1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:34,049 --> 00:00:36,689 Hello, everyone. Welcome to Becker's Healthcare Podcast. I'm 14 00:00:36,689 --> 00:00:38,609 Scott King. Thrilled today to be joined by 15 00:00:38,609 --> 00:00:42,129 very special guest, Emily Durfee, partner, corporate venture 16 00:00:42,129 --> 00:00:42,629 capital 17 00:00:42,954 --> 00:00:44,875 with HealthWorks. Emily Hardy, thanks so much for 18 00:00:44,875 --> 00:00:45,774 joining the podcast. 19 00:00:46,234 --> 00:00:47,594 Thank you so much for having me. I'm 20 00:00:47,594 --> 00:00:49,295 doing really well. How are you doing today? 21 00:00:49,594 --> 00:00:51,195 I'm doing great. We were just talking before. 22 00:00:51,195 --> 00:00:52,634 You know, it's getting, like, a little bit 23 00:00:52,634 --> 00:00:55,114 warmer in Chicago, which is, like, 25 degrees. 24 00:00:55,114 --> 00:00:58,109 So, you know, getting those sunglasses ready. But, 25 00:00:58,270 --> 00:00:59,710 no, we thanks so much for joining. We 26 00:00:59,710 --> 00:01:00,829 have a lot to to get to, a 27 00:01:00,829 --> 00:01:02,670 lot of kind of big topics in in 28 00:01:02,670 --> 00:01:04,349 health care and and with health plans as 29 00:01:04,349 --> 00:01:06,189 always. But, before we do that, Emily, I 30 00:01:06,189 --> 00:01:07,709 was wondering if you could just share a 31 00:01:07,709 --> 00:01:10,030 little about your background and your, career in 32 00:01:10,030 --> 00:01:10,689 health care. 33 00:01:11,284 --> 00:01:12,884 Absolutely. So I have one of those quote, 34 00:01:12,884 --> 00:01:13,864 unquote, nontraditional 35 00:01:14,244 --> 00:01:16,244 backgrounds, which is either a good thing or 36 00:01:16,244 --> 00:01:18,564 a bad thing depending on your perspective. Obviously, 37 00:01:18,564 --> 00:01:20,484 I think it's a good thing. But I 38 00:01:20,484 --> 00:01:23,125 spent most of my career in startups and 39 00:01:23,125 --> 00:01:25,849 venture capital. So actually started my career in 40 00:01:25,849 --> 00:01:28,090 Nairobi, Kenya, worked for a startup in Sub 41 00:01:28,090 --> 00:01:29,870 Saharan Africa for about five years, 42 00:01:30,329 --> 00:01:32,569 did impact investing into health care and education 43 00:01:32,569 --> 00:01:34,890 over there, and then moved more into The 44 00:01:34,890 --> 00:01:37,625 US focused world. So, worked for, at that 45 00:01:37,625 --> 00:01:40,505 point, a Neo, insurance company called Clover Health 46 00:01:40,505 --> 00:01:43,084 from 2015 to 2017 out in San Francisco, 47 00:01:43,625 --> 00:01:45,784 and joined this company about five years ago. 48 00:01:45,784 --> 00:01:48,344 So since then, have been working, HealthWorks as 49 00:01:48,344 --> 00:01:50,924 the innovation investment arm of CareFirst BlueCross BlueShield, 50 00:01:51,540 --> 00:01:53,140 and have been focused on how can we 51 00:01:53,140 --> 00:01:55,380 drive innovation in health care as well as, 52 00:01:55,380 --> 00:01:57,700 you know, meet the needs of the strategics 53 00:01:57,700 --> 00:01:59,140 in health care, like the big payers and 54 00:01:59,140 --> 00:01:59,640 providers, 55 00:02:00,020 --> 00:02:02,359 in order to marry the the traditional, 56 00:02:03,780 --> 00:02:06,655 reach and value of, health care players, and 57 00:02:06,655 --> 00:02:08,175 the innovation of some of the folks coming 58 00:02:08,175 --> 00:02:10,094 out of whether it's San Francisco, New York, 59 00:02:10,094 --> 00:02:12,114 or whatever small town you're part of. 60 00:02:12,735 --> 00:02:14,014 Well, I think sometimes, you know, it gives 61 00:02:14,014 --> 00:02:15,935 you a really unique perspective to be outside 62 00:02:15,935 --> 00:02:17,474 of that, you know, traditional 63 00:02:18,759 --> 00:02:21,560 landscape of of health care and, you know, 64 00:02:21,560 --> 00:02:23,040 a career trajectory. So I think you bring 65 00:02:23,040 --> 00:02:24,680 a really unique perspective, and thanks so much 66 00:02:24,680 --> 00:02:27,639 for sharing all that. Absolutely. I'm excited to 67 00:02:27,639 --> 00:02:29,479 share what I can and, obviously, just really 68 00:02:29,479 --> 00:02:31,080 grateful for the opportunities that I've gotten through 69 00:02:31,080 --> 00:02:32,139 the course of my career. 