1 00:00:00,160 --> 00:00:02,899 Evernorth brings the power of wonder and relentless 2 00:00:02,960 --> 00:00:05,919 innovation to create world class pharmacy care and 3 00:00:05,919 --> 00:00:09,199 benefit solutions. Our connected health services make the 4 00:00:09,199 --> 00:00:12,080 treatment, prediction, and prevention of health care's most 5 00:00:12,080 --> 00:00:13,059 complex conditions 6 00:00:13,605 --> 00:00:16,344 easier and more accessible as we drive organizations 7 00:00:16,725 --> 00:00:19,524 and people forward. Ever North Home Based Care 8 00:00:19,524 --> 00:00:22,004 provides value based care that helps patients with 9 00:00:22,004 --> 00:00:23,384 multiple chronic conditions 10 00:00:23,844 --> 00:00:26,085 and social determinant of health barriers get the 11 00:00:26,085 --> 00:00:28,884 care they need and the personalized experience they 12 00:00:28,884 --> 00:00:31,660 deserve. We serve patients who struggle to navigate 13 00:00:31,660 --> 00:00:34,060 the health care system by bringing high quality 14 00:00:34,060 --> 00:00:34,560 primary 15 00:00:34,939 --> 00:00:37,739 and preventative care services to the home. By 16 00:00:37,739 --> 00:00:40,619 providing clinical care and support services that provide 17 00:00:40,619 --> 00:00:44,105 whole person care, we improve health equity, access, 18 00:00:44,105 --> 00:00:46,605 and outcomes for the populations we serve. 19 00:00:47,465 --> 00:00:49,225 Hello, and welcome to the Becker's Health Care 20 00:00:49,225 --> 00:00:51,865 podcast. I'm joined today by Edward Jung, chief 21 00:00:51,865 --> 00:00:54,800 quality officer at Inland Empire Health Plan. Edward, 22 00:00:54,800 --> 00:00:56,800 can you take a brief moment to, tell 23 00:00:56,800 --> 00:00:58,079 us a little bit about your background and 24 00:00:58,079 --> 00:01:00,800 your organization? Sure. Happy to. Again, my name 25 00:01:00,800 --> 00:01:02,560 is Ed Jung. I serve as chief quality 26 00:01:02,560 --> 00:01:05,599 officer at Inland Empire Health Plan, often referred 27 00:01:05,599 --> 00:01:06,659 to as IHP. 28 00:01:07,305 --> 00:01:10,844 IHP is a large Medi Cal or Medicaid 29 00:01:11,145 --> 00:01:13,165 organization serving about 1,500,000 30 00:01:14,025 --> 00:01:14,525 members 31 00:01:14,825 --> 00:01:16,665 in the Inland Empire, which is made up 32 00:01:16,665 --> 00:01:19,545 of Riverside and San Bernardino counties. Just to 33 00:01:19,545 --> 00:01:20,685 give it a little context, 34 00:01:21,159 --> 00:01:23,159 the Inland Empire is very large. It's about 35 00:01:23,159 --> 00:01:23,659 27,000 36 00:01:24,040 --> 00:01:26,380 square miles, making us larger than 10 states. 37 00:01:26,920 --> 00:01:29,240 And so we work really hard to ensure 38 00:01:29,240 --> 00:01:31,560 that our members receive the highest quality of 39 00:01:31,560 --> 00:01:32,540 care in our region. 40 00:01:33,575 --> 00:01:36,454 So from improving member experience and expanding value 41 00:01:36,454 --> 00:01:38,875 based care, to controlling fair costs, 42 00:01:39,174 --> 00:01:41,495 care executives have ambitious growth goals for the 43 00:01:41,495 --> 00:01:43,255 rest of the year and next year. In 44 00:01:43,255 --> 00:01:44,694 your role, what would you say is your 45 00:01:44,694 --> 00:01:46,775 top priority, and, how are you planning on 46 00:01:46,775 --> 00:01:48,659 getting there? Well, I think for us, our 47 00:01:48,659 --> 00:01:51,939 top priority is focusing on quality outcomes for 48 00:01:51,939 --> 00:01:53,939 our members and ultimately doing the right thing 49 00:01:53,939 --> 00:01:56,500 to ensure that these members get those quality 50 00:01:56,500 --> 00:01:58,040 outcomes that they deserve. 