1 00:00:00,160 --> 00:00:02,159 Everyone. This is Lucas Voss with Becker's Healthcare. 2 00:00:02,159 --> 00:00:03,279 Thanks so much for tuning in to the 3 00:00:03,279 --> 00:00:05,779 Becker's Healthcare podcast series. It's fantastic 4 00:00:06,160 --> 00:00:08,980 to have you excited for today's episode 5 00:00:09,279 --> 00:00:11,300 from reactive to proactive 6 00:00:11,839 --> 00:00:14,724 AI's role in the next generation of care 7 00:00:14,865 --> 00:00:17,024 management. And joining me for today's discussion, very 8 00:00:17,024 --> 00:00:19,524 excited to have them both on, Michelle Fullerton, 9 00:00:19,585 --> 00:00:21,984 vice president care management and customer consulting at 10 00:00:21,984 --> 00:00:24,704 Blue Cross Blue Shield of Michigan, and Connie 11 00:00:24,704 --> 00:00:28,260 Duquesne, senior vice president strategic solutions of MindYou. 12 00:00:28,640 --> 00:00:30,399 Michelle and Connie, thanks so much for being 13 00:00:30,399 --> 00:00:31,780 here today. It's great to have you. 14 00:00:32,079 --> 00:00:34,719 Excited. Happy to be here. Absolutely. It's great 15 00:00:34,719 --> 00:00:36,420 to have you. We'll start off with introductions, 16 00:00:36,960 --> 00:00:39,600 for our audience here. Michelle, why don't you 17 00:00:39,600 --> 00:00:40,799 kick us off? Can you share a little 18 00:00:40,799 --> 00:00:42,479 bit about your background and your work in 19 00:00:42,479 --> 00:00:43,219 health care? 20 00:00:43,844 --> 00:00:46,565 Sure. Well, hi, everyone. I'm Michelle Fullerton. I 21 00:00:46,565 --> 00:00:49,285 am a nurse. I'm also a certified case 22 00:00:49,285 --> 00:00:51,925 manager. I have been with Blue Cross Blue 23 00:00:51,925 --> 00:00:52,825 Shield of Michigan 24 00:00:53,605 --> 00:00:55,225 for twenty eight years, 25 00:00:55,750 --> 00:00:58,630 have worked in a variety of roles as 26 00:00:58,630 --> 00:01:00,409 a nurse on the phone with patients, 27 00:01:01,350 --> 00:01:03,109 all the way to now being the vice 28 00:01:03,109 --> 00:01:05,769 president of care management, but I've also worked 29 00:01:05,909 --> 00:01:08,810 with our group customers in population health. 30 00:01:09,375 --> 00:01:11,295 I love care management. I think it's a 31 00:01:11,295 --> 00:01:12,435 wonderful profession, 32 00:01:13,055 --> 00:01:15,395 and I think that we are the core 33 00:01:15,454 --> 00:01:17,615 of what a health plan can deliver to 34 00:01:17,615 --> 00:01:18,834 help patients 35 00:01:19,295 --> 00:01:21,795 when they're in their times of trouble. 36 00:01:22,575 --> 00:01:24,594 Absolutely. Connie, over to you. 37 00:01:25,079 --> 00:01:26,920 Yeah. So thank you. So first, I wanna 38 00:01:26,920 --> 00:01:28,539 say I agree with Michelle 39 00:01:28,840 --> 00:01:31,719 core of care with land with the care 40 00:01:31,719 --> 00:01:32,219 managers. 41 00:01:33,399 --> 00:01:35,899 My background is telephonic intervention, 42 00:01:36,359 --> 00:01:38,939 call centers. I'm a behavior change professional. 43 00:01:39,944 --> 00:01:42,025 So I have more decades than I should 44 00:01:42,025 --> 00:01:43,385 probably say on this, 45 00:01:43,865 --> 00:01:44,365 podcast 46 00:01:45,064 --> 00:01:45,564 experience. 47 00:01:46,265 --> 00:01:48,584 But now I have the opportunity to bring 48 00:01:48,584 --> 00:01:50,204 those skills to MindYou 49 00:01:50,905 --> 00:01:51,564 to help 50 00:01:52,259 --> 00:01:55,060 payers and providers and other groups sort of 51 00:01:55,060 --> 00:01:57,459 think about how do we incorporate what we 52 00:01:57,459 --> 00:02:00,119 do here at MindYou into their current processes 53 00:02:00,979 --> 00:02:02,280 and sort of reimagine 54 00:02:03,299 --> 00:02:05,000 how could they use 55 00:02:05,864 --> 00:02:06,364 AI, 56 00:02:06,825 --> 00:02:08,284 mind you, Eleanor, 57 00:02:08,585 --> 00:02:11,164 in providing care to their members and patients. 58 00:02:11,865 --> 00:02:13,865 Absolutely. And it's a very interesting topic because 59 00:02:13,865 --> 00:02:16,205 it's developing so much for so many organizations, 60 00:02:16,264 --> 00:02:18,264 and it's constantly developing. It seems like every 61 00:02:18,264 --> 00:02:20,490 single day, there's something new. Right? New news, 62 00:02:20,650 --> 00:02:23,290 new technology. And this was an interesting stat 63 00:02:23,290 --> 00:02:24,270 from from McKinsey. 