← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Brad Riley, Vice President, Analytics and Reporting, Longevity Health
00:10:56
Loading summary
Transcript15 lines
- [00:00]
A
Evernorth brings the power of wonder and relentless innovation to create world class pharmacy care and benefits solutions. Barriers to care can lead to gaps in care which can drive up the total cost of care. Our capabilities work seamlessly together to create innovative pharmacy care and benefit solutions for today and tomorrow. Our connected health services make the treatment, prediction and prevention of healthcare's most complex conditions easier and more accessible as we drive organizations and people forward.
- [00:29]
B
This is Hayley Rutger with the Beckers Payer Podcast and today we are recording live at the Becker's third annual Spring Payer Issues Roundtable. I am thrilled today to be joined by Brad Riley, Vice President of analytics and reporting at Longevity Health. Brad, thank you so much for joining me today.
- [00:44]
C
Hey, happy to be here.
- [00:46]
B
So before we get started, can I just have you go ahead and introduce yourself and a little bit about your background?
- [00:50]
C
Sure, absolutely. So I appreciate the opportunity to be here. I think this is the second time doing it. So happy, happy to be here and to take part. So, like Haley said, I'm Brad Riley. I'm the VP of analytics and reporting at Longevity Health Plan. Longevity is the fastest growing national ISNP plan. So we're a clinical services organization and an ICE SNP plan. We just crossed a 10,000 member threshold this year, so we're really excited about that. And we currently partner with over 300 SNFs in roughly 13 different markets and we're hoping to expand that a little this year. So, excited to be here. Excited to talk about tech, AI and ways that, you know, from my perspective, I'm getting to see that impact the industry and Longevity Health.
- [01:38]
B
Well, that's awesome. Thank you so much for sharing. Now, to begin our conversation today, I want to talk about balancing affordability and quality. So how is your organization innovating to manage cost of care while maintaining or improving member outcomes?
- [01:52]
C
That's a good question. I mean, especially with the rates the way they are now and everything else. You know, 25 is a tough year. 26 is ramping up to be a look a little better. But with the Medicaid stuff coming in, you know, nobody's ever quite sure how that's going to look. It's, it's, you know, changes month by month. So I think a couple things. One, obviously at the forefront of everything else right now is, is both quality based care agreements and quality based payment agreements. I think that's absolutely where the industry is going. That's how Longevity is structured and how we partner with our partners. I think the other piece obviously is leveraging technology Specifically the buzzwords AI, especially this pass at Becker's, but everywhere else too. And I think understanding how to do that is important. With Longevity Health, we treat our members in the facilities and so we only partner, our members are only in skilled nursing facilities. And so we have nurse practitioners and registered nurses and LPNs that dependent upon the market, will go in and they have a specific facility with a specific panel. And we found that that really impacts avoidable admissions readmissions. It lifts the resident's experience so they're not constantly going back and forth. And so from a model perspective, that absolutely avoids inpatient costs. But at the same time, from an administrative perspective, corporate perspective, understanding how we could leverage different technology tools like AI to do things, I think it's definitely a little early still on the clinical end of using AI. There's a lot of proof of concepts out there that are really cool. But having the ability to kind of leverage different tools, whether it's machine learning tools to better stratify your population or to augment or identify broad waste and abuse, anything like that that we could use to kind of optimize the existing workflows that aren't particularly clinical in nature, I think is a low hanging fruit. And then I think also just administrative tasking, equipping employees with the proper tools that are available in today's market to help them be more efficient. And frankly, you know, everyone's tired of hearing this, but do more with less. I think give them a really cool tool, let them, let them use these tools to help them optimize their work. You still have a person involved there. So we're not talking pure agentics at this point. Right. But you have human level oversight with a tool that can help them improve their day to day tasking and keep them more efficient.
- [04:35]
B
Absolutely. Well, I'd like to keep that conversation going about that quality of care. So what best practices or tools does your organization rely on to keep quality of care at the forefront?
