1 00:00:00,000 --> 00:00:02,740 Evernorth brings the power of wonder and relentless 2 00:00:02,799 --> 00:00:05,599 innovation to create world class pharmacy, care, and 3 00:00:05,599 --> 00:00:06,580 benefit solutions. 4 00:00:07,200 --> 00:00:08,960 Barriers to care can lead to gaps in 5 00:00:08,960 --> 00:00:10,719 care, which can drive up the total cost 6 00:00:10,719 --> 00:00:13,839 of care. Our capabilities work seamlessly together to 7 00:00:13,839 --> 00:00:17,245 create innovative pharmacy care and benefit solutions for 8 00:00:17,245 --> 00:00:18,225 today and tomorrow. 9 00:00:18,765 --> 00:00:21,565 Our connected health services make the treatment, prediction, 10 00:00:21,565 --> 00:00:24,225 and prevention of health care's most complex conditions 11 00:00:24,685 --> 00:00:27,265 easier and more accessible as we drive organizations 12 00:00:27,484 --> 00:00:28,464 and people forward. 13 00:00:29,210 --> 00:00:31,369 This is Haley Recker with the Becker's Payer 14 00:00:31,369 --> 00:00:33,450 Podcast. And today, we're recording live at the 15 00:00:33,450 --> 00:00:36,030 Becker's third annual spring payer issues roundtable. 16 00:00:36,570 --> 00:00:38,329 I am thrilled today to be joined by 17 00:00:38,329 --> 00:00:40,969 Brad Riley, vice president of analytics and reporting 18 00:00:40,969 --> 00:00:43,049 at Longevity Health. Brad, thank you so much 19 00:00:43,049 --> 00:00:45,045 for joining me today. Hey. Happy to be 20 00:00:45,045 --> 00:00:47,125 here. So before we get started, can I 21 00:00:47,125 --> 00:00:48,644 just have you go ahead and introduce yourself 22 00:00:48,644 --> 00:00:50,484 and a little bit about your background? Sure. 23 00:00:50,484 --> 00:00:53,604 Absolutely. So, appreciate the opportunity to be here. 24 00:00:53,604 --> 00:00:54,964 I think this is the second time doing 25 00:00:54,964 --> 00:00:55,704 it. So, 26 00:00:56,324 --> 00:00:58,244 happy happy to be here and to take 27 00:00:58,244 --> 00:01:01,399 part. So, like Haley said, I'm Brad Riley. 28 00:01:01,460 --> 00:01:03,619 I'm the VP of analytics and reporting at 29 00:01:03,619 --> 00:01:07,560 Longevity Health Plan. Longevity is the fastest growing 30 00:01:07,619 --> 00:01:09,540 national I SNP plan, so we're a clinical 31 00:01:09,540 --> 00:01:11,959 services organization and an I SNP plan. 32 00:01:12,585 --> 00:01:15,145 We just crossed the 10,000 member threshold this 33 00:01:15,145 --> 00:01:16,924 year, so we're really excited about that. 34 00:01:17,225 --> 00:01:18,844 And we currently partner with, 35 00:01:19,944 --> 00:01:21,325 over 300 SNPs 36 00:01:21,865 --> 00:01:24,585 in roughly 13 different markets, and we're hoping 37 00:01:24,585 --> 00:01:26,025 to expand that a little this year. So 38 00:01:26,025 --> 00:01:27,870 excited to be here. Excited to talk about 39 00:01:29,069 --> 00:01:30,130 tech, AI, 40 00:01:30,829 --> 00:01:32,990 and and ways that, you know, I'm from 41 00:01:32,990 --> 00:01:35,090 my perspective, I'm getting to see that impact 42 00:01:35,310 --> 00:01:37,950 the industry and and longevity health. Well, that's 43 00:01:37,950 --> 00:01:39,810 awesome. Thank you so much for sharing. 44 00:01:40,225 --> 00:01:42,465 Now to begin our conversation today, I wanna 45 00:01:42,465 --> 00:01:45,665 talk about balancing affordability and quality. So how 46 00:01:45,665 --> 00:01:48,225 is your organization innovating to manage cost of 47 00:01:48,225 --> 00:01:51,045 care while maintaining or improving member outcomes? 