64 00:02:24,650 --> 00:02:26,110 In 2024, 65 00:02:26,409 --> 00:02:29,230 70% of US health care organizations were exploring 66 00:02:29,290 --> 00:02:32,030 or already using AI across clinical and administrative 67 00:02:32,250 --> 00:02:33,310 functions. So, really, 68 00:02:33,770 --> 00:02:36,305 most of the industry were already there, and 69 00:02:36,305 --> 00:02:37,824 we know it's a critical part of care 70 00:02:37,824 --> 00:02:38,324 management. 71 00:02:39,185 --> 00:02:40,865 Michelle, I'd love to start with you on 72 00:02:40,865 --> 00:02:41,365 this. 73 00:02:41,745 --> 00:02:43,764 How are you using AI today, 74 00:02:44,064 --> 00:02:45,604 and what's really motivating 75 00:02:46,064 --> 00:02:49,104 continued investment in these technologies for you and 76 00:02:49,104 --> 00:02:49,764 your teams? 77 00:02:51,000 --> 00:02:53,979 Well, for every leader of care management, 78 00:02:54,680 --> 00:02:57,099 this is all about our cost to deliver 79 00:02:57,319 --> 00:02:59,180 and how to be more efficient 80 00:03:00,199 --> 00:03:02,139 and also letting nurses 81 00:03:02,680 --> 00:03:03,180 perform 82 00:03:03,685 --> 00:03:05,764 all of their tasks at the top of 83 00:03:05,764 --> 00:03:08,745 their licensure. I think those are three 84 00:03:09,125 --> 00:03:10,104 huge factors 85 00:03:10,644 --> 00:03:11,625 that drive 86 00:03:12,084 --> 00:03:14,084 what care management is all about. We have 87 00:03:14,084 --> 00:03:15,144 a large organization 88 00:03:15,444 --> 00:03:18,099 between commercial and Medicare Medicare Advantage Care Management. 89 00:03:18,099 --> 00:03:19,719 We have over 500 employees. 90 00:03:20,099 --> 00:03:21,480 Mhmm. That is expensive. 91 00:03:22,099 --> 00:03:24,840 Nurses are expensive. They're an extremely 92 00:03:25,219 --> 00:03:26,439 important asset, 93 00:03:26,900 --> 00:03:29,080 but we need to use them efficiently, 94 00:03:30,245 --> 00:03:30,745 effectively, 95 00:03:31,685 --> 00:03:32,185 and 96 00:03:32,485 --> 00:03:32,985 also 97 00:03:33,284 --> 00:03:34,425 at top of license. 98 00:03:34,724 --> 00:03:37,925 So those are really three drivers that have 99 00:03:37,925 --> 00:03:40,965 always driven us in how we create our 100 00:03:40,965 --> 00:03:42,264 care management programs. 101 00:03:42,805 --> 00:03:43,305 Yeah. 102 00:03:43,849 --> 00:03:44,349 So 103 00:03:44,729 --> 00:03:45,229 AI 104 00:03:45,689 --> 00:03:46,750 has stepped in 105 00:03:47,129 --> 00:03:49,629 to help us become more cost efficient. 106 00:03:50,810 --> 00:03:52,729 Which is a a key driver, obviously, as 107 00:03:52,729 --> 00:03:54,650 you've mentioned for a lot of organizations. And, 108 00:03:54,650 --> 00:03:56,715 again, we have that 70% number. 109 00:03:57,114 --> 00:04:00,074 Connie, I'd love to hear your perspectives on 110 00:04:00,074 --> 00:04:00,974 this too, 111 00:04:01,435 --> 00:04:03,754 specifically around that second part, which I think 112 00:04:03,754 --> 00:04:06,155 is very interesting, right? Why now? Why is 113 00:04:06,155 --> 00:04:08,574 this happening now? Why are we seeing this 114 00:04:08,634 --> 00:04:11,439 great increase, the 70% number? Why are we 115 00:04:11,439 --> 00:04:13,699 so many organizations going that route? 116 00:04:14,479 --> 00:04:16,160 Well, there's always been a need to do 117 00:04:16,160 --> 00:04:17,300 more with less. 118 00:04:18,000 --> 00:04:19,699 Right? And that's even magnified, 119 00:04:20,000 --> 00:04:20,579 I think, 120 00:04:20,959 --> 00:04:22,419 more now than ever. 121 00:04:23,039 --> 00:04:23,539 And 122 00:04:24,194 --> 00:04:26,454 more and more people are getting comfortable 123 00:04:26,834 --> 00:04:30,354 with the utilization of AI. Right? So so 124 00:04:30,354 --> 00:04:30,854 organizations 125 00:04:31,154 --> 00:04:33,794 are getting comfortable whether you they're using it 126 00:04:33,794 --> 00:04:34,534 for stratification 127 00:04:35,314 --> 00:04:37,735 or ambient listening, whatever the reason 128 00:04:38,189 --> 00:04:40,830 that organizations are getting comfortable and humans are 129 00:04:40,830 --> 00:04:43,149 getting comfortable. Right? So we are using a 130 00:04:43,550 --> 00:04:46,110 AI more and more. I mean, it's 01:00 131 00:04:46,110 --> 00:04:49,170 in the afternoon, and I've already used AI 132 00:04:49,870 --> 00:04:51,089 a half a dozen times, 133 00:04:51,665 --> 00:04:52,625 and I'm not alone. I think if we 134 00:04:52,625 --> 00:04:54,305 all step back and looked at our lives, 135 00:04:54,305 --> 00:04:57,105 we would say, everybody's using it. So let's 136 00:04:57,105 --> 00:04:59,824 find more ways to bring the tools to 137 00:04:59,824 --> 00:05:00,485 the workforce 138 00:05:01,264 --> 00:05:03,105 so they can, you know, create more space 139 00:05:03,105 --> 00:05:04,964 in their day to do the important work. 140 00:05:05,310 --> 00:05:07,649 Yeah. Just as a follow-up to that, Connie, 141 00:05:07,710 --> 00:05:09,889 really quickly, are are you feeling like leaders 142 00:05:10,029 --> 00:05:12,930 are understanding that more and they're bringing in 143 00:05:12,990 --> 00:05:14,750 more of that expertise to be able to 144 00:05:14,750 --> 00:05:16,430 say, this is how we can use AI 145 00:05:16,430 --> 00:05:16,930 better? 