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This is Haley Recker with the Becker's Payer
Podcast. And today, we're recording live at the
Becker's third annual spring payer issues roundtable.
I am thrilled today to be joined by
Brad Riley, vice president of analytics and reporting
at Longevity Health. Brad, thank you so much
for joining me today. Hey. Happy to be
here. So before we get started, can I
just have you go ahead and introduce yourself
and a little bit about your background? Sure.
Absolutely. So, appreciate the opportunity to be here.
I think this is the second time doing
it. So,
happy happy to be here and to take
part. So, like Haley said, I'm Brad Riley.
I'm the VP of analytics and reporting at
Longevity Health Plan. Longevity is the fastest growing
national I SNP plan, so we're a clinical
services organization and an I SNP plan.
We just crossed the 10,000 member threshold this
year, so we're really excited about that.
And we currently partner with,
over 300 SNPs
in roughly 13 different markets, and we're hoping
to expand that a little this year. So
excited to be here. Excited to talk about
tech, AI,
and and ways that, you know, I'm from
my perspective, I'm getting to see that impact
the industry and and longevity health. Well, that's
awesome. Thank you so much for sharing.
Now to begin our conversation today, I wanna
talk about balancing affordability and quality. So how
is your organization innovating to manage cost of
care while maintaining or improving member outcomes?
That's a good question. I mean, especially with
the rates the way the way they are
now and everything else. You know, '25 is
a tough year. '26 is ramping up to
be look a little better. But, with the
Medicaid stuff coming in, you know, nobody's ever
quite sure how that's gonna look. It's it's
you know, changes
month by month. So I think a couple
things. One,
obviously, at the forefront of everything else right
now is is both quality based care agreements
and quality based payment agreements.
I I think that's
absolutely where the industry is going. That's how
longevity is structured,
and how we, you know,
partner with with our partners. I think the
other piece, obviously, is leveraging technology, specifically,
the buzzwords AI, especially, you know, this past
at at Becker's, but, you know, everywhere else
too. And I think understanding how to
how
to do that is important. You know? With
with Longevity Health, we treat our members
in the facilities, and so we we only
partner well, our members are only in skilled
nursing facilities. And so we have nurse practitioners
and registered nurses and LPNs,
that dependent upon the market will go in
and and they they have a specific facility
with a specific panel. And, you know, we
found that,
that really impacts avoidable admissions, readmissions.
It lifts the residents' experience so they're not
constantly going back and forth. And so from
a model perspective, that absolutely avoids
inpatient costs.
But at the same time,
from an administrative perspective, corporate perspective, understanding how
we could
leverage different technology tools like AI,
to do things. I think it's definitely a
little early still on the clinical end of
using AI. There's a lot of proof of
concepts out there that are really cool,
but having
the ability to kind of leverage different tools,
whether it's,
machine learning tools to better stratify your population
or to augment or identify
fraud waste and abuse, anything like that that
we could use to kind of optimize
the existing workflows that aren't,
particularly clinical in nature, I think, is is
a low hanging fruit. And then I think
also just administrative
tasking,
equipping
employees with the proper tools that are available
in today's market,
to help them be more efficient.
And and, frankly, you know, everyone's tired of
hearing this, but do more with less. I
I think,
give them a really cool tool. Let them
let them use these tools to help them
optimize their work. You still have a person
involved there, so we're not talking pure Agentics
at this point. Right? But,
you have human level oversight
with a tool that can help them,
improve their day to day tasking and keep
them more efficient.
Absolutely.
Well, I'd like to keep that conversation going
about that quality of care. Mhmm. So what
best practices or tools does your organization rely
on to keep quality of care at the
forefront?
So, I mean, a couple things. I think
one,
quality of care is
there's different couple different angles. Right? You've got,
like, the HEDIS angle, but you also have
the the actual quality of the care. I
already touched on, the quality based agreements. I
think that's vital. Right? Moving away from fee
for service and and incentivizing people purely based
off of the quality of of care that
they're delivering to patients, I think, is is
key. That's with PCP groups. That's with with
skilled nursing facility. You know, every everything across
the board. I think,
at the same time,
understanding
broader
provider behavior
is important. Right? So when we look at
and we leverage
machine learning or predictive analytics to,
create these
more network driven
oversight tools that allow you to see, you
know, of your inpatient stays,
which inpatient stay is really you know, what's
the readmission rate based off of different inpatient
providers?