70 00:02:32,775 --> 00:02:34,055 Excellent. And, you know, the first thing I 71 00:02:34,055 --> 00:02:35,895 wanted to ask you about, Emily, is how 72 00:02:35,895 --> 00:02:38,455 are your relationships with providers changing as both 73 00:02:38,455 --> 00:02:41,275 sides face, you know, all kinds of regulatory 74 00:02:41,335 --> 00:02:43,355 pressures, but specifically cost pressure 75 00:02:43,814 --> 00:02:45,115 and workforce shortages? 76 00:02:45,849 --> 00:02:47,689 Yeah. Absolutely. I mean, I I would say 77 00:02:47,689 --> 00:02:49,210 that I don't think that this is new. 78 00:02:49,210 --> 00:02:50,729 Right? We've been seeing the writing on the 79 00:02:50,729 --> 00:02:52,969 wall for these pressures, these cost pressures, these 80 00:02:52,969 --> 00:02:55,530 employment pressures for a really long time. And 81 00:02:55,530 --> 00:02:57,290 so I would say that our strategies haven't 82 00:02:57,290 --> 00:03:00,074 changed significantly. They're just accelerating. Right? And so 83 00:03:00,155 --> 00:03:01,754 we're really focused on how can we continue 84 00:03:01,754 --> 00:03:02,655 to work collaboratively 85 00:03:03,114 --> 00:03:04,735 with providers. How can we identify 86 00:03:05,194 --> 00:03:07,194 win wins for both of us. Right? So 87 00:03:07,194 --> 00:03:09,514 whether that's certain types of contract types, value 88 00:03:09,514 --> 00:03:12,235 based care arrangements, shared savings contracts, if that's 89 00:03:12,235 --> 00:03:13,935 different types of referral systems. 90 00:03:14,460 --> 00:03:16,060 And then also, right, we're looking at how 91 00:03:16,060 --> 00:03:17,979 do we partner with new types of providers, 92 00:03:17,979 --> 00:03:21,040 whether that's different types of nationalized telemedicine providers 93 00:03:21,099 --> 00:03:22,319 or local providers, 94 00:03:23,020 --> 00:03:24,780 that cover some of the gaps that our 95 00:03:24,780 --> 00:03:26,540 members are experiencing. And so how can we 96 00:03:26,540 --> 00:03:29,435 continue to both work creatively with our current 97 00:03:29,435 --> 00:03:32,175 provider partners and add additional provider partners in 98 00:03:32,235 --> 00:03:33,914 to ensure that we are, you know, working 99 00:03:33,914 --> 00:03:35,614 across the board to serve our members? 100 00:03:36,474 --> 00:03:37,914 But the reality is I don't think there's 101 00:03:37,914 --> 00:03:39,754 a silver bullet in this one, and we 102 00:03:39,754 --> 00:03:42,419 need to continue to be collaborative and thoughtful 103 00:03:42,419 --> 00:03:44,099 in how we approach each other to solve 104 00:03:44,099 --> 00:03:45,560 these problems together. 105 00:03:46,419 --> 00:03:47,699 You know, some people I've talked to on 106 00:03:47,699 --> 00:03:49,699 the health plan side feel like there is 107 00:03:49,699 --> 00:03:51,159 more of a kind of collaboration. 108 00:03:51,540 --> 00:03:53,620 You know, I don't wanna say it's easier 109 00:03:53,620 --> 00:03:55,300 and working easier right now, but it's there 110 00:03:55,379 --> 00:03:57,724 it seems more collaborative, I guess, because both 111 00:03:57,784 --> 00:04:00,104 payers and providers are both up against, you 112 00:04:00,104 --> 00:04:03,064 know, all kinds of specifically regulatory pressures. Is 113 00:04:03,064 --> 00:04:04,185 that is that what you find? Like, people 114 00:04:04,185 --> 00:04:05,784 are both sides just kinda wanna get things 115 00:04:05,784 --> 00:04:07,544 done, so maybe there is a little more 116 00:04:07,544 --> 00:04:09,564 collaboration right now than than normally? 