146 00:05:17,644 --> 00:05:19,644 I think so. I I think there's a 147 00:05:19,644 --> 00:05:21,964 a lot of information, podcasts like this, a 148 00:05:21,964 --> 00:05:23,185 lot of written materials 149 00:05:23,564 --> 00:05:25,985 that are helping people to to know more, 150 00:05:26,764 --> 00:05:29,324 appreciate it more, and so they're leaning in. 151 00:05:29,324 --> 00:05:31,084 So it isn't just me going out to 152 00:05:31,084 --> 00:05:33,300 payers and saying, hey. You should check out 153 00:05:33,300 --> 00:05:34,120 this technology. 154 00:05:34,500 --> 00:05:37,300 There are payers coming to us saying, we 155 00:05:37,300 --> 00:05:38,919 wanna check out your technology. 156 00:05:39,620 --> 00:05:41,459 Yeah. Yeah. How can we be more efficient, 157 00:05:41,459 --> 00:05:44,120 which Michelle mentioned, right, efficiency across a large 158 00:05:44,259 --> 00:05:46,425 employee base. And, again, I I think the 159 00:05:46,504 --> 00:05:48,504 the top of the licensure is such a 160 00:05:48,504 --> 00:05:50,904 big and important piece of the puzzle for 161 00:05:50,904 --> 00:05:51,884 a lot of organizations. 162 00:05:52,985 --> 00:05:54,904 Michelle, I'd love to come back to that 163 00:05:54,904 --> 00:05:56,745 too in terms of the use cases that 164 00:05:56,745 --> 00:05:57,404 you have, 165 00:05:58,745 --> 00:06:00,444 for your organization specifically. 166 00:06:01,029 --> 00:06:02,790 Can you expand a little bit on on 167 00:06:02,790 --> 00:06:04,709 some of the use cases and especially what 168 00:06:04,709 --> 00:06:07,050 outcomes you've seen? How have they 169 00:06:07,350 --> 00:06:10,470 affected your your teams and especially the workflows, 170 00:06:10,470 --> 00:06:12,149 etcetera? What are some of the things that 171 00:06:12,149 --> 00:06:13,129 you're seeing there? 172 00:06:13,824 --> 00:06:15,504 Absolutely. I would love to talk about this 173 00:06:15,504 --> 00:06:17,264 because I will tell you I was probably 174 00:06:17,264 --> 00:06:19,904 one of the doubting Thomases at the very 175 00:06:19,904 --> 00:06:21,125 beginning of AI, 176 00:06:21,504 --> 00:06:23,204 and I would say that AI, 177 00:06:23,745 --> 00:06:25,604 does not replace a nurse. 178 00:06:25,909 --> 00:06:28,629 Yeah. But what I have learned is that 179 00:06:28,629 --> 00:06:31,750 AI can aid a nurse, and it can 180 00:06:31,750 --> 00:06:34,629 aid in our workflow. So number one, we 181 00:06:34,629 --> 00:06:36,550 use a lot of AI in our ID 182 00:06:36,550 --> 00:06:37,289 and stratification 183 00:06:38,144 --> 00:06:38,884 of patients. 184 00:06:39,345 --> 00:06:42,225 Mhmm. Then of any care management program for 185 00:06:42,225 --> 00:06:44,144 anyone that's listening, we all do the same 186 00:06:44,144 --> 00:06:45,985 thing. We have to reach out to members, 187 00:06:45,985 --> 00:06:47,925 and we have to try to engage them 188 00:06:48,225 --> 00:06:50,939 in our programs, whatever those programs may be. 189 00:06:51,019 --> 00:06:52,620 It may be a rising risk. It may 190 00:06:52,620 --> 00:06:53,839 be an ER reduction. 191 00:06:54,379 --> 00:06:56,639 It may be a disease management program, 192 00:06:57,019 --> 00:06:59,120 but we need to reach out to members 193 00:06:59,180 --> 00:07:01,740 and engage them in our program with our 194 00:07:01,740 --> 00:07:04,540 nurse. Yeah. Well, I call that dialing for 195 00:07:04,540 --> 00:07:06,925 dollars. If you have a 100 nurses 196 00:07:07,384 --> 00:07:08,605 that are on a phone 197 00:07:08,985 --> 00:07:09,884 calling patients 198 00:07:10,264 --> 00:07:11,944 and you only get a hold of 50 199 00:07:11,944 --> 00:07:14,105 of them and then you only gauge, you 200 00:07:14,105 --> 00:07:15,324 know, another 30, 201 00:07:15,704 --> 00:07:17,245 there is a lot of 202 00:07:18,120 --> 00:07:20,439 work left on the floor, right, on on 203 00:07:20,439 --> 00:07:22,379 the Cutting Room Floor. So 204 00:07:22,759 --> 00:07:24,699 why do we not use AI 205 00:07:25,639 --> 00:07:27,420 more effectively and efficiently 206 00:07:28,040 --> 00:07:29,500 in these work processes? 