What what type of costs are we seeing
coming from them? Is the is it qualitative
in nature? And I and I think there's
a lot of opportunity there in,
optimizing network, understanding and this is across the
industry, right, not just at longevity health, but
understanding
what providers are delivering quality care versus just
delivering care. And I think when you optimize
your network to focus specifically on the quality
care,
I think that's a big big next step
because you can only control what you can
control.
And if you're not
being proactive in that space and identifying your
network
and,
trying to encourage
proactivity
amongst
the providers that are that are delivering that
that high quality.
Whatever KPI is gonna reflect that, I think
that's probably that's key.
Absolutely.
We've talked about the imperative to reduce costs,
improve quality, and advance health equity, none of
which are small tasks.
How do you approach aligning these priorities in
your organization's strategic vision?
So I think the theme of the day
is gonna be, you know, technology and tools.
And I think the biggest thing,
one, is allowing
the use of technology. I think over the
last three years, right, generative AI has blown
up, but
artificial intelligence is the big buzzword, but it's
really existed since the nineteen fifties.
So you have machine learning, predictive analytics, different
types of things like that. And I think
making sure that we are
implementing
efficiencies
and, by leveraging technology, but at the same
time,
not reducing
the quality and governance of the oversight we
have to make sure that we're remaining compliant
and to make sure that we're doing it
the right way within, you know, CMS standards
and whatever other types of standard standards that
we operate within. I think that's key. Right?
So,
driving forward
with technology while ensuring that there's governance and
oversight,
and I think that
that also includes ethical oversight as well. I
think some of these really cool models that
are coming out with
are being shown and found to have,
some maybe nonethical
steps and and and bias that inherently,
was inadvertently
added to the model because of of human
data that that was ingested and and used
to train it. Right? And I think
so taking those resources that we're getting from
creating efficiencies and implementing these type of tools
and taking a portion of those to be
more efficient and and create cost savings, but
also leveraging some of those savings, not just
pocketing it all and investing a little bit
more in the governance and the oversight into
the types of tools that you're using is
probably a a more
robust and long term strategy
to make sure that
that through leveraging these new tools, we don't
introduce new risk.
Well, before we wrap up here, is there
anything else that you'd like to share with
our listeners today that we haven't already discussed?
Yeah. I think my big thing and what
I would encourage everybody listening and,
especially leaders of teams and executives is
if your staff don't become literate
with the new tools that are available to
them,
they're going to get behind and you'll get
behind. And,
I think that that means
it's important for us to find ways,
risk free, while keeping risk and and governance
in mind
of getting our staff,
familiar
and used to and exposed to tools, not
just in their personal lives. Right? Like, I
think everyone's like, oh, I've got Chad GPT
on my phone or I've got this. And,
you know, when I when I press Google,
Gemini pops up at the top. But at
the end of the day, if if people
aren't thinking of how to use these tools
in a professional manner,
they're gonna miss out. Right? We've got a
lot of really smart people, and something I
believe,
in is, you know, I wanna hire people
smarter than me. Right? That's that's how you
do do well.
And and so
empowering that staff
to do that, is something that I think
is is an opportunity. There's a lot of
people that are engaged and excited to do
it themselves, but at the same time, there's
people that might need a little bit of
a push. And so one of the things
I actually did for this, I realized on
on my team is that I had a
lot of really good technical skills, but my
staff
had an opportunity to learn a little bit
more. I like to say how the machine
works, but, like, the managed care like, what
is managed care? What's a claim? How does
a claim process? How does an authorization process?
And so I actually created a a customized
large language model. And it's just trained. It's
a chatbot. Right? But it's trained on stuff.
You can actually it's it's open source, so
anybody can can go and look at it
and use it. You can go to
app.managedcare101.ai.
But ask it anything about managed care. Right?
Get people used to navigating
large language models, NLP, and encourage your staff
and empower your staff to operate at the
top of of what they're capable of doing.
And I think that's gonna take us a
long way over the next few years as
continue to see technology,
you know, go down the path it's going.
Absolutely. Well, thank you so much for joining
me today. Again, this is Haley Rutger with
the Becker's Payer podcast
recording live at the Becker's third annual spring
Payer issues roundtable. Brad, thank you so much.
Thank you.