- [04:46]
C
So I mean, a couple things, I think one quality of care is there's a couple different angles, right? You've got like the Hedis angle, but you also have the actual quality of the care. I already touched on the quality based agreements. I think that's vital, Right. Moving away from fee for service and incentivizing people purely based off of the quality of care that they're delivering to patients, I think is key. That's with PCP groups, that's with skilled nursing facilities, you know, everything across the board. I think at the same time, understanding broader provider behavior is important. Right. So when we look at and we leverage machine learning or predictive analytics to create these more network driven oversight tools that allow you to see, you know, of your inpatient stays, which inpatient stay is really, you know, what's the readmission rate based off of different inpatient providers? What, what type of costs are we seeing coming from them? Is, is it qualitative in nature? And I think there's a lot of opportunity there in optimizing network understanding. And this is across the industry, right. Not just at longevity Health, but understanding what providers are delivering quality care versus just delivering care. And I think when you optimize your network to focus specifically on the quality care, I think that's a big, big next step because you can only control what you can control. And if you're not being proactive in that space and identifying your network and trying to encourage proactivity amongst the providers that are, that are delivering that, that high quality, whatever, KPI is going to reflect that. I think that's probably, that's key.
- [06:34]
B
Absolutely. We've talked about the imperative to reduce costs, improve quality and advance health equity. None of which are small tasks. How do you approach aligning these priorities in your organization's strategic vision?
- [06:47]
C
So I think the theme of the day is going to be, you know, technology and tools. And I think the biggest thing one is allowing the use of technology. I think over the last three years generative AI has blown up, but artificial intelligence is the big buzzword, but it's really existed since the 1950s. So you have machine learning, predictive analytics, different types of things like that. And I think making sure that we are implementing efficiencies and by leveraging technology, but at the same time not reducing the quality and governance of oversight, we have to make sure that we're remaining compliant and to make sure that we're doing it the right way within, you know, CMS standards and whatever other types of standard standards that we operate within. I think that's key. Right. So driving forward with technology while ensuring that there's governance and oversight and I think that that also includes ethical oversight as well. I think some of these really cool models that are coming out with are being shown and found to have some maybe non ethical steps and bias that inherently was inadvertently added to the model because of human data that was ingested and used to train it. Right. And I think so taking those resources that we're getting from creating efficiencies and implementing these type of tools and taking a portion of those to be more efficient and create cost savings, but also leveraging some of those savings, not just pocketing it all and investing a little bit more in the governance and the oversight into the types of tools that you're using is probably a more robust and long term strategy to make sure that, that through leveraging these new tools, we don't introduce new risk.
- [08:34]
B
Well, before we wrap up here, is there anything else that you'd like to share with our listeners today that we haven't already discussed?
- [08:40]
C
Yeah, I think my big thing and what I would encourage everybody listening, and especially leaders of teams and executives, is if your staff don't become literate with the new tools that are available to them, they're going to get behind and you'll get behind. And I think that that means it's important for us to find ways risk free while keeping risk and governance in mind of getting our staff familiar and used to and exposed to tools, not just in their personal lives. Right. I think everyone's like, oh, I've got chat GPT on my phone or I've got this and you know, when I, when I press Google, Gemini pops up at the top. But at the end of the day, if people aren't thinking of how to use these tools in a professional manner, they're going to miss out. Right. We've got a lot of really smart people and something I believe in is, you know, I want to hire people smarter than me, right? That's, that's how you do, do well. And, and so empowering that staff to do that is something that I think is an opportunity. There's a lot of people that are engaged and excited to do it themselves, but at the same time there's people that might need a little bit of a push. And so one of the things I actually did for this, I realized on my team is that I had a lot of really good technical skills, but my staff had an opportunity to learn a little bit more. I like to say how the machine works, but the managed care, like what is managed care? What's a claim? How does the claim process? How does an authorization process? And so I actually created a customized large language model. It's just trained, it's a chat bot, right. But it's trained on stuff. You can actually, it's open source, so anybody can go and look at it and use it. You can go to app managed care, one on one AI but ask it anything about managed care. Right. Get people used to navigating like large language models, nlp and encourage your staff and empower your staff to operate at the top of what they're capable of doing. And I think that's going to take us a long way over the next few years as we continue to see technology go down the path.
- [10:40]
B
It's going absolutely well. Thank you so much for joining me today. Again, this is Haley Rutger with the Beckers Pair podcast, recording live at the Becker's third annual Spring Pear Issues Roundtable. Brad, thank you so much.
- [10:51]
C
Thank you.