48 00:01:51,825 --> 00:01:53,680 That's a good question. I mean, especially with 49 00:01:53,680 --> 00:01:54,959 the rates the way the way they are 50 00:01:54,959 --> 00:01:56,560 now and everything else. You know, '25 is 51 00:01:56,560 --> 00:01:58,400 a tough year. '26 is ramping up to 52 00:01:58,400 --> 00:02:00,480 be look a little better. But, with the 53 00:02:00,480 --> 00:02:02,799 Medicaid stuff coming in, you know, nobody's ever 54 00:02:02,799 --> 00:02:04,480 quite sure how that's gonna look. It's it's 55 00:02:04,799 --> 00:02:05,859 you know, changes 56 00:02:06,159 --> 00:02:08,555 month by month. So I think a couple 57 00:02:08,555 --> 00:02:09,294 things. One, 58 00:02:10,555 --> 00:02:12,634 obviously, at the forefront of everything else right 59 00:02:12,634 --> 00:02:15,194 now is is both quality based care agreements 60 00:02:15,194 --> 00:02:16,655 and quality based payment agreements. 61 00:02:17,914 --> 00:02:18,974 I I think that's 62 00:02:19,354 --> 00:02:21,675 absolutely where the industry is going. That's how 63 00:02:21,675 --> 00:02:22,974 longevity is structured, 64 00:02:23,680 --> 00:02:24,979 and how we, you know, 65 00:02:25,759 --> 00:02:28,000 partner with with our partners. I think the 66 00:02:28,000 --> 00:02:31,459 other piece, obviously, is leveraging technology, specifically, 67 00:02:32,639 --> 00:02:35,360 the buzzwords AI, especially, you know, this past 68 00:02:35,360 --> 00:02:37,680 at at Becker's, but, you know, everywhere else 69 00:02:37,680 --> 00:02:40,294 too. And I think understanding how to 70 00:02:40,675 --> 00:02:41,175 how 71 00:02:41,555 --> 00:02:43,955 to do that is important. You know? With 72 00:02:43,955 --> 00:02:46,294 with Longevity Health, we treat our members 73 00:02:46,915 --> 00:02:48,915 in the facilities, and so we we only 74 00:02:48,915 --> 00:02:50,915 partner well, our members are only in skilled 75 00:02:50,915 --> 00:02:53,094 nursing facilities. And so we have nurse practitioners 76 00:02:53,235 --> 00:02:55,469 and registered nurses and LPNs, 77 00:02:56,969 --> 00:02:58,730 that dependent upon the market will go in 78 00:02:58,730 --> 00:03:01,210 and and they they have a specific facility 79 00:03:01,210 --> 00:03:03,129 with a specific panel. And, you know, we 80 00:03:03,129 --> 00:03:03,950 found that, 81 00:03:04,810 --> 00:03:07,790 that really impacts avoidable admissions, readmissions. 82 00:03:08,655 --> 00:03:10,735 It lifts the residents' experience so they're not 83 00:03:10,735 --> 00:03:12,974 constantly going back and forth. And so from 84 00:03:12,974 --> 00:03:15,394 a model perspective, that absolutely avoids 85 00:03:15,854 --> 00:03:16,995 inpatient costs. 86 00:03:17,775 --> 00:03:18,914 But at the same time, 87 00:03:19,215 --> 00:03:22,414 from an administrative perspective, corporate perspective, understanding how 88 00:03:22,414 --> 00:03:23,155 we could 89 00:03:23,819 --> 00:03:27,040 leverage different technology tools like AI, 90 00:03:27,659 --> 00:03:29,979 to do things. I think it's definitely a 91 00:03:29,979 --> 00:03:32,699 little early still on the clinical end of 92 00:03:32,699 --> 00:03:34,060 using AI. There's a lot of proof of 93 00:03:34,060 --> 00:03:35,680 concepts out there that are really cool, 94 00:03:37,655 --> 00:03:38,314 but having 95 00:03:39,175 --> 00:03:41,915 the ability to kind of leverage different tools, 96 00:03:42,215 --> 00:03:42,955 whether it's, 97 00:03:44,055 --> 00:03:47,194 machine learning tools to better stratify your population 98 00:03:47,335 --> 00:03:49,194 or to augment or identify 99 00:03:50,770 --> 00:03:53,409 fraud waste and abuse, anything like that that 100 00:03:53,409 --> 00:03:55,270 we could use to kind of optimize 101 00:03:55,650 --> 00:03:57,509 the existing workflows that aren't, 102 00:03:58,370 --> 00:04:00,370 particularly clinical in nature, I think, is is 103 00:04:00,370 --> 00:04:02,129 a low hanging fruit. And then I think 104 00:04:02,129 --> 00:04:03,270 also just administrative 105 00:04:03,729 --> 00:04:04,229 tasking, 106 00:04:05,175 --> 00:04:05,675 equipping 107 00:04:06,215 --> 00:04:08,615 employees with the proper tools that are available 108 00:04:08,615 --> 00:04:09,675 in today's market, 109 00:04:10,055 --> 00:04:11,435 to help them be more efficient. 110 00:04:11,735 --> 00:04:14,055 And and, frankly, you know, everyone's tired of 111 00:04:14,055 --> 00:04:15,895 hearing this, but do more with less. I 112 00:04:15,895 --> 00:04:16,529 I think, 113 00:04:17,250 --> 00:04:19,089 give them a really cool tool. Let them 114 00:04:19,089 --> 00:04:20,930 let them use these tools to help them 115 00:04:20,930 --> 00:04:23,009 optimize their work. You still have a person 116 00:04:23,009 --> 00:04:25,250 involved there, so we're not talking pure Agentics 117 00:04:25,250 --> 00:04:26,550 at this point. Right? But, 118 00:04:27,009 --> 00:04:28,790 you have human level oversight 119 00:04:29,185 --> 00:04:30,865 with a tool that can help them, 120 00:04:31,345 --> 00:04:33,104 improve their day to day tasking and keep 121 00:04:33,104 --> 00:04:33,925 them more efficient. 122 00:04:34,544 --> 00:04:35,044 Absolutely. 123 00:04:35,504 --> 00:04:37,504 Well, I'd like to keep that conversation going 124 00:04:37,504 --> 00:04:40,544 about that quality of care. Mhmm. So what 125 00:04:40,544 --> 00:04:43,345 best practices or tools does your organization rely 126 00:04:43,345 --> 00:04:44,769 on to keep quality of care at the 127 00:04:44,769 --> 00:04:45,269 forefront? 128 00:04:46,290 --> 00:04:48,610 So, I mean, a couple things. I think 129 00:04:48,610 --> 00:04:49,110 one, 130 00:04:49,569 --> 00:04:51,110 quality of care is 131 00:04:52,370 --> 00:04:54,129 there's different couple different angles. Right? You've got, 132 00:04:54,129 --> 00:04:55,649 like, the HEDIS angle, but you also have 133 00:04:55,649 --> 00:04:57,329 the the actual quality of the care. I 134 00:04:57,329 --> 00:04:59,854 already touched on, the quality based agreements. I 135 00:04:59,854 --> 00:05:02,254 think that's vital. Right? Moving away from fee 136 00:05:02,254 --> 00:05:04,975 for service and and incentivizing people purely based 137 00:05:04,975 --> 00:05:06,414 off of the quality of of care that 138 00:05:06,414 --> 00:05:08,334 they're delivering to patients, I think, is is 139 00:05:08,334 --> 00:05:10,574 key. That's with PCP groups. That's with with 140 00:05:10,574 --> 00:05:12,894 skilled nursing facility. You know, every everything across 141 00:05:12,894 --> 00:05:13,769 the board. I think, 142 00:05:14,569 --> 00:05:15,870 at the same time, 143 00:05:17,449 --> 00:05:17,949 understanding 144 00:05:18,810 --> 00:05:19,310 broader 145 00:05:20,169 --> 00:05:21,310 provider behavior 146 00:05:21,930 --> 00:05:24,329 is important. Right? So when we look at 147 00:05:24,569 --> 00:05:25,470 and we leverage 148 00:05:26,514 --> 00:05:29,095 machine learning or predictive analytics to, 149 00:05:29,875 --> 00:05:31,175 create these 150 00:05:33,074 --> 00:05:34,615 more network driven 151 00:05:35,154 --> 00:05:37,474 oversight tools that allow you to see, you 152 00:05:37,474 --> 00:05:39,654 know, of your inpatient stays, 153 00:05:40,199 --> 00:05:42,199 which inpatient stay is really you know, what's 154 00:05:42,199 --> 00:05:44,279 the readmission rate based off of different inpatient 155 00:05:44,279 --> 00:05:44,600 providers? 