GuideWell CEO Pat Geraghty is optimistic that Congress will extend the enhanced exchange subsidies past 2025 despite Republicans' historic antagonism toward the Affordable Care Act.
The subsidies helped drive exchange enrollment to a record of 24.3 million this year. Over the past five years, marketplace sign-ups grew fastest in states President Donald Trump won in the 2024 election, up 157% compared with 113% nationwide, according to a recent analysis by KFF, a health policy research firm.
Related: Florida Blue, GuideWell CEO Pat Geraghty to retire
“Republicans are looking at that, understanding that their base really cares about this issue and that it would have an impact in those states,” Geraghty said.
Working to preserve the increased tax credits is one of the final priorities for Geraghty, who will retire from the Florida Blue parent company at the end of the year. Geraghty has led nonprofit, customer-owned GuideWell since 2011. The company is also the parent of insurer Triple-S Management, a chain of retail clinics, a home health arm and an administrative services business. It counts 38 million members nationwide.
This interview has been edited for length and clarity.
Do you think Congress will extend the enhanced premium tax credits for exchange plans past this year?
I’m talking to everybody that can make a difference in the decision process.
In February, Tony Fabrizio, a Republican pollster, conducted a survey on the issue and found that there is about an 80% support rate. It's really in all areas. Republicans, Democrats and independents are in favor of continuing the tax credits.
We have been part of a coalition to make sure people are well aware of the impact. We believe it is in everyone's best interest to keep as many people covered as possible. Many hospitals, doctors, health plans, they're all trying to make sure that we make a fully informed decision.
It would be a dramatic change, depending on where you're situated from an income perspective, to have the enhanced tax credits go away. About 300,000 of our more than 1 million Florida Blue customers would be impacted if they expire.
Ideally, we would know before we have to get our rates submitted for 2026 in June whether the credits will be extended, but that's not likely to happen on the legislative timeline. In Florida, we're going to submit one rate, but have the opportunity to make some adjustments in the fall.
We would want to have an answer about the extension by September before we release our marketing materials so there isn't any confusion in the marketplace.
How do you educate consumers about the value of prior authorization?
There’s been a lot of noise around this topic recently.
We don't want to come out and say, "let me just explain prior auth to you." What we're trying to do is say, "We know we can be better. We can use technology to help us be better. We can make the process quicker and smoother, and we're going to do that and we're committing to that."
We also want to be clear about the rest of the issues around prior auth. There is some clarification and explaining that is appropriate, but it's not the lead thing. The lead thing is making sure we're taking the hassle out of the process.
How are you using technology to improve the process?
We use AI to say yes, not deny, and that allows us to get a very quick answer to the provider. We had 2.4 million authorizations last year that were done in just seconds. About 80% of our prior authorizations are on an automated basis.
But the more complex the issue is, the more it really does involve the oversight of a clinician who understands the area that is being reviewed. You wouldn't want to give up those kinds of dialogues. Oftentimes the discussions may end up with a modified treatment plan that’s best for all involved. It also is one of the ways we have a check on fraud, waste and abuse.
The thing we find that drives the highest volume for denials is when a service is not covered by the health plan.
Last year, Guidewell launched an in-house ChatGPT tool for employees. How did that come about?
We looked at, "What are the things that people would be concerned about?" Some of the top issues are privacy, cybersecurity and hallucinations, which is when you get bad information from the technology. How do we control for these?
We bought our own graphics processing units, or infrastructure, to create our own ChatGPT model called GuideWell Chat. We're not in an open model where we're dealing with a lot of information that we don't control. We use our own databases. We have large language models. We obviously have lots of data in our organization and we spent three years scrubbing that data.
One of the interesting side effects is we don't have a lot of user fees because this is our own model, so we have everybody engaged in it. If you work at Florida Blue, you're on GuideWell Chat.
How does the company use GuideWell Chat?
In our medical practices, we have real-time conversation translations because we have AI in place. We can translate text to voice and voice to text across many different languages. Many languages are used in Florida, so it makes our medical team more responsive.
It's also very effective for our customer service representatives. We can easily look into a benefit concern for a member. AI will bring that to the fingertips of a customer service rep much quicker than trying to navigate through it and find those answers yourself.
How does President Donald Trump’s DEI executive order impact Florida Blue?
We're trying to make sure we fully understand what's in the executive order. Executive orders are indications of intent. In many cases, we're still waiting for the detailed descriptions behind the order.
When we talk about what we're doing, we discuss how we need to be able to reflect the people we serve and their cultural backgrounds. We need to understand all of that and be able to be responsive.
The data will tell us where we have care gaps, and then we have to close those gaps wherever they exist.
