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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy, care, and

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benefit solutions.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward.

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Hello. And welcome to the Becker's Payers Issues

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podcast recorded live at the Becker's

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I'm joined today by doctor Ayesha Raheem.

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Ayesha, can you take a moment to introduce

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yourself and tell us a little bit about

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your organization?

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Sure. Yeah. Thank you for having me today.

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Really appreciate.

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My name is Ayesha Rahim. I'm a medical

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director at Johns Hopkins health plan.

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I'm also a co lead at AI governance

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council at Johns Hopkins health plans. And,

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Johns Hopkins health plan serves, close to 350

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to 400 member

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lives in state of Maryland, Virginia, DC. We

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have portfolio of health plans, including Medicaid,

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Medicare,

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uniform services, family health plan, as well as

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employer health program.

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And so what we are trying to do

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is trying to

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build enterprise wide artificial intelligence strategy that can

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serve our members,

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our employees, and our organization as a whole.

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Balancing affordability and quality is a constant challenge

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for health plans. So how is your organization

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innovating to manage the cost of care while

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maintaining or improving member outcomes?

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That's a great question, actually. And

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as you know, all or most of the

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health plans are trying to balance that. I

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mean, affordability,

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has changed over a period of time, and

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a lot of health care has been less

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affordable.

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And so plans have to become more innovative

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in terms of how they can offer their

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services

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in a lesser cost, but at the same

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time offer a higher quality of care. And

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at any given point in time, we are

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trying to see where we can

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streamline our services.

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We can,

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focus on members

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that are just only high risk but at

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risk, but also we can make some impact

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in their lives. And so we use artificial

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intelligence. We use a lot of data analytics

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to identify those members so that we can,

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interact with them, impact them, and,

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make changes so that they we can improve

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their lives as well as their health

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and, so that we can,

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leverage technology

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to,

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to improve member outcome. And when we do

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that, we are using lesser resources to,

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produce more gain and improve the lives of

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our members. So there's a constant struggle, and

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a lot of times, you know, the health

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plans are on a receiving end. But at

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the same time, the struggle, we keep on

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doing that so that we know that at

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the end of the day, we are serving

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our members, and we're trying to do best

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for our members.

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And so you mentioned your organization has a

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very large, geographic footprint. Mhmm.

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So within that geographic footprint, there must be

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a lot of diversity

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and different demographics. So addressing health equity has

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become a critical focus for many health plans.

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Can you share an overview of a key

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initiative

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here that you're involved in, and you're particularly

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excited about? And what are you hoping to

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achieve?

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That's a great question. And,

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HealthEquity has been at the forefront of our

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health plan strategy for a long time. Johns

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Hopkins health system

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as well as Johns Hopkins,

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health plan has been focusing,

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on it,

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because we serve diverse population in state of

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Maryland with a very different demographics. And so

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some of our portfolio health plans are actually

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pursuing health equity accreditation,

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which means that we're gonna

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we are doing organization

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wide transformation

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and collecting data based on race, ethnicity, and

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then building up strategy to,

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improve the lives of our member based on

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that data.

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For example, we have a class program, which

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is a culturally linguistically

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appropriate services.

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And what we do is we when we

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collect the data, we analyze the data and

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find out if there any disparity,

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in terms of health outcome regarding particular disease

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process in one

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member demographic versus another. And when we find

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that demographic disparity, what we do is we

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institute programs, services, care management to address those

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disparities, and, hence,

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we sort of try to reduce or close

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the gaps in terms of the race.

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And then we have other,

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programs in terms of improving the language services

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that we offer. Mhmm. You know, improving the

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data gathering process,

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improving,

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network accessibility

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for our,

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our diverse population. And so, we are taking

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these actions and hoping to per, achieve health

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equity accreditation,

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at least by August or September

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2025.

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And with this big patient population,

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member satisfaction

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is really essential to thrive in today's hyper

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competitive health care market. What experience or engagement

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strategies have proven effective for your organization,

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and what are your KPIs? How are you

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measuring this?

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Right. Great question. So I think member satisfaction,

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is one of the key initiatives that we

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are taking on, especially

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in last year and this year as well.

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And that involves,

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you know, building a brand new member portal,

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also,

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leveraging artificial intelligence

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to,

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figure out which members are high risk of,

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the member turnout and so that we can

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proactively,

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reach out to them and figure out what's

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causing that

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friction and address that. Also, you know, when

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we meet members where they are, it it

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gives us the opportunity

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to

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to engage them in a way that,

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which is different from other health plans. For

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example, like, if the members are going to

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a certain clinic or a certain market, we

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would try to see if we can get

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our services rendered there as well so that

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we can get their members where they are.

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In terms of, like, using artificial intelligence, we

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have,

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we are looking into chatbots

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to proactively,

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remind our members that, you know, these are

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the health care services and screenings that are

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due. And, also, when they're trying to reach

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out to our plan to get information, we

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can use them, you use the chatbots to

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engage them. Mhmm. And and in terms of

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KPI, we are using cap scores. We are

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doing other metrics, measuring other metric

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metrics in terms of member satisfaction,

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that are standard across industries and trying to

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see how we can using artificial intelligence as

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well as,

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trying to see where members are and reach

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out to them because also sizable population of

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our members

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are are working within Hopkins as well. So

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we can also leverage our own provider,

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database and providers to engage them as well.

