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Hello. And welcome to the Becker's Payers Issues
podcast recorded live at the Becker's
I'm joined today by doctor Ayesha Raheem.
Ayesha, can you take a moment to introduce
yourself and tell us a little bit about
your organization?
Sure. Yeah. Thank you for having me today.
Really appreciate.
My name is Ayesha Rahim. I'm a medical
director at Johns Hopkins health plan.
I'm also a co lead at AI governance
council at Johns Hopkins health plans. And,
Johns Hopkins health plan serves, close to 350
to 400 member
lives in state of Maryland, Virginia, DC. We
have portfolio of health plans, including Medicaid,
Medicare,
uniform services, family health plan, as well as
employer health program.
And so what we are trying to do
is trying to
build enterprise wide artificial intelligence strategy that can
serve our members,
our employees, and our organization as a whole.
Balancing affordability and quality is a constant challenge
for health plans. So how is your organization
innovating to manage the cost of care while
maintaining or improving member outcomes?
That's a great question, actually. And
as you know, all or most of the
health plans are trying to balance that. I
mean, affordability,
has changed over a period of time, and
a lot of health care has been less
affordable.
And so plans have to become more innovative
in terms of how they can offer their
services
in a lesser cost, but at the same
time offer a higher quality of care. And
at any given point in time, we are
trying to see where we can
streamline our services.
We can,
focus on members
that are just only high risk but at
risk, but also we can make some impact
in their lives. And so we use artificial
intelligence. We use a lot of data analytics
to identify those members so that we can,
interact with them, impact them, and,
make changes so that they we can improve
their lives as well as their health
and, so that we can,
leverage technology
to,
to improve member outcome. And when we do
that, we are using lesser resources to,
produce more gain and improve the lives of
our members. So there's a constant struggle, and
a lot of times, you know, the health
plans are on a receiving end. But at
the same time, the struggle, we keep on
doing that so that we know that at
the end of the day, we are serving
our members, and we're trying to do best
for our members.
And so you mentioned your organization has a
very large, geographic footprint. Mhmm.
So within that geographic footprint, there must be
a lot of diversity
and different demographics. So addressing health equity has
become a critical focus for many health plans.
Can you share an overview of a key
initiative
here that you're involved in, and you're particularly
excited about? And what are you hoping to
achieve?
That's a great question. And,
HealthEquity has been at the forefront of our
health plan strategy for a long time. Johns
Hopkins health system
as well as Johns Hopkins,
health plan has been focusing,
on it,
because we serve diverse population in state of
Maryland with a very different demographics. And so
some of our portfolio health plans are actually
pursuing health equity accreditation,
which means that we're gonna
we are doing organization
wide transformation
and collecting data based on race, ethnicity, and
then building up strategy to,
improve the lives of our member based on
that data.
For example, we have a class program, which
is a culturally linguistically
appropriate services.
And what we do is we when we
collect the data, we analyze the data and
find out if there any disparity,
in terms of health outcome regarding particular disease
process in one
member demographic versus another. And when we find
that demographic disparity, what we do is we
institute programs, services, care management to address those
disparities, and, hence,
we sort of try to reduce or close
the gaps in terms of the race.
And then we have other,
programs in terms of improving the language services
that we offer. Mhmm. You know, improving the
data gathering process,
improving,
network accessibility
for our,
our diverse population. And so, we are taking
these actions and hoping to per, achieve health
equity accreditation,
at least by August or September
2025.
And with this big patient population,
member satisfaction
is really essential to thrive in today's hyper
competitive health care market. What experience or engagement
strategies have proven effective for your organization,
and what are your KPIs? How are you
measuring this?
Right. Great question. So I think member satisfaction,
is one of the key initiatives that we
are taking on, especially
in last year and this year as well.
And that involves,
you know, building a brand new member portal,
also,
leveraging artificial intelligence
to,
figure out which members are high risk of,
the member turnout and so that we can
proactively,
reach out to them and figure out what's
causing that
friction and address that. Also, you know, when
we meet members where they are, it it
gives us the opportunity
to
to engage them in a way that,
which is different from other health plans. For
example, like, if the members are going to
a certain clinic or a certain market, we
would try to see if we can get
our services rendered there as well so that
we can get their members where they are.
In terms of, like, using artificial intelligence, we
have,
we are looking into chatbots
to proactively,
remind our members that, you know, these are
the health care services and screenings that are
due. And, also, when they're trying to reach
out to our plan to get information, we
can use them, you use the chatbots to
engage them. Mhmm. And and in terms of
KPI, we are using cap scores. We are
doing other metrics, measuring other metric
metrics in terms of member satisfaction,
that are standard across industries and trying to
see how we can using artificial intelligence as
well as,
trying to see where members are and reach
out to them because also sizable population of
our members
are are working within Hopkins as well. So
we can also leverage our own provider,
database and providers to engage them as well.
So a lot of different tactics,
it's a work in progress, and I can
tell you it is one of the toughest
ones. Especially at high risk members,
I would say they are very difficult to
engage. Mhmm. And that's where we are having
some challenges in trying to figure out how
what would be the right engagement strategy
other than
engaging their providers, engaging where they work or
where they reside and play
and, you know, the the artificial intelligence. A
lot of these populations are not tech savvy
too. So it also creates a digital divide,
and we have to work on digital literacy
and other areas.