51 00:01:58,739 --> 00:02:00,979 For us, whether it's in focusing on how 52 00:02:00,979 --> 00:02:02,280 to support our providers 53 00:02:02,834 --> 00:02:04,995 to better enable them to provide these high 54 00:02:04,995 --> 00:02:08,354 quality services or walking alongside our members to 55 00:02:08,354 --> 00:02:10,514 provide them their needs, I think that's something 56 00:02:10,514 --> 00:02:11,895 that our entire organization 57 00:02:12,275 --> 00:02:15,574 is rallying and focusing on. For example, internally 58 00:02:15,634 --> 00:02:18,080 within our organization, we have a quality starts 59 00:02:18,080 --> 00:02:18,979 with me campaign 60 00:02:19,280 --> 00:02:21,759 because we recognize that every interaction is an 61 00:02:21,759 --> 00:02:24,159 opportunity for us as a health plan to 62 00:02:24,159 --> 00:02:25,620 do what's right for our members. 63 00:02:26,719 --> 00:02:28,719 At an industry level, how would you describe 64 00:02:28,719 --> 00:02:31,280 the biggest barriers to effectively serving and engaging 65 00:02:31,280 --> 00:02:31,780 members? 66 00:02:32,205 --> 00:02:35,004 And, what opportunities are you currently seeing for 67 00:02:35,004 --> 00:02:37,405 large scale improvements, and how are you implying 68 00:02:37,405 --> 00:02:38,864 all this in your current strategies? 69 00:02:39,644 --> 00:02:40,384 Well, I think 70 00:02:40,685 --> 00:02:41,504 a barrier, 71 00:02:42,044 --> 00:02:45,264 for example, in our region is our low 72 00:02:45,599 --> 00:02:47,379 provider to patient's ratio. 73 00:02:49,680 --> 00:02:50,340 For us, 74 00:02:51,120 --> 00:02:51,939 our opportunity 75 00:02:52,240 --> 00:02:54,819 is to find ways to bring more providers 76 00:02:54,879 --> 00:02:56,879 into the region to care for the most 77 00:02:56,879 --> 00:02:57,379 vulnerable. 78 00:02:57,794 --> 00:02:59,814 So I think the provider to patient's, 79 00:03:00,594 --> 00:03:03,655 ratio is one thing. Definitely, that's an opportunity. 80 00:03:04,354 --> 00:03:06,675 We also recognize that access and access to 81 00:03:06,675 --> 00:03:08,775 care is an opportunity. I think that stems 82 00:03:08,834 --> 00:03:09,334 from, 83 00:03:09,634 --> 00:03:11,974 the opportunity for us to bring on more 84 00:03:12,219 --> 00:03:13,759 highly qualified providers 85 00:03:14,060 --> 00:03:15,120 into our region, 86 00:03:15,659 --> 00:03:16,879 to serve our members. 87 00:03:18,300 --> 00:03:20,159 Keeping up to, with today's 88 00:03:20,620 --> 00:03:22,879 dynamic health care landscape is challenging. 89 00:03:23,340 --> 00:03:24,939 You know, with your experience, what would you 90 00:03:24,939 --> 00:03:26,379 say are some of your top pieces of 91 00:03:26,379 --> 00:03:29,354 advice for other peer leaders, in in your 92 00:03:29,354 --> 00:03:31,594 in your industry right now? I think one 93 00:03:31,594 --> 00:03:33,775 of the things that we always have to, 94 00:03:34,715 --> 00:03:37,275 keep our minds focused on is the member. 