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So a lot of different tactics,

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it's a work in progress, and I can

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tell you it is one of the toughest

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ones. Especially at high risk members,

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I would say they are very difficult to

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engage. Mhmm. And that's where we are having

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some challenges in trying to figure out how

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what would be the right engagement strategy

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other than

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engaging their providers, engaging where they work or

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where they reside and play

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and, you know, the the artificial intelligence. A

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lot of these populations are not tech savvy

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too. So it also creates a digital divide,

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and we have to work on digital literacy

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and other areas.

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So So looking ahead, what do you see

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as the biggest opportunity for payers to really

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lead the charge in transforming health care delivery

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and driving better outcomes for all stakeholders?

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And what can leaders like yourself do to

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take a step in this direction right now?

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Right. I mean, that's a that's a very,

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loaded question, I would say. And I think

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we can do a lot, but at the

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same time, our hands are sort of tied

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because we are not directly,

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we we we are not providers so that

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we cannot,

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directly engage members 100% of the time.

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But I think we have a lot of

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areas that we can work on in order

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to achieve that. And one of the areas

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I think sort of untapped is that use

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of artificial intelligence in detection of social determinants

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of health. Mhmm. I think,

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that area is not really well

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studied and how we can use artificial intelligence

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to address care gaps in minoritized group. I

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think that's where I think we could possibly

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invest more and figure out what could be

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the resources that are already available and how

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you can use AI to link our members

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to those resources

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without heavily,

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utilizing internal resources so that we can it

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is more like an organic connection, and we

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don't have to invest a lot internally for

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that. So I think that's, SDOH

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detection as well as,

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mobilization and providing resources that are outside the

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organization to our members is one area we

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can work on.

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Member engagement is another area we can work

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on, and I think artificial intelligence has a

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lot of promise in terms of improving the

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quality as well as reducing the cost and

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making sure that we meet the business needs,

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with the use of artificial intelligence.

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But in order to be successful,

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and to successfully employ this technology, we need

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to have an enterprise wide strategy. We need

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to have data that backs up that technology,

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and we cannot just

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use one off vendors to address that. We

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have to have a more robust system within

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organization

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to drive that change and to make that

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ROI with the best use case.

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So,

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you know, you work very closely with AI.

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And I'm very curious. As someone who, you

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know, likely has their ear to the ground

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more than most,

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is there a particular

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use case for AI that maybe people aren't

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using yet that, you know, maybe two, four,

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five, ten years from now, there might be

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they might be using in a way to

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really

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transform things in a way that most people

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don't even see it. Is there anything, like,

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kinda up and coming that you're particularly excited

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about?

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I think a lot of use cases that

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we are using currently

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are up and around in the market for

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a while. Mhmm. And so in terms of

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artificial intelligence

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and use cases, I'm thinking out loud.

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We talked about our use of artificial intelligence

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and social determinants of health.

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I mean, I've I speak about artificial intelligence

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and

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process improvement.

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I think where artificial intelligence could be great

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is,

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within health plan is, like, if you have

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a helper like agentic AI Mhmm. Which does

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the task autonomously

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Mhmm. Which sort of, like,

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is is mirroring what you do. Like, for

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example, I'm,

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doctor Raheem. I'm logging into system. I'm I'm

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I have certain checklist that I have to

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do before I start my work. Agentic AI

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makes helps me do those tasks autonomously without

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my intervention so that I have more extra

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time to do other things. Mhmm. Same stands

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for other areas in the plan where,

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we can automate the repetitive

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tasks

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and free up that time to do meaningful

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work, I think that's where I would be

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more

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focused on because I feel like

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it's there, it's on our face, but we

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we are not utilizing that as much. Right.

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Right. And we are thinking about it, but

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we are not operationalizing on it. Right. Right.

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And,

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and,

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like, it it's it's within our organization, and

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we and it can be specific to

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different folks, like, let's say, medical directors, human

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work nurses, claim management,

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to quality improvement. There are people in the

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organization that are doing the same work over

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and on mundane task. And if we can

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somehow

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automate those tasks specific to their field Mhmm.

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The way they do it, it's like sort

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of creating a digital twin where you have

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a better version of me doing it faster

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Right. And,

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able to achieve things that I'm doing,

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but at the same time, leaving some time

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for me so that I can look into

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more Right. Definitely cognitively diverse tasks so that

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I can be more productive

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and more engaged. In fact, it is gonna

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improve engagement

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at workplace because if I'm not doing mundane

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task and repetitive task, I'm probably doing something

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more meaningful to me. Right. Right. And so

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that would be improve,

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my engagement in workplace and

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reduce the turnaround or attrition within the workplace.

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Because I feel like within a health plan,

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nurses and,

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the

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workflow has a lot of turnaround and a

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lot of attrition, and so that can be

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tackled using, you know, that technology as well

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as

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emphasizing and investing in those areas. Well, in

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a lot of those main mundane tasks that

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you're talking about automating are probably a lot

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of what leads to burns and stuff too.

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Right. Yeah. Just like I log in every

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day. I have to do check-in into my,

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you know, let's say, my clock in or

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whatever it is. I if I'm logged in,

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I'm probably clocking in. So that could be

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automatic step. Yep. Yep. I'm opening my email

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box. That should not be another click. We

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have to do so many clicks just to

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do the work that we do. Mhmm. And

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that could be made quite easy with the

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use of artificial intelligence and automation, I would

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say.

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Right. Well, doctor Raheem, I really appreciate your

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time today. I can tell you're passionate, and

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I can tell you're very innovative, and this

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is a lot of fun. So thank you

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so much for joining us today. I really

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appreciate it. Appreciate. Thank you for having me

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here and giving me an opportunity to talk

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about our right there at Johns Hopkins Health

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Plans. It's our pleasure. You have a lovely

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rest of your day. Alright. Awesome.