So So looking ahead, what do you see
as the biggest opportunity for payers to really
lead the charge in transforming health care delivery
and driving better outcomes for all stakeholders?
And what can leaders like yourself do to
take a step in this direction right now?
Right. I mean, that's a that's a very,
loaded question, I would say. And I think
we can do a lot, but at the
same time, our hands are sort of tied
because we are not directly,
we we we are not providers so that
we cannot,
directly engage members 100% of the time.
But I think we have a lot of
areas that we can work on in order
to achieve that. And one of the areas
I think sort of untapped is that use
of artificial intelligence in detection of social determinants
of health. Mhmm. I think,
that area is not really well
studied and how we can use artificial intelligence
to address care gaps in minoritized group. I
think that's where I think we could possibly
invest more and figure out what could be
the resources that are already available and how
you can use AI to link our members
to those resources
without heavily,
utilizing internal resources so that we can it
is more like an organic connection, and we
don't have to invest a lot internally for
that. So I think that's, SDOH
detection as well as,
mobilization and providing resources that are outside the
organization to our members is one area we
can work on.
Member engagement is another area we can work
on, and I think artificial intelligence has a
lot of promise in terms of improving the
quality as well as reducing the cost and
making sure that we meet the business needs,
with the use of artificial intelligence.
But in order to be successful,
and to successfully employ this technology, we need
to have an enterprise wide strategy. We need
to have data that backs up that technology,
and we cannot just
use one off vendors to address that. We
have to have a more robust system within
organization
to drive that change and to make that
ROI with the best use case.
So,
you know, you work very closely with AI.
And I'm very curious. As someone who, you
know, likely has their ear to the ground
more than most,
is there a particular
use case for AI that maybe people aren't
using yet that, you know, maybe two, four,
five, ten years from now, there might be
they might be using in a way to
really
transform things in a way that most people
don't even see it. Is there anything, like,
kinda up and coming that you're particularly excited
about?
I think a lot of use cases that
we are using currently
are up and around in the market for
a while. Mhmm. And so in terms of
artificial intelligence
and use cases, I'm thinking out loud.
We talked about our use of artificial intelligence
and social determinants of health.
I mean, I've I speak about artificial intelligence
and
process improvement.
I think where artificial intelligence could be great
is,
within health plan is, like, if you have
a helper like agentic AI Mhmm. Which does
the task autonomously
Mhmm. Which sort of, like,
is is mirroring what you do. Like, for
example, I'm,
doctor Raheem. I'm logging into system. I'm I'm
I have certain checklist that I have to
do before I start my work. Agentic AI
makes helps me do those tasks autonomously without
my intervention so that I have more extra
time to do other things. Mhmm. Same stands
for other areas in the plan where,
we can automate the repetitive
tasks
and free up that time to do meaningful
work, I think that's where I would be
more
focused on because I feel like
it's there, it's on our face, but we
we are not utilizing that as much. Right.
Right. And we are thinking about it, but
we are not operationalizing on it. Right. Right.
And,
and,
like, it it's it's within our organization, and
we and it can be specific to
different folks, like, let's say, medical directors, human
work nurses, claim management,
to quality improvement. There are people in the
organization that are doing the same work over
and on mundane task. And if we can
somehow
automate those tasks specific to their field Mhmm.
The way they do it, it's like sort
of creating a digital twin where you have
a better version of me doing it faster
Right. And,
able to achieve things that I'm doing,
but at the same time, leaving some time
for me so that I can look into
more Right. Definitely cognitively diverse tasks so that
I can be more productive
and more engaged. In fact, it is gonna
improve engagement
at workplace because if I'm not doing mundane
task and repetitive task, I'm probably doing something
more meaningful to me. Right. Right. And so
that would be improve,
my engagement in workplace and
reduce the turnaround or attrition within the workplace.
Because I feel like within a health plan,
nurses and,
the
workflow has a lot of turnaround and a
lot of attrition, and so that can be
tackled using, you know, that technology as well
as
emphasizing and investing in those areas. Well, in
a lot of those main mundane tasks that
you're talking about automating are probably a lot
of what leads to burns and stuff too.
Right. Yeah. Just like I log in every
day. I have to do check-in into my,
you know, let's say, my clock in or
whatever it is. I if I'm logged in,
I'm probably clocking in. So that could be
automatic step. Yep. Yep. I'm opening my email
box. That should not be another click. We
have to do so many clicks just to
do the work that we do. Mhmm. And
that could be made quite easy with the
use of artificial intelligence and automation, I would
say.
Right. Well, doctor Raheem, I really appreciate your
time today. I can tell you're passionate, and
I can tell you're very innovative, and this
is a lot of fun. So thank you
so much for joining us today. I really
appreciate it. Appreciate. Thank you for having me
here and giving me an opportunity to talk
about our right there at Johns Hopkins Health
Plans. It's our pleasure. You have a lovely
rest of your day. Alright. Awesome.