207 00:07:29,800 --> 00:07:31,240 And that's what made me 208 00:07:32,175 --> 00:07:33,875 my ear started to listen 209 00:07:34,415 --> 00:07:36,435 when Connie was presenting 210 00:07:37,295 --> 00:07:39,074 what they do in an organization 211 00:07:40,254 --> 00:07:42,595 and how their use case could help me. 212 00:07:42,975 --> 00:07:43,875 Yeah. Absolutely. 213 00:07:44,870 --> 00:07:47,029 Connie, this is a the the dialing for 214 00:07:47,029 --> 00:07:48,949 dollars piece is a is a great transition 215 00:07:48,949 --> 00:07:49,610 for me 216 00:07:50,069 --> 00:07:52,069 because I think that's where it gets sort 217 00:07:52,069 --> 00:07:53,990 of the rubber meets the road to bring 218 00:07:53,990 --> 00:07:56,389 in another cliche. Right? Is how do we 219 00:07:56,389 --> 00:07:59,444 evaluate this? I'm spending money, but I wanna 220 00:07:59,444 --> 00:08:01,064 make sure this actually works. 221 00:08:01,524 --> 00:08:03,944 When in your conversations with leaders, 222 00:08:04,404 --> 00:08:06,345 when it comes to evaluating ROI, 223 00:08:06,884 --> 00:08:08,964 what are some of the metrics or outcomes 224 00:08:08,964 --> 00:08:11,064 that you're specifically looking for 225 00:08:11,524 --> 00:08:12,904 that leaders should prioritize? 226 00:08:13,925 --> 00:08:14,745 Yeah. So 227 00:08:15,069 --> 00:08:16,610 it's a good question. So 228 00:08:17,149 --> 00:08:19,730 it often starts with a conversation about ROI, 229 00:08:19,790 --> 00:08:21,790 but then when we keep talking, it's really 230 00:08:21,790 --> 00:08:24,589 about value. What value are you gonna bring? 231 00:08:24,589 --> 00:08:27,889 And so there's three categories. There's the efficiency 232 00:08:28,269 --> 00:08:28,769 component, 233 00:08:29,274 --> 00:08:31,595 there's a quality component, and then there's an 234 00:08:31,595 --> 00:08:32,815 economics component. 235 00:08:33,195 --> 00:08:35,615 So depending on the program will determine 236 00:08:36,475 --> 00:08:39,534 what does value look like. So, for example, 237 00:08:40,075 --> 00:08:42,315 Michelle referenced some of these already. Let's say 238 00:08:42,315 --> 00:08:42,975 it's about 239 00:08:43,470 --> 00:08:45,409 supporting a person who was 240 00:08:45,789 --> 00:08:48,289 recently discharged from the emergency department. 241 00:08:48,669 --> 00:08:50,529 We can measure the value 242 00:08:51,070 --> 00:08:51,570 of 243 00:08:51,949 --> 00:08:53,089 the patient 244 00:08:54,669 --> 00:08:57,329 selecting the right type of care, 245 00:08:57,945 --> 00:09:00,285 potentially PCP or urgent care 246 00:09:00,665 --> 00:09:03,165 as compared to an ED. We can quantify 247 00:09:03,225 --> 00:09:03,725 that. 248 00:09:04,264 --> 00:09:05,804 Others are harder to quantify. 249 00:09:06,345 --> 00:09:08,764 For example, if we call 50,000 250 00:09:09,065 --> 00:09:11,884 patients whose provider went out of network 251 00:09:12,429 --> 00:09:14,429 and we want to help them get connected 252 00:09:14,429 --> 00:09:15,490 with a new provider, 253 00:09:15,870 --> 00:09:18,830 that's harder to quantify. It's important, but it's 254 00:09:18,830 --> 00:09:20,750 not as easy to measure. And then there 255 00:09:20,750 --> 00:09:22,029 are those that are sort of in the 256 00:09:22,029 --> 00:09:24,590 middle. And this one, Michelle has referenced a 257 00:09:24,590 --> 00:09:26,529 couple of times. It's helping 258 00:09:26,990 --> 00:09:27,490 the 259 00:09:28,004 --> 00:09:29,465 care managers, the nurses 260 00:09:30,325 --> 00:09:31,465 work top of license 261 00:09:31,845 --> 00:09:32,665 by taking 262 00:09:33,684 --> 00:09:34,745 low skilled tasks 263 00:09:35,845 --> 00:09:37,785 off their workload. That's measurable. 264 00:09:38,325 --> 00:09:40,804 But what's not measurable is what does that 265 00:09:40,804 --> 00:09:42,985 do to the quality of their work life? 266 00:09:43,580 --> 00:09:45,820 Right? How do we measure that? So some 267 00:09:45,820 --> 00:09:48,379 are very concrete and some are softer, but 268 00:09:48,379 --> 00:09:50,059 there are a lot of different ways of 269 00:09:50,059 --> 00:09:51,120 measuring value. 270 00:09:51,500 --> 00:09:53,740 And those that I'm talking to are looking 271 00:09:53,740 --> 00:09:55,600 at all three of those buckets, 272 00:09:56,299 --> 00:09:56,799 efficiencies, 273 00:09:57,674 --> 00:09:59,375 quality, and economics. 