95 00:03:37,275 --> 00:03:39,275 At the end of the day, there's a 96 00:03:39,275 --> 00:03:41,114 lot of data out there. There's a lot 97 00:03:41,114 --> 00:03:43,909 of analytics out there. But for us at 98 00:03:43,909 --> 00:03:44,409 IHP, 99 00:03:45,270 --> 00:03:48,790 these numbers represent people, families, and communities. And 100 00:03:48,790 --> 00:03:50,810 for us to always remember that 101 00:03:51,189 --> 00:03:53,770 the work that we do is a privilege. 102 00:03:53,909 --> 00:03:56,710 It's an honor in service to serving some 103 00:03:56,710 --> 00:03:58,250 of the most vulnerable people. 104 00:03:58,665 --> 00:04:00,504 And so for us to always keep that 105 00:04:00,504 --> 00:04:03,465 in mind and not be distracted by some 106 00:04:03,465 --> 00:04:05,064 of the other things that might come with 107 00:04:05,064 --> 00:04:06,365 that. Mhmm. Mhmm. 108 00:04:08,025 --> 00:04:09,085 In an ever evolving 109 00:04:09,465 --> 00:04:09,965 regulatory 110 00:04:10,264 --> 00:04:12,060 environment, you know, what are some of the 111 00:04:12,060 --> 00:04:14,319 tools and strategies that have helped your organization 112 00:04:14,540 --> 00:04:16,900 improve quality and clinical outcomes for members that 113 00:04:16,900 --> 00:04:19,439 are staying compliant with this regulatory change? 114 00:04:19,819 --> 00:04:21,259 Well, I think for us, it's, 115 00:04:21,899 --> 00:04:23,834 as I shared before, finding ways 116 00:04:24,394 --> 00:04:27,214 to walk alongside our providers to ensure that 117 00:04:27,274 --> 00:04:28,574 that they're meeting, 118 00:04:29,194 --> 00:04:31,055 some of the requirements that are 119 00:04:31,435 --> 00:04:35,115 asked from us as health plans, whether it's 120 00:04:35,115 --> 00:04:36,414 finding ways to support, 121 00:04:36,939 --> 00:04:40,060 their clinical practice, whether it's billing, coding, or 122 00:04:40,060 --> 00:04:41,040 workflow opportunities, 123 00:04:41,580 --> 00:04:43,660 whether it's finding ways to improve the way 124 00:04:43,660 --> 00:04:45,420 that we engage with our members and how 125 00:04:45,420 --> 00:04:46,639 they experience care, 126 00:04:47,100 --> 00:04:49,180 whether it's the way that we outreach to 127 00:04:49,180 --> 00:04:51,920 them, whether it's the support services we provide. 128 00:04:52,375 --> 00:04:55,975 I think, we really focus on all those 129 00:04:55,975 --> 00:04:57,595 pieces and everything in between. 130 00:04:57,975 --> 00:04:59,894 I also think it's important for us to, 131 00:05:00,854 --> 00:05:02,774 never lose the sight of the fact that 132 00:05:02,774 --> 00:05:05,735 we always have to evolve and get better 133 00:05:05,735 --> 00:05:07,514 and do better and be better 134 00:05:07,839 --> 00:05:10,000 for the people that we serve, whether it's 135 00:05:10,000 --> 00:05:10,500 leveraging 136 00:05:10,959 --> 00:05:12,180 new tools and technologies, 137 00:05:13,039 --> 00:05:16,639 such as AI, machine learning, whether it's finding 138 00:05:16,639 --> 00:05:19,139 ways to leverage things such as automation. 139 00:05:20,345 --> 00:05:22,264 I think just finding the right tools at 140 00:05:22,264 --> 00:05:24,264 the right place is really going to be 141 00:05:24,264 --> 00:05:26,584 important for us as an industry to move 142 00:05:26,584 --> 00:05:29,625 forward, again, to better serve the people that 143 00:05:29,625 --> 00:05:31,705 we have an opportunity to serve and deliver 144 00:05:31,705 --> 00:05:33,705 the high quality outcomes that we want for 145 00:05:33,705 --> 00:05:34,205 them. 146 00:05:34,519 --> 00:05:36,519 You talked about some of these emerging technologies 147 00:05:36,519 --> 00:05:37,339 such as AI. 148 00:05:37,959 --> 00:05:39,959 How are they playing a role in your 149 00:05:39,959 --> 00:05:42,439 organization's growth strategies? And can you elaborate a 150 00:05:42,439 --> 00:05:43,980 little more on maybe a couple examples? 