|
Getting your Trinity Audio player ready...
|
Of all the experiences in the impressive career of Prominence Health Plan’s Chief Compliance Officer Philip Ramirez, the one he sees as the most impactful might be a strange one. It was a layoff, and a particularly hard one at that.
Early in his career, Ramirez and several others had helped found a start-up company, but with the departure of the CEO, a new leader came in and abruptly parted with most of the people who had helped get the business to where it was. “It was really a shock to my system and a huge challenge I had never experienced in my life,” Ramirez remembers. “If you work long enough, you find that we’re all going to be on the other side of a layoff one time or another.”
It wasn’t the layoff that defined Ramirez’s future, but what came next. Rather than limiting his job search to his hometown of San Antonio, Texas, Ramirez and his wife opened their search to just about anywhere in the US. After one interview, Ramirez fell in love with the Sierra Nevada Mountains and the Reno–Lake Tahoe area that he calls home today.
“I took that job and the rest was history,” Ramirez says. “Both my wife and I have had the opportunity to excel here—so much more than we ever imagined.”
Ramirez has been at Prominence Health Plan for the past three years, and the CCO brings a deep and enduring passion for compliance and operational excellence to his role. It was a journey that began in graduate school. “I really consider myself drawn to ethics and compliance theory and finding the best way to do the right thing,” Ramirez says. “This approach really would guide the rest of my career.”
Integrating compliance into the broader company culture, the CCO says, creates a halo effect that grounds an organization not just in regulatory compliance but in the service and care of Prominence’s patients. That foundation has proven especially beneficial in serving the members of the insurance plan that are most in need.
Prominence’s Medicare Advantage plans are tailored to Medicare-eligible beneficiaries who prefer the delivery of their medical benefits by a local health plan rather than by the government.
“We’re able to provide an insurance product to people that is richer than any benefit they can obtain from the state or federal government,” Ramirez explains. “We’re able to offer this by leveraging the partnership and reputation of our parent company—Universal Health Services, a Fortune 300 hospital management company—and by putting our local resources and clinical expertise to work to exceed our patients’ care needs.”
While Prominence Health Plan is headquartered in Nevada, according to the CCO, its Medicare Advantage plans are particularly impactful in the company’s key markets in two of the most underserved areas in the nation: South Texas, along the US/Mexico border, and South Florida. Members can access an interdisciplinary team of healthcare professionals, including primary care physicians, specialty providers, behavioral health and mental health care, case managers, and social workers. They also enjoy a comprehensive suite of supplemental benefits, including dental, vision, hearing, meal delivery, transportation, health and wellness, and over-the-counter drugs.
“We have found that one’s health is inextricably linked not only to traditional medical and prescription drug benefits but other products and services that address the psychosocial aspects of health,” Ramirez says, “such as transportation to doctors’ appointments, to the grocery store to obtain healthy nutrition, and to the pharmacy to help the patient comply with medication regimens.”
“Someone has to step up to the plate and say, ‘I’m going to make a difference, and this is how I’m going to do it.’”
From a regulatory compliance perspective, the last year has brought on several developments in the insurance world. Two key pieces of legislation passed in the waning days of the Trump administration, the No Surprises Act and the Transparency in Coverage rule, were both written in the right spirit, Ramirez says. However, as the saying goes, “no good deed goes unpunished.” While these regulations aimed to create a more informed healthcare consumer and help providers and insurers unveil the cost formula for different medical services, they’ve also created an operational challenge for the healthcare delivery system, which must retrofit systems and process to comply with these new regulations.
“These are probably the most significant changes that the health insurance industry has seen since the Affordable Care Act, and while it may seem incredibly disruptive to day-to-day operations,” the CCO explains, “at the end of the day, it’s the right thing to do for healthcare consumers.”
Along with a passion for compliance and service, Ramirez is an ardent participant in mentorship activities to serve his community. In partnership with Prominence’s parent company, UHS, Ramirez was selected to mentor a director for one of Prominence’s markets in North Texas. The week of speaking, the CCO was preparing for another meeting with his mentee that would include coaching, discussion, and collaboration.
“Mentors have been a big part of my own success,” Ramirez says. “I’m just happy to be able to pass along some of the things I’ve learned along the way.”
But there is another beneficiary of Ramirez’s time, talent, and experience. As part of the Big Brothers Big Sisters program, Ramirez has acted as a mentor and friend for his pal Jose for the last four years. Ramirez has shared his love of the outdoors, fishing, cooking, and camping when watching a ball game or heading to the arcade.
“I just believe in reaching back to those who might need a hand,” Ramirez says. “That’s the mark of a true leader. Someone has to step up to the plate and say, ‘I’m going to make a difference, and this is how I’m going to do it.’ And that investment in one’s brother or sister is really what it’s all about.”