274 00:10:00,075 --> 00:10:02,235 Yeah. And those are the primary ones that 275 00:10:02,235 --> 00:10:04,235 that organizations should be looking at, leaders should 276 00:10:04,235 --> 00:10:05,054 be looking at. 277 00:10:05,674 --> 00:10:09,115 When we measure this this ROI piece, taking 278 00:10:09,115 --> 00:10:10,654 a step back here really quickly, 279 00:10:11,159 --> 00:10:12,839 can you touch on some of the use 280 00:10:12,839 --> 00:10:14,839 cases that you've seen where this IUI is 281 00:10:14,919 --> 00:10:17,559 ROI is, like, clearly showing, okay, this makes 282 00:10:17,559 --> 00:10:18,459 the most sense, 283 00:10:18,919 --> 00:10:22,120 how it's affecting teams, etcetera. You've mentioned the 284 00:10:22,120 --> 00:10:23,799 the work life balance piece, right, that's hard 285 00:10:23,799 --> 00:10:25,785 to measure, etcetera. Can you touch on those 286 00:10:25,785 --> 00:10:29,144 use cases, and and which ones are important 287 00:10:29,144 --> 00:10:31,465 to you, and which ones are are have 288 00:10:31,465 --> 00:10:33,085 you seen make the biggest difference? 289 00:10:33,544 --> 00:10:36,024 I certainly can start, and I'll let Connie 290 00:10:36,024 --> 00:10:36,904 finish. But, 291 00:10:37,465 --> 00:10:38,605 let's just take 292 00:10:39,690 --> 00:10:40,190 avoidable 293 00:10:40,490 --> 00:10:42,110 ER visits or 294 00:10:42,889 --> 00:10:45,290 talking to every patient who's been in the 295 00:10:45,290 --> 00:10:46,509 emergency room. 296 00:10:46,970 --> 00:10:49,370 So we can identify people that we wanna 297 00:10:49,370 --> 00:10:51,309 reach out to who we feel 298 00:10:51,705 --> 00:10:53,465 maybe they shouldn't have been in the ER. 299 00:10:53,465 --> 00:10:55,144 They're paying a high co pay when they 300 00:10:55,144 --> 00:10:57,465 go to an ER when they could have 301 00:10:57,465 --> 00:10:59,625 done telehealth or they could have gone to 302 00:10:59,625 --> 00:11:02,985 an urgent care. And number two is when 303 00:11:02,985 --> 00:11:04,764 they get home, are they okay? 304 00:11:05,144 --> 00:11:06,605 Did did their issue 305 00:11:07,679 --> 00:11:09,919 get resolved, or do they need to follow-up 306 00:11:09,919 --> 00:11:12,080 with their primary care physician? If they don't 307 00:11:12,080 --> 00:11:14,080 have a primary care physician, how do we 308 00:11:14,080 --> 00:11:16,179 get them one? So there are many scenarios 309 00:11:16,320 --> 00:11:19,139 just with ER. Now in our program today, 310 00:11:19,535 --> 00:11:21,615 I may only be able to reach out 311 00:11:21,615 --> 00:11:23,535 with the capacity that I have with my 312 00:11:23,535 --> 00:11:26,254 nursing staff. I may only be able to 313 00:11:26,254 --> 00:11:29,375 reach out to, let's say, 200 members a 314 00:11:29,375 --> 00:11:31,955 day. But in our book of business, 315 00:11:32,500 --> 00:11:35,379 maybe we had 500 members that went to 316 00:11:35,379 --> 00:11:36,040 the ER 317 00:11:36,580 --> 00:11:37,080 yesterday. 318 00:11:37,860 --> 00:11:40,040 We wanna reach out to all 500. 319 00:11:40,580 --> 00:11:41,879 We can do that 320 00:11:42,660 --> 00:11:43,160 with 321 00:11:43,620 --> 00:11:46,519 Eleanor. Right? Eleanor can make those calls. 322 00:11:47,144 --> 00:11:48,365 So then 323 00:11:48,745 --> 00:11:50,904 Eleanor can make those calls, and if the 324 00:11:50,904 --> 00:11:53,245 member wants to talk to a human, 325 00:11:53,945 --> 00:11:55,865 we let them come through to talk to 326 00:11:55,865 --> 00:11:56,524 a nurse. 327 00:11:56,985 --> 00:11:59,004 But many times, surprisingly, 328 00:11:59,384 --> 00:12:01,384 the patient is just happy to talk to 329 00:12:01,384 --> 00:12:01,884 Eleanor, 330 00:12:02,639 --> 00:12:05,440 and Eleanor can call the patient back. They 331 00:12:05,440 --> 00:12:07,920 monitor the patient. How are you doing today? 332 00:12:07,920 --> 00:12:09,700 Can I call you back next week? 333 00:12:10,240 --> 00:12:12,960 So all of that work, all of that 334 00:12:12,960 --> 00:12:16,000 phone work has now been taken over by 335 00:12:16,000 --> 00:12:16,500 Eleanor, 336 00:12:17,174 --> 00:12:17,914 but, also, 337 00:12:18,774 --> 00:12:20,855 it allows the nurses to get the cases 338 00:12:20,855 --> 00:12:22,615 that a member wants to talk to a 339 00:12:22,615 --> 00:12:26,455 nurse. Right? But, also, that patient has now 340 00:12:26,455 --> 00:12:28,934 been reached we've reached 500 of them versus 341 00:12:28,934 --> 00:12:29,674 200. 342 00:12:29,949 --> 00:12:30,769 That's powerful. 343 00:12:31,149 --> 00:12:33,549 Right? And what you've mentioned, it's that tandem 344 00:12:33,549 --> 00:12:37,070 work of provider and AI working together. Right? 345 00:12:37,070 --> 00:12:39,789 It's not the the we're not eliminating one 346 00:12:39,789 --> 00:12:40,610 or the other. 