same as it will be three to five years down the road.

HealthLeaders: That goes back to the change management you mentioned. How do you define that?

Antonucci: Change management involves the 3Cs and the 3Ps: Care, Curiosity, and Communication plus Patience, Pacing, and Perspective.

Strategy is a constant work in progress. You can’t move too fast, too slow, or put too much on your plate at once. We manage this through weekly meetings of our executive team — assessing our governance processes and tracking ROI, but not just financial.

HealthLeaders: What is one of Providence Health Plan’s biggest strategic priorities and what has changed pre-pandemic versus post?

Antonucci: Health equity. We are taking big steps in this space and it’s a huge area of focus for us.

One of the key differences is a new executive role position that we’ve put in place. In June, we brought on board our first ever Providence Health Plan Chief Equity Officer, Timshel Tarbet. We wanted to have someone who focused on equity 100% at the health plan level. Getting the right information on your population and knowing where the real gaps are with health equity in the markets that we serve — Timshel is going to be able to find very specific, impactful strategies for us as a health plan. I'm just so excited about that.

This also fits with Providence as a larger delivery system organization. I’m proud to say that Providence noticed two years ago a need to do better on health equity outcomes and announced a five-year $50 million grant to fund very specific pilots and initiatives to improve health equity.

A related focus is our volunteerism.

HealthLeaders: That seems like a unique focus. How does volunteerism have a presence at Providence?

Antonucci: Volunteerism influences things like who we partner with. I'm a big volunteer including with some local groups for the American Heart Association. Heart health is really important for all but the AHA also has a huge focus on health equity. Picking organizations that really fit with that theme and focus has been important for us.

Another example is our Health for All campaign, an initiative that brings whole-person, compassionate, and equitable care to the populations we serve. We partner with community-based organizations that deliver non-traditional healthcare services like housing and food. We launched Health for All at the June AHIP conference in Portland. Our booth focused on the campaign and our volunteer efforts. We packed lunches for organizations and made significant donations there.

It was just such an amazing draw at the conference. People were coming up to us from everywhere and saying, ‘We have absolutely have never seen anything like this. It’s not focused on you. It’s focused on the community, the local organizations that you're involved.”

It was amazing, just really cool.

Note: At AHIP, Providence Health Plan made a surprise donation of $390,000 to three new community partners: Oregon Food Bank, North by Northeast Community Health Center, and Central City Concern. In addition, PHP caregivers pledged 1,000 community service hours to Oregon Food Bank. Learn more here.