Welcome everyone to the Becker's Healthcare podcast series.
I'm Mariah Muhammad, writer and moderator with Becker's
Healthcare. And I'm thrilled to have with me
today, Brian Jansen, chief information officer for Medicare
at WPS
Health Insurance.
Ryan, welcome to the podcast. We're very excited
to have you join us today. To get
us started, would you mind please introducing yourself
and telling us a bit about your background?
Sure. Thank you very much for having me
today. I really enjoy the Becker's,
daily updates and these podcasts.
So my name is Brian Jansen, as you
mentioned, and I've been with just the health
insurance industry for the last twenty years, you
know, starting with EMR implementations
at hospitals and clinics with Epic systems
before going from the provider side to the
the payer side,
working both at a regional HMO
here in Southern Wisconsin
before moving to a PPO commercial
product,
spending time with technology
and operations here at Wisconsin's Physicians Insurance,
and now CIO of our Medicare
division,
currently overseeing six states across two,
CMS contracts, a
little over a hundred million claims a year
for 7,000,000
beneficiaries.
Wonderful. Thank you so much for giving us
that information.
So what are some of the biggest issues
you're following in health care,
whether on the provider side, insurance side, for
for 2025?
Yeah. I think 2025
is gonna be an exciting year.
When it comes to just the pace of
change, I don't know who whether your payer
or provider right now isn't really focused on
government policy
with a new administration,
better understanding
where
the entire market's gonna go when it comes
to Medicare Advantage,
reimbursement
rates.
Clearly, DOGE is now going to get more
involved with fraud, waste, and abuse as well
as likely some operational,
items at the government level.
I I think
government policy
is really gonna dictate where the industry is
going in the next few years, especially under
new CMS leadership,
and will really help guide both commercial
providers,
commercial payers,
and government entities readjust their their own strategies.
It's in addition to
government policy.
I think in the last two years,
we've had
speed
of technology
development
and implementation
that I think the entire industry
right now is really focusing on how to
best leverage,
you know, whether it's
changes in how we're able to use data
to better understand our customers,
or I I don't even think we can
answer
or have a response that doesn't include some
sort of mention of AI these days.
And
how is
AI within health care gonna be
used and used responsibly
in order to get better patient outcomes
and reduce our overall
cost
structure in
in the nation.
And we've got such a heart such a
large percentage of our GDP
focused on health care, and, hopefully, changes in
technology
can start to
bring health care outcomes
more in alignment with our overall expenditures.
So I think 2025
is gonna be pivotal
when it comes to
both government policy setting a direction
And how are some of these new technologies
going to help everyone achieve positive
outcomes,
for both our providers
and our patients?
Yeah. Definitely. Thank you so much for giving
us that that insight into kinda what you're
thinking about for this year. Is there anything
that's making you
the most excited or a little bit nervous,
and pertaining to,
the trends of 2025,
the news of 2025,
anything you're specifically doing at your organization?
Yeah. I would say
the things that make me excited
always have a flip side of the coin
and also make us nervous.
You know, one of the things when we
talk about the changing pace of technology,
I think 2025
in some respects,
our technological
capabilities have also,
in some ways, out paced
our ability to implement
policy
and
safeguards in the health care sector.
So I think
not only am I excited about our new
capabilities,
I'm a little bit nervous about
our ability as an industry
to
understand and stay stay ahead of those changes.
It's certainly gonna reshape organizational
budgets.
How do we
view insourcing versus outsourcing?
It's gonna dynamically change how we're able to
interact with our customers.
And the question is gonna be, are we
using it
in a responsible
way for positive outcomes,
or are we gonna kinda get behind
behind the eight ball on this?
That's a conscious effort, I think, at most
organizations,
ours included.
Another thing that makes me excited this year,
really
coming off of 2024,
I think we've got a an opportunity
really to focus more on health care literacy.
I think some of the tragic events of
2024
really showed us
areas that we can better educate
our customers,
better educate
the population
on
who are the actors, who are the responsible
parties
when it comes to the administration of health
care
from your providers to your PBMs
to
your your payers.
I think there's a real opportunity
that we can all come together in the
industry to help
educate
and
inform,
ultimately, the consumers of of health care. I
think I'm a little nervous if we don't
take this opportunity
to really advance the industry and help inform
our our consumers.
I think probably the last thing that really
makes me nervous
is I think the fragility of the health
care environment has really kinda started to pop
up more and more in 2024.
We're starting to understand
impacts if, say, a clearinghouse goes down
or we have issues at a PBM.
When
the health care sector becomes more and more
concentrated
with fewer players,
I think we need to better understand
how that can impact the stability of of
the health care system as a whole. I
know it's something that
we're certainly
taking into consideration over the next year and
just to better understand where
where some of those, like, opportunities
or fail safes exist.
Yeah. That completely makes a lot of sense.
I definitely agree with you on a lot
of things that you said.
In your your opinion and, you know, you
touched a little bit on this about, having
the responsibility,
to kinda teach others, but what would the
most effective health care leaders need in order
to be successful in the next two to
three years do you think?
Yeah. I think this is gonna be a
challenging time for health care leaders.
When we have such rapid
changes in a sector,
you know,
the ability to really
pivot on strategic plans
is going to be
necessary for any health care leader. I remember
years ago, we used to talk about three
year and five year plans.
I I I think most organizations
have certainly
shrunk those time frames
just given the rapid pace of health care
change, and successful leaders are gonna have to
really have a plan a and a plan
b
with strategic goals and outcomes
based on changes that could
really happen with
federal,
policy changes,
when it comes to
reimbursement rates, when it comes to
technological changes that
really shift
where work happens.
You know, the ability to
understand
where a market is going
and
pivot accordingly
to
really leverage that and turn headwinds into tailwinds,
I think is gonna be critical for health
care leaders,
both
from the financial
aspects of their organizations
as well as
the health outcomes of
patients or or plan members.
You know, I I look at those two
things as
not mutually exclusive.
I think that's gonna be
key and better understanding
what the customers are looking for and how
you can profitably
deliver great customer expectations,
experience,
and positive health outcomes.
Yeah. Yeah. Definitely. Thank you so much for
those final thoughts. It's definitely been,
a formative discussion. So, again, I wanna thank
you so much for coming on at Becker's
Healthcare,
especially for the first time.
And I look forward to connecting with you
again soon.
Yeah. Thank you very much for the opportunity.
It was great speaking with you. You as
well.