347 00:12:40,990 --> 00:12:43,514 It's that that working together that really makes 348 00:12:43,514 --> 00:12:45,115 a difference. Connie, feel free to weigh in 349 00:12:45,115 --> 00:12:46,894 here too and on on your thoughts. 350 00:12:47,355 --> 00:12:49,455 Yeah. So always, it's about augmenting 351 00:12:50,715 --> 00:12:53,455 the clinical staff. Right? So we're the clinical 352 00:12:53,514 --> 00:12:54,894 staff's plus one. 353 00:12:55,460 --> 00:12:56,899 But there's a lot of work we can 354 00:12:56,899 --> 00:12:57,399 do 355 00:12:57,779 --> 00:13:00,580 where the majority of it, 85, 90% does 356 00:13:00,580 --> 00:13:03,299 not require a human. So, potentially, it's making 357 00:13:03,299 --> 00:13:06,340 outreach calls for vaccinations in the fall and 358 00:13:06,340 --> 00:13:08,259 to help people see the value of getting 359 00:13:08,259 --> 00:13:11,955 vaccinated. It's calling patients that are newly diagnosed 360 00:13:12,095 --> 00:13:12,995 with diabetes 361 00:13:13,375 --> 00:13:15,794 and educating them and then tracking with them 362 00:13:15,934 --> 00:13:18,735 and only sending them to a nurse when 363 00:13:18,735 --> 00:13:21,154 there's a need for a nurse. Right? 364 00:13:21,534 --> 00:13:22,274 And so, 365 00:13:22,894 --> 00:13:25,170 Michelle made a comment that people are happy 366 00:13:25,170 --> 00:13:26,769 to talk to Eleanor, and that is a 367 00:13:26,769 --> 00:13:29,009 true statement. We have people who have talked 368 00:13:29,009 --> 00:13:29,670 with her 369 00:13:30,210 --> 00:13:32,370 for months. Right? And then we have some 370 00:13:32,370 --> 00:13:34,450 outliers that we will say have maybe done 371 00:13:34,450 --> 00:13:36,870 it for years. Right? So people 372 00:13:37,170 --> 00:13:38,950 feel safe and cared for 373 00:13:39,284 --> 00:13:40,424 when an empathetic 374 00:13:41,284 --> 00:13:41,784 voice 375 00:13:42,644 --> 00:13:45,044 is outreaching. So I I you know, just 376 00:13:45,044 --> 00:13:47,304 to be very specific about this is Eleanor 377 00:13:47,365 --> 00:13:48,664 calls patients directly, 378 00:13:49,365 --> 00:13:51,365 and she's talking to them about what's going 379 00:13:51,365 --> 00:13:53,769 on in their world and then transferring when 380 00:13:53,769 --> 00:13:55,690 needed. So there's a whole host of use 381 00:13:55,690 --> 00:13:56,669 cases where 382 00:13:57,129 --> 00:13:58,190 the patient wins, 383 00:13:58,970 --> 00:14:02,990 the provider wins, everybody wins because the patient 384 00:14:03,129 --> 00:14:04,829 member feels heard. 385 00:14:05,875 --> 00:14:07,875 We're not losing the human touch even though 386 00:14:07,875 --> 00:14:10,834 we have an AI piece in Eleanor that 387 00:14:10,834 --> 00:14:13,394 takes care of an automated task piece, which 388 00:14:13,394 --> 00:14:15,794 is important. We're we're feeding volume, which is 389 00:14:15,794 --> 00:14:16,454 very important. 390 00:14:16,834 --> 00:14:17,815 And then your 391 00:14:18,470 --> 00:14:20,330 use cases become limitless. 392 00:14:20,710 --> 00:14:24,009 How do you integrate this into your program? 393 00:14:24,070 --> 00:14:26,490 So to anyone else that's running a program, 394 00:14:26,550 --> 00:14:27,210 you know, 395 00:14:27,750 --> 00:14:29,670 ER is just one use case, but there 396 00:14:29,670 --> 00:14:32,570 are so many different use cases. 397 00:14:33,404 --> 00:14:36,304 And that is the fun part of AI 398 00:14:36,605 --> 00:14:37,105 is 399 00:14:37,725 --> 00:14:38,625 just the creativity 400 00:14:39,084 --> 00:14:41,664 of how you integrate this. But you do 401 00:14:41,964 --> 00:14:43,964 so for all of those listening, you do 402 00:14:43,964 --> 00:14:45,985 need to integrate it into your 403 00:14:46,289 --> 00:14:49,089 processes. That's the work. Integrating it into your 404 00:14:49,089 --> 00:14:49,589 workflows, 405 00:14:50,209 --> 00:14:53,169 training your staff all about AI. Those are 406 00:14:53,169 --> 00:14:54,709 two very important things. 407 00:14:55,330 --> 00:14:56,149 But then 408 00:14:57,009 --> 00:14:59,490 the potential is seen by everybody. And so 409 00:14:59,490 --> 00:15:00,709 we have our nurses 410 00:15:01,264 --> 00:15:03,904 creating new workflows and asking, why don't we 411 00:15:03,904 --> 00:15:06,465 use AI for this? Yeah. So it is 412 00:15:06,465 --> 00:15:06,965 exciting. 