151 00:05:44,439 --> 00:05:46,360 Sure. So one of the things that we 152 00:05:46,360 --> 00:05:48,220 actually did as an organization, 153 00:05:49,375 --> 00:05:50,995 over the past couple years 154 00:05:51,375 --> 00:05:53,875 was focused on how to be better stewards 155 00:05:54,014 --> 00:05:54,834 of our data. 156 00:05:55,454 --> 00:05:57,535 With all the big push for big data, 157 00:05:57,535 --> 00:06:01,214 predictive analytics, AI, machine learning, we recognize that 158 00:06:01,214 --> 00:06:04,710 there was an ethical stewardship of that piece. 159 00:06:05,009 --> 00:06:06,370 So one of the things that we've done 160 00:06:06,370 --> 00:06:07,430 is actually conducted 161 00:06:07,810 --> 00:06:09,509 algorithmic bias audits 162 00:06:10,210 --> 00:06:12,069 on our care management algorithms 163 00:06:12,689 --> 00:06:14,389 to ensure that the outputs 164 00:06:15,009 --> 00:06:16,230 were, being 165 00:06:17,754 --> 00:06:18,254 appropriately, 166 00:06:19,115 --> 00:06:20,254 assessed and evaluated 167 00:06:20,875 --> 00:06:23,455 to minimize and mitigate to the extent possible 168 00:06:23,595 --> 00:06:24,654 any biases 169 00:06:25,115 --> 00:06:27,694 and unintended biases that might have been generated 170 00:06:27,754 --> 00:06:30,810 by the algorithms themselves. It's a continual process 171 00:06:30,810 --> 00:06:33,209 that our teams are, working on, but I 172 00:06:33,209 --> 00:06:34,669 know that we were ahead, 173 00:06:35,209 --> 00:06:36,509 of starting that process, 174 00:06:37,050 --> 00:06:38,269 about a few years ago. 175 00:06:39,129 --> 00:06:41,209 Ed, I really appreciate all your insights today. 176 00:06:41,529 --> 00:06:42,810 But before I let you go, do you 177 00:06:42,810 --> 00:06:44,430 have any final thoughts for our audience? 178 00:06:45,125 --> 00:06:47,044 Again, I think for us, especially for us 179 00:06:47,044 --> 00:06:48,024 at IHP, 180 00:06:48,485 --> 00:06:50,164 you know, for us, our mission is to 181 00:06:50,164 --> 00:06:52,884 heal and inspire the human spirit, and our 182 00:06:52,884 --> 00:06:55,845 vision is to do the right thing for 183 00:06:55,845 --> 00:06:56,504 our members. 184 00:06:56,884 --> 00:06:58,425 And just to keep that 185 00:06:58,879 --> 00:07:00,720 at the forefront of everything that we do, 186 00:07:00,720 --> 00:07:02,560 I think, is gonna be critically important with 187 00:07:02,560 --> 00:07:04,639 everything that's going on. Because at the end 188 00:07:04,639 --> 00:07:06,479 of the day, it's about our members. It's 189 00:07:06,479 --> 00:07:08,399 about their health, and it's about their quality 190 00:07:08,399 --> 00:07:08,899 outcomes. 191 00:07:09,839 --> 00:07:11,919 Perfect. Thank you again for joining us today 192 00:07:11,919 --> 00:07:14,079 on the Beckers Healthcare Podcast. I really appreciate 193 00:07:14,079 --> 00:07:15,349 it. Thanks so much for having me. I 194 00:07:15,349 --> 00:07:16,549 think you have a lovely rest of your 195 00:07:16,549 --> 00:07:17,449 day. You too.