156 00:05:45,800 --> 00:05:47,959 What what type of costs are we seeing 157 00:05:47,959 --> 00:05:49,740 coming from them? Is the is it qualitative 158 00:05:49,879 --> 00:05:51,720 in nature? And I and I think there's 159 00:05:51,720 --> 00:05:53,319 a lot of opportunity there in, 160 00:05:54,264 --> 00:05:56,824 optimizing network, understanding and this is across the 161 00:05:56,824 --> 00:05:58,985 industry, right, not just at longevity health, but 162 00:05:58,985 --> 00:05:59,485 understanding 163 00:06:00,824 --> 00:06:03,944 what providers are delivering quality care versus just 164 00:06:03,944 --> 00:06:06,105 delivering care. And I think when you optimize 165 00:06:06,105 --> 00:06:09,144 your network to focus specifically on the quality 166 00:06:09,144 --> 00:06:09,600 care, 167 00:06:10,000 --> 00:06:11,759 I think that's a big big next step 168 00:06:11,759 --> 00:06:13,199 because you can only control what you can 169 00:06:13,199 --> 00:06:13,699 control. 170 00:06:14,399 --> 00:06:15,860 And if you're not 171 00:06:16,399 --> 00:06:18,879 being proactive in that space and identifying your 172 00:06:18,879 --> 00:06:19,379 network 173 00:06:19,839 --> 00:06:20,240 and, 174 00:06:20,639 --> 00:06:22,100 trying to encourage 175 00:06:22,879 --> 00:06:23,379 proactivity 176 00:06:24,160 --> 00:06:24,660 amongst 177 00:06:25,754 --> 00:06:27,835 the providers that are that are delivering that 178 00:06:27,835 --> 00:06:28,814 that high quality. 179 00:06:29,675 --> 00:06:31,595 Whatever KPI is gonna reflect that, I think 180 00:06:31,595 --> 00:06:33,455 that's probably that's key. 181 00:06:34,395 --> 00:06:34,895 Absolutely. 182 00:06:35,675 --> 00:06:37,995 We've talked about the imperative to reduce costs, 183 00:06:37,995 --> 00:06:40,750 improve quality, and advance health equity, none of 184 00:06:40,750 --> 00:06:41,970 which are small tasks. 185 00:06:42,350 --> 00:06:44,509 How do you approach aligning these priorities in 186 00:06:44,509 --> 00:06:46,290 your organization's strategic vision? 187 00:06:47,389 --> 00:06:49,230 So I think the theme of the day 188 00:06:49,230 --> 00:06:51,149 is gonna be, you know, technology and tools. 189 00:06:51,149 --> 00:06:53,345 And I think the biggest thing, 190 00:06:53,724 --> 00:06:55,024 one, is allowing 191 00:06:56,285 --> 00:06:59,084 the use of technology. I think over the 192 00:06:59,084 --> 00:07:01,404 last three years, right, generative AI has blown 193 00:07:01,404 --> 00:07:02,064 up, but 194 00:07:02,444 --> 00:07:04,685 artificial intelligence is the big buzzword, but it's 195 00:07:04,685 --> 00:07:06,540 really existed since the nineteen fifties. 196 00:07:07,100 --> 00:07:09,259 So you have machine learning, predictive analytics, different 197 00:07:09,259 --> 00:07:11,600 types of things like that. And I think 198 00:07:11,660 --> 00:07:13,680 making sure that we are 199 00:07:14,060 --> 00:07:14,560 implementing 200 00:07:15,339 --> 00:07:15,839 efficiencies 201 00:07:16,939 --> 00:07:19,580 and, by leveraging technology, but at the same 202 00:07:19,580 --> 00:07:20,080 time, 203 00:07:20,779 --> 00:07:21,520 not reducing 204 00:07:22,835 --> 00:07:24,995 the quality and governance of the oversight we 205 00:07:24,995 --> 00:07:26,754 have to make sure that we're remaining compliant 206 00:07:26,754 --> 00:07:27,875 and to make sure that we're doing it 207 00:07:27,875 --> 00:07:30,375 the right way within, you know, CMS standards 208 00:07:30,435 --> 00:07:32,675 and whatever other types of standard standards that 209 00:07:32,675 --> 00:07:35,555 we operate within. I think that's key. Right? 