413 00:15:07,745 --> 00:15:09,504 Once you get your hands in there and 414 00:15:09,504 --> 00:15:11,745 start to use it, you can see a 415 00:15:11,745 --> 00:15:13,365 lot of different potential 416 00:15:14,065 --> 00:15:14,884 use cases 417 00:15:15,370 --> 00:15:17,070 for other things that you do. 418 00:15:17,929 --> 00:15:19,929 Yeah. And and we've touched on this earlier, 419 00:15:20,170 --> 00:15:22,250 in the conversation as well. Right? This is 420 00:15:22,250 --> 00:15:25,149 a a complex space. There's a lot happening. 421 00:15:25,370 --> 00:15:27,370 It can be intimidating. There's a lot of 422 00:15:27,370 --> 00:15:29,850 questions. A lot of folks don't necessarily know 423 00:15:29,850 --> 00:15:31,070 how everything works. 424 00:15:31,574 --> 00:15:32,934 Michelle, I'd love to stay with you on 425 00:15:32,934 --> 00:15:34,375 this. You've touched on it just a little 426 00:15:34,375 --> 00:15:35,595 bit here in your answer. 427 00:15:35,975 --> 00:15:38,934 But what's the the one piece of advice 428 00:15:38,934 --> 00:15:40,774 that you have that you want to offer 429 00:15:40,774 --> 00:15:43,414 peers that are looking to integrate more AI 430 00:15:43,414 --> 00:15:45,034 into care management programs? 431 00:15:45,495 --> 00:15:46,714 Where should they start, 432 00:15:47,149 --> 00:15:48,769 and what should they try to avoid? 433 00:15:49,230 --> 00:15:49,730 Sure. 434 00:15:50,110 --> 00:15:52,850 AI is not gonna solve the entire world, 435 00:15:52,990 --> 00:15:56,049 which some people promise. That is not true. 436 00:15:56,429 --> 00:15:58,529 AI is not going to replace 437 00:15:58,990 --> 00:16:00,129 nurses' jobs. 438 00:16:00,865 --> 00:16:02,404 Those are two big things. 439 00:16:02,865 --> 00:16:05,285 Then number three is don't be intimidated 440 00:16:06,384 --> 00:16:07,365 by AI. 441 00:16:08,144 --> 00:16:10,085 Every leader in care management 442 00:16:10,465 --> 00:16:13,445 knows that we must constantly change. 443 00:16:13,930 --> 00:16:15,389 Adaptation and change 444 00:16:15,769 --> 00:16:18,509 is in our DNA as a case manager, 445 00:16:19,050 --> 00:16:20,190 and this is just 446 00:16:20,490 --> 00:16:21,629 a new technology 447 00:16:22,490 --> 00:16:23,629 that helps nurses 448 00:16:24,090 --> 00:16:25,470 work at top of licensure. 449 00:16:26,504 --> 00:16:28,445 And don't be afraid 450 00:16:28,825 --> 00:16:32,184 to test it. So go small. Test one 451 00:16:32,184 --> 00:16:33,085 small thing 452 00:16:33,705 --> 00:16:36,985 and become comfortable with it. Let your teams 453 00:16:36,985 --> 00:16:39,440 become comfortable with it. And 454 00:16:39,820 --> 00:16:40,639 then you know 455 00:16:41,100 --> 00:16:43,740 that as people become more comfortable, they will 456 00:16:43,740 --> 00:16:44,720 see the potential, 457 00:16:45,259 --> 00:16:47,580 and the use cases will grow. So start 458 00:16:47,580 --> 00:16:48,960 small. Don't be intimidated 459 00:16:49,340 --> 00:16:50,320 and start small. 460 00:16:51,054 --> 00:16:53,695 Dave mentioned the workflow integration piece, which is 461 00:16:53,695 --> 00:16:56,014 so important to let teams explore how it's 462 00:16:56,014 --> 00:16:57,715 working within their own workflows 463 00:16:58,175 --> 00:17:00,175 so they feel like they're still in charge. 464 00:17:00,175 --> 00:17:02,254 Right? It's not taking Absolutely. What they're doing, 465 00:17:02,254 --> 00:17:04,335 which is so important. Connie, same question for 466 00:17:04,335 --> 00:17:06,000 you. What are the some of the things 467 00:17:06,000 --> 00:17:08,160 that you're talking about in terms of, hey. 468 00:17:08,160 --> 00:17:10,080 This is what folks should pay attention to. 469 00:17:10,080 --> 00:17:11,619 This is what they should they avoid. 470 00:17:12,000 --> 00:17:12,980 What are your thoughts? 471 00:17:13,519 --> 00:17:16,080 Yeah. So so one of the things that 472 00:17:16,080 --> 00:17:18,900 we encourage people to do is ask 473 00:17:19,434 --> 00:17:21,134 solution partners hard questions. 474 00:17:22,315 --> 00:17:25,214 Ask about how are you training the models 475 00:17:25,755 --> 00:17:26,974 that you are using. 476 00:17:27,434 --> 00:17:28,575 How do you prevent 477 00:17:28,955 --> 00:17:29,455 hallucinations? 478 00:17:30,394 --> 00:17:32,474 How are you going to attend to a 479 00:17:32,474 --> 00:17:34,255 critical issue? If 480 00:17:34,880 --> 00:17:37,840 technology if in our case, Eleanor is talking 481 00:17:37,840 --> 00:17:38,660 to a person 482 00:17:39,039 --> 00:17:40,580 and a person is expressing 483 00:17:41,360 --> 00:17:42,420 suicidal ideation, 484 00:17:43,200 --> 00:17:45,440 what are you gonna do? So ask the 485 00:17:45,440 --> 00:17:46,340 hard question. 