117 00:04:10,330 --> 00:04:12,409 Yeah. I would say I at least from 118 00:04:12,409 --> 00:04:14,489 my perspective, we haven't had bad collaboration in 119 00:04:14,489 --> 00:04:16,250 the past. I think, you know, we're really 120 00:04:16,250 --> 00:04:19,370 lucky as a regional blues plan. We're really 121 00:04:19,370 --> 00:04:21,930 much more focused on, you know, building deep 122 00:04:21,930 --> 00:04:24,404 relationships in our geographic region. And so, you 123 00:04:24,485 --> 00:04:25,764 know, I think compared to some of the 124 00:04:25,764 --> 00:04:27,845 maybe larger and more national players, we already 125 00:04:27,845 --> 00:04:29,444 have a lot of that collaboration and that 126 00:04:29,444 --> 00:04:31,845 goodwill between us. But, yes, of course. Right? 127 00:04:31,845 --> 00:04:33,925 Like, the reality is that we we both 128 00:04:33,925 --> 00:04:35,944 know that we can't function without each other. 129 00:04:36,564 --> 00:04:39,044 And given all of the the movements that 130 00:04:39,044 --> 00:04:40,529 are happening in the payer and the provider 131 00:04:40,529 --> 00:04:41,970 space. Right? If you're thinking about roll ups, 132 00:04:41,970 --> 00:04:44,050 if you're thinking about, certain types of especially 133 00:04:44,050 --> 00:04:46,850 government programs, payer, per like, state shutting down. 134 00:04:46,850 --> 00:04:48,850 There's just so much that's going on that's 135 00:04:48,850 --> 00:04:50,529 making us turn towards each other as opposed 136 00:04:50,529 --> 00:04:52,129 to away from each other even more right 137 00:04:52,129 --> 00:04:52,629 now. 138 00:04:53,394 --> 00:04:53,894 Absolutely. 139 00:04:54,354 --> 00:04:55,954 And where do you see the biggest gap 140 00:04:55,954 --> 00:04:59,175 today between payer strategy and operational execution? 141 00:04:59,875 --> 00:05:02,035 You know, obviously, I'm a little biased because 142 00:05:02,035 --> 00:05:03,555 I sit on the kind of innovation and 143 00:05:03,555 --> 00:05:06,274 investment perspective. But from my perspective, it's really 144 00:05:06,274 --> 00:05:08,709 the speed of adoption around new technologies for 145 00:05:08,709 --> 00:05:09,610 payers. Right? 146 00:05:10,229 --> 00:05:11,689 This isn't really new. 147 00:05:12,069 --> 00:05:13,509 I feel like one of my favorite facts 148 00:05:13,509 --> 00:05:15,349 or or jokes to make around this is, 149 00:05:15,349 --> 00:05:17,669 you know, email has existed for decades at 150 00:05:17,669 --> 00:05:19,509 this point. Right? And yet still health care 151 00:05:19,509 --> 00:05:21,305 depends significantly on faxes 152 00:05:21,605 --> 00:05:24,245 as a form of communication, which seems slightly 153 00:05:24,245 --> 00:05:24,745 suboptimal. 154 00:05:25,605 --> 00:05:27,444 But especially right now as we're seeing the 155 00:05:27,444 --> 00:05:28,985 rise in artificial intelligence, 156 00:05:29,524 --> 00:05:32,084 and other types of technological advancements, and as 157 00:05:32,084 --> 00:05:34,345 we're seeing these rising costs and especially these 158 00:05:35,610 --> 00:05:37,569 burdens, both for payers and providers, you know, 159 00:05:37,569 --> 00:05:39,129 it's, I think, even more critical that we're 160 00:05:39,129 --> 00:05:40,810 able to quickly adopt some of these new 161 00:05:40,810 --> 00:05:41,310 technologies. 