210 00:07:35,555 --> 00:07:35,955 So, 211 00:07:37,529 --> 00:07:38,670 driving forward 212 00:07:39,290 --> 00:07:42,490 with technology while ensuring that there's governance and 213 00:07:42,490 --> 00:07:42,990 oversight, 214 00:07:43,449 --> 00:07:44,430 and I think that 215 00:07:44,810 --> 00:07:47,129 that also includes ethical oversight as well. I 216 00:07:47,129 --> 00:07:49,689 think some of these really cool models that 217 00:07:49,689 --> 00:07:50,750 are coming out with 218 00:07:51,314 --> 00:07:53,095 are being shown and found to have, 219 00:07:54,275 --> 00:07:55,415 some maybe nonethical 220 00:07:56,035 --> 00:07:59,095 steps and and and bias that inherently, 221 00:07:59,955 --> 00:08:01,095 was inadvertently 222 00:08:01,634 --> 00:08:04,035 added to the model because of of human 223 00:08:04,035 --> 00:08:06,379 data that that was ingested and and used 224 00:08:06,379 --> 00:08:07,740 to train it. Right? And I think 225 00:08:08,699 --> 00:08:10,939 so taking those resources that we're getting from 226 00:08:10,939 --> 00:08:13,180 creating efficiencies and implementing these type of tools 227 00:08:13,180 --> 00:08:15,180 and taking a portion of those to be 228 00:08:15,180 --> 00:08:17,019 more efficient and and create cost savings, but 229 00:08:17,019 --> 00:08:19,214 also leveraging some of those savings, not just 230 00:08:19,214 --> 00:08:20,974 pocketing it all and investing a little bit 231 00:08:20,974 --> 00:08:22,814 more in the governance and the oversight into 232 00:08:22,814 --> 00:08:24,654 the types of tools that you're using is 233 00:08:24,654 --> 00:08:26,034 probably a a more 234 00:08:26,495 --> 00:08:28,435 robust and long term strategy 235 00:08:28,814 --> 00:08:29,954 to make sure that 236 00:08:30,334 --> 00:08:32,254 that through leveraging these new tools, we don't 237 00:08:32,254 --> 00:08:33,315 introduce new risk. 238 00:08:34,230 --> 00:08:35,830 Well, before we wrap up here, is there 239 00:08:35,830 --> 00:08:37,350 anything else that you'd like to share with 240 00:08:37,350 --> 00:08:39,529 our listeners today that we haven't already discussed? 241 00:08:40,149 --> 00:08:41,669 Yeah. I think my big thing and what 242 00:08:41,669 --> 00:08:43,669 I would encourage everybody listening and, 243 00:08:44,149 --> 00:08:47,610 especially leaders of teams and executives is 244 00:08:48,245 --> 00:08:50,985 if your staff don't become literate 245 00:08:51,445 --> 00:08:53,284 with the new tools that are available to 246 00:08:53,284 --> 00:08:53,784 them, 247 00:08:54,325 --> 00:08:56,084 they're going to get behind and you'll get 248 00:08:56,084 --> 00:08:57,125 behind. And, 249 00:08:57,524 --> 00:08:58,904 I think that that means 250 00:08:59,284 --> 00:09:01,464 it's important for us to find ways, 251 00:09:01,929 --> 00:09:04,730 risk free, while keeping risk and and governance 252 00:09:04,730 --> 00:09:05,389 in mind 253 00:09:05,769 --> 00:09:07,389 of getting our staff, 254 00:09:08,730 --> 00:09:09,230 familiar 255 00:09:09,690 --> 00:09:12,170 and used to and exposed to tools, not 256 00:09:12,170 --> 00:09:13,769 just in their personal lives. Right? Like, I 257 00:09:13,769 --> 00:09:15,529 think everyone's like, oh, I've got Chad