486 00:17:46,799 --> 00:17:47,920 Right? And, 487 00:17:48,744 --> 00:17:50,605 solutions that have been in practice 488 00:17:51,144 --> 00:17:53,785 for a while will have protocols for those 489 00:17:53,785 --> 00:17:54,285 things, 490 00:17:55,625 --> 00:17:57,865 and you will get the answers. One of 491 00:17:57,865 --> 00:17:59,785 the things that we've created is a list 492 00:17:59,785 --> 00:18:02,684 of questions that the people we're working with, 493 00:18:03,599 --> 00:18:06,740 payers, providers, whoever, here's a list of questions 494 00:18:06,960 --> 00:18:10,160 that you will wanna consider asking anyone who 495 00:18:10,160 --> 00:18:12,799 is going to be speaking with your patients 496 00:18:12,799 --> 00:18:13,460 and members. 497 00:18:13,920 --> 00:18:14,420 Yeah. 498 00:18:14,880 --> 00:18:17,779 Right? So you can feel confident to Michelle's 499 00:18:18,265 --> 00:18:19,565 point that 500 00:18:19,865 --> 00:18:21,484 the solution isn't overpromising, 501 00:18:22,664 --> 00:18:24,285 but that they are gonna deliver 502 00:18:24,904 --> 00:18:25,724 or overdeliver. 503 00:18:26,105 --> 00:18:28,924 Right? So good questions make a big difference. 504 00:18:29,785 --> 00:18:33,320 Can I possibly end with a wonderful case? 505 00:18:33,320 --> 00:18:35,900 I find giving people real life cases 506 00:18:36,680 --> 00:18:39,960 helps people understand how this works. Sure. So 507 00:18:39,960 --> 00:18:42,119 we're calling patients who have been to the 508 00:18:42,119 --> 00:18:44,519 emergency room, checking in on them, making sure 509 00:18:44,519 --> 00:18:45,259 they're okay. 510 00:18:45,684 --> 00:18:47,845 First of all, for all of those that 511 00:18:47,845 --> 00:18:50,484 are listening, we have a 72% 512 00:18:50,484 --> 00:18:53,365 answer rate. So 72% of the people we're 513 00:18:53,365 --> 00:18:55,365 calling are answering the phone and talking to 514 00:18:55,365 --> 00:18:55,865 Eleanor. 515 00:18:56,805 --> 00:18:57,785 In this situation, 516 00:18:58,404 --> 00:19:00,025 Eleanor talked to a patient 517 00:19:00,789 --> 00:19:02,730 who asked to be transferred 518 00:19:03,029 --> 00:19:04,490 to a nurse case manager 519 00:19:05,109 --> 00:19:07,210 because she was having palpitations, 520 00:19:08,390 --> 00:19:10,710 and she couldn't get an appointment with her 521 00:19:10,710 --> 00:19:11,210 cardiologist 522 00:19:12,470 --> 00:19:14,170 within the next week. 523 00:19:14,515 --> 00:19:16,115 And she was nervous. She didn't know what 524 00:19:16,115 --> 00:19:18,755 to do. This is exactly the patient that 525 00:19:18,755 --> 00:19:20,515 will go back to the ER, right, because 526 00:19:20,515 --> 00:19:22,294 she can't get in to see the cardiologist. 527 00:19:23,554 --> 00:19:25,255 Call was transferred from Eleanor 528 00:19:26,035 --> 00:19:28,054 into our care advocate program. 529 00:19:28,595 --> 00:19:29,095 Advocate 530 00:19:30,029 --> 00:19:32,210 picked up the call, talked to the patient, 531 00:19:32,590 --> 00:19:33,410 turned around, 532 00:19:33,710 --> 00:19:35,090 called the doctor's office, 533 00:19:35,549 --> 00:19:38,049 and got the person in the next day 534 00:19:38,430 --> 00:19:39,490 with their specialist. 535 00:19:40,509 --> 00:19:42,529 That is advocating for the member, 536 00:19:43,294 --> 00:19:43,794 and 537 00:19:44,494 --> 00:19:46,674 we avoided a future ER visit. 538 00:19:47,054 --> 00:19:48,434 That's where she would have gone. 539 00:19:48,734 --> 00:19:50,674 So isn't that a wonderful story? 540 00:19:51,134 --> 00:19:53,454 Yeah. Absolutely. Again, it it illustrates partnership. It 541 00:19:53,454 --> 00:19:53,954 illustrates 542 00:19:54,335 --> 00:19:56,095 understanding it, what it can actually do. So 543 00:19:56,095 --> 00:19:57,730 I appreciate you sharing that because, again, I 544 00:19:57,730 --> 00:20:00,210 agree. Use cases are very important for folks 545 00:20:00,210 --> 00:20:02,470 to understand how this actually works. 546 00:20:02,769 --> 00:20:04,609 Michelle and Connie, thank you so much for 547 00:20:04,609 --> 00:20:06,470 taking the time today. This was a fantastic 548 00:20:06,529 --> 00:20:08,930 conversation. So many great insights. Thanks so much 549 00:20:08,930 --> 00:20:09,750 for being here. 550 00:20:10,345 --> 00:20:12,825 Appreciate the help of you today. Yes. Absolutely. 551 00:20:12,825 --> 00:20:14,424 And we also want to thank our podcast 552 00:20:14,424 --> 00:20:16,265 sponsor. Mind you, you can tune in to 553 00:20:16,265 --> 00:20:18,345 more podcasts from Becker's Healthcare by visiting our 554 00:20:18,345 --> 00:20:21,805 podcast page at beckershospitalreview.com.