162 00:05:41,930 --> 00:05:43,610 And to be clear, I understand why that's 163 00:05:43,610 --> 00:05:45,850 not happening. Right? It's not all AI has 164 00:05:45,850 --> 00:05:48,170 been fully vetted for the really sensitive business 165 00:05:48,170 --> 00:05:50,004 of health care. There's a lot of risk 166 00:05:50,004 --> 00:05:52,085 for us in adopting new technologies for some 167 00:05:52,085 --> 00:05:54,165 of our core programs because no one likes 168 00:05:54,165 --> 00:05:55,464 it if you have a technological 169 00:05:55,764 --> 00:05:58,025 issue and then suddenly a claim isn't paid. 170 00:05:58,165 --> 00:05:59,605 Right? And so I think that there are 171 00:05:59,605 --> 00:06:02,399 a lot of, reasons that that adoption hasn't 172 00:06:02,479 --> 00:06:04,240 happened quickly. But I do think that that 173 00:06:04,240 --> 00:06:05,839 is the biggest gap right now and the 174 00:06:05,839 --> 00:06:07,360 thing that I'm most excited to try to 175 00:06:07,360 --> 00:06:08,879 work to solve, which is how can we 176 00:06:08,879 --> 00:06:10,639 do this in ways that are lower risk 177 00:06:10,639 --> 00:06:12,899 for providers, for patients, for, 178 00:06:13,360 --> 00:06:15,839 individuals on the payer side, etcetera, but is 179 00:06:15,839 --> 00:06:16,740 actually accelerating 180 00:06:17,625 --> 00:06:19,545 us towards a better and more streamlined future, 181 00:06:20,105 --> 00:06:21,865 because I think we have to in order 182 00:06:21,865 --> 00:06:23,485 to stay sustainable as a business. 183 00:06:24,425 --> 00:06:26,044 Is there a new tech or 184 00:06:26,345 --> 00:06:28,345 or perhaps an AI rollout that was easy 185 00:06:28,345 --> 00:06:29,485 for you or 186 00:06:29,785 --> 00:06:32,125 or HealthWorks to adopt to recently? 187 00:06:32,959 --> 00:06:34,720 You know, I think the easiest options when 188 00:06:34,720 --> 00:06:36,080 it comes to these rollouts are, 189 00:06:36,879 --> 00:06:39,360 niche products. Right? So they're the things that 190 00:06:39,360 --> 00:06:40,580 are very specifically 191 00:06:41,199 --> 00:06:43,279 working with one type of provider, right, or 192 00:06:43,279 --> 00:06:45,199 one type of patient or are part of 193 00:06:45,199 --> 00:06:48,134 one small element of a member's journey through 194 00:06:48,134 --> 00:06:49,115 our system, etcetera. 195 00:06:49,974 --> 00:06:52,134 I think that those are important and they're 196 00:06:52,134 --> 00:06:54,294 really, really good experiments. And the good news 197 00:06:54,294 --> 00:06:56,314 about those is they do, in fact, affect 198 00:06:56,615 --> 00:06:59,354 the outcomes of our members and our providers 199 00:06:59,495 --> 00:07:00,154 and us, 200 00:07:00,935 --> 00:07:03,670 but aren't super, super high risk. If something 201 00:07:03,670 --> 00:07:05,270 doesn't go well, right, if there's a glitch 202 00:07:05,270 --> 00:07:07,189 in the system, if someone can't get to 203 00:07:07,189 --> 00:07:08,790 a web page for a little while, obviously, 204 00:07:08,790 --> 00:07:10,310 that's not something we want, but it's not 205 00:07:10,310 --> 00:07:12,069 going to be, you know, detrimental to the 206 00:07:12,069 --> 00:07:12,889 entire system. 207 00:07:13,634 --> 00:07:15,154 Unfortunately, those are the things that aren't going 208 00:07:15,154 --> 00:07:16,914 to have as much lift. Right? If you 209 00:07:16,914 --> 00:07:19,235 start to talk about, you know, overall claims 210 00:07:19,235 --> 00:07:19,735 processing, 211 00:07:20,354 --> 00:07:21,095 prior authorization, 212 00:07:21,474 --> 00:07:24,595 etcetera. Right? That's where the biggest opportunity set 213 00:07:24,595 --> 00:07:26,194 is, and that's also where the biggest risk 214 00:07:26,194 --> 00:07:28,034 is. And so I think we're still figuring 215 00:07:28,034 --> 00:07:30,250 out exactly how we can continue to to 216 00:07:30,250 --> 00:07:30,750 test 217 00:07:31,370 --> 00:07:33,790 and manage, those types of rollouts effectively. 