GPT 258 00:09:15,529 --> 00:09:17,129 on my phone or I've got this. And, 259 00:09:17,129 --> 00:09:18,845 you know, when I when I press Google, 260 00:09:18,845 --> 00:09:20,845 Gemini pops up at the top. But at 261 00:09:20,845 --> 00:09:22,125 the end of the day, if if people 262 00:09:22,125 --> 00:09:23,644 aren't thinking of how to use these tools 263 00:09:23,644 --> 00:09:24,865 in a professional manner, 264 00:09:25,165 --> 00:09:26,684 they're gonna miss out. Right? We've got a 265 00:09:26,684 --> 00:09:28,365 lot of really smart people, and something I 266 00:09:28,365 --> 00:09:28,684 believe, 267 00:09:29,580 --> 00:09:31,019 in is, you know, I wanna hire people 268 00:09:31,019 --> 00:09:32,940 smarter than me. Right? That's that's how you 269 00:09:32,940 --> 00:09:33,840 do do well. 270 00:09:34,379 --> 00:09:35,279 And and so 271 00:09:35,740 --> 00:09:37,120 empowering that staff 272 00:09:37,500 --> 00:09:39,580 to do that, is something that I think 273 00:09:39,580 --> 00:09:41,420 is is an opportunity. There's a lot of 274 00:09:41,420 --> 00:09:43,735 people that are engaged and excited to do 275 00:09:43,735 --> 00:09:45,335 it themselves, but at the same time, there's 276 00:09:45,335 --> 00:09:46,934 people that might need a little bit of 277 00:09:46,934 --> 00:09:48,934 a push. And so one of the things 278 00:09:48,934 --> 00:09:51,414 I actually did for this, I realized on 279 00:09:51,414 --> 00:09:52,855 on my team is that I had a 280 00:09:52,855 --> 00:09:55,095 lot of really good technical skills, but my 281 00:09:55,095 --> 00:09:55,595 staff 282 00:09:56,090 --> 00:09:57,610 had an opportunity to learn a little bit 283 00:09:57,610 --> 00:09:58,970 more. I like to say how the machine 284 00:09:58,970 --> 00:10:01,050 works, but, like, the managed care like, what 285 00:10:01,050 --> 00:10:02,649 is managed care? What's a claim? How does 286 00:10:02,649 --> 00:10:04,910 a claim process? How does an authorization process? 287 00:10:05,690 --> 00:10:08,350 And so I actually created a a customized 288 00:10:08,570 --> 00:10:11,125 large language model. And it's just trained. It's 289 00:10:11,125 --> 00:10:12,804 a chatbot. Right? But it's trained on stuff. 290 00:10:12,804 --> 00:10:14,725 You can actually it's it's open source, so 291 00:10:14,725 --> 00:10:16,245 anybody can can go and look at it 292 00:10:16,245 --> 00:10:18,105 and use it. You can go to 293 00:10:18,485 --> 00:10:21,785 app.managedcare101.ai. 294 00:10:22,325 --> 00:10:24,210 But ask it anything about managed care. Right? 295 00:10:24,210 --> 00:10:25,670 Get people used to navigating 296 00:10:26,050 --> 00:10:28,690 large language models, NLP, and encourage your staff 297 00:10:28,690 --> 00:10:30,450 and empower your staff to operate at the 298 00:10:30,450 --> 00:10:33,250 top of of what they're capable of doing. 299 00:10:33,250 --> 00:10:34,610 And I think that's gonna take us a 300 00:10:34,610 --> 00:10:36,529 long way over the next few years as 301 00:10:36,529 --> 00:10:38,070 continue to see technology, 302 00:10:38,585 --> 00:10:40,365 you know, go down the path it's going. 303 00:10:40,424 --> 00:10:42,745 Absolutely. Well, thank you so much for joining 304 00:10:42,745 --> 00:10:44,745 me today. Again, this is Haley Rutger with 305 00:10:44,745 --> 00:10:45,965 the Becker's Payer podcast 306 00:10:46,424 --> 00:10:49,065 recording live at the Becker's third annual spring 307 00:10:49,065 --> 00:10:51,544 Payer issues roundtable. Brad, thank you so much. 308 00:10:51,544 --> 00:10:52,205 Thank you.