218 00:07:35,050 --> 00:07:37,689 If you could change one regulatory or industry 219 00:07:37,689 --> 00:07:40,910 practice tomorrow to improve affordability and access, 220 00:07:41,370 --> 00:07:42,670 what would it be and why? 221 00:07:43,274 --> 00:07:44,555 Yeah. You know, I was thinking about this, 222 00:07:44,555 --> 00:07:46,235 and I, like, I have two answers for 223 00:07:46,235 --> 00:07:46,735 you. 224 00:07:47,274 --> 00:07:49,274 The first is maybe table stakes, but I 225 00:07:49,274 --> 00:07:51,675 do think it's important. Like, realistically, on the 226 00:07:51,675 --> 00:07:53,834 regulatory side, I feel like the most important 227 00:07:53,834 --> 00:07:55,295 thing that we would have 228 00:07:55,740 --> 00:07:56,639 is clarity. 229 00:07:57,019 --> 00:07:59,660 Right? And it's not a specific regulatory initiative 230 00:07:59,660 --> 00:08:01,339 that I'm arguing for. It's mostly that, you 231 00:08:01,339 --> 00:08:03,500 know, over the last few years, I think 232 00:08:03,500 --> 00:08:05,899 there's been a lot of swings around, what 233 00:08:05,899 --> 00:08:07,660 to expect on the Medicare side, on the 234 00:08:07,660 --> 00:08:10,620 Medicaid side, on, certain types of states funding, 235 00:08:10,620 --> 00:08:11,120 etcetera. 236 00:08:11,794 --> 00:08:13,735 And I think that's made it really difficult 237 00:08:15,555 --> 00:08:17,794 for payers certainly, I imagine providers too to 238 00:08:17,794 --> 00:08:19,394 make effective decisions and to be able to 239 00:08:19,394 --> 00:08:21,394 stand by those strategic decisions and see through 240 00:08:21,394 --> 00:08:23,094 kind of the long arcs of implementation 241 00:08:23,394 --> 00:08:24,055 and change 242 00:08:24,479 --> 00:08:26,720 that often come with really established systems. 243 00:08:27,439 --> 00:08:29,759 And I think just the the amount of 244 00:08:29,759 --> 00:08:31,919 difference and some some amount of even chaos. 245 00:08:31,919 --> 00:08:33,440 Right? If you even look at kind of, 246 00:08:33,600 --> 00:08:36,000 the number of, debates and shutdowns that the 247 00:08:36,000 --> 00:08:38,019 federal government has had around, 248 00:08:38,355 --> 00:08:40,595 certain types of funding makes it really difficult 249 00:08:40,595 --> 00:08:43,095 for those changes to be implemented in strategic 250 00:08:43,154 --> 00:08:44,674 ways. And so I think at the very 251 00:08:44,674 --> 00:08:45,634 least some amount of, 252 00:08:46,514 --> 00:08:48,995 you know, kind of clarity and stability in 253 00:08:48,995 --> 00:08:50,995 regulation, I think is actually going to be 254 00:08:50,995 --> 00:08:53,259 the biggest and most important driver in the 255 00:08:53,259 --> 00:08:55,179 health care space. At the same time, I 256 00:08:55,179 --> 00:08:56,539 would be remiss if I didn't mention the 257 00:08:56,539 --> 00:08:58,139 fact that, like, the speed of review and 258 00:08:58,139 --> 00:09:00,080 approval around new health care solutions 259 00:09:00,460 --> 00:09:02,320 does make it harder to bring new innovations 260 00:09:02,379 --> 00:09:03,820 to the table. And so I do think 261 00:09:03,820 --> 00:09:05,740 that there's also certain types of regulations that 262 00:09:05,740 --> 00:09:07,115 I would love to see around, you know, 263 00:09:07,115 --> 00:09:09,134 how we can very quickly understand and measure, 264 00:09:09,595 --> 00:09:12,075 whether or not these new innovations work. And 265 00:09:12,075 --> 00:09:14,075 if they are working, bring them to market 266 00:09:14,075 --> 00:09:15,995 more quickly. So I do think that there's 267 00:09:15,995 --> 00:09:17,294 opportunity there as well. 268 00:09:17,674 --> 00:09:19,195 What what do you think is is maybe 269 00:09:19,195 --> 00:09:21,460 one big step that that needs to be 270 00:09:21,460 --> 00:09:24,360 taken to work towards that clarity and stabilization 271 00:09:24,500 --> 00:09:25,480 you were talking about? 272 00:09:26,179 --> 00:09:28,740 Oh, you know, honestly, I think that's outside 273 00:09:28,740 --> 00:09:30,179 of my pay grade, right, in the sense 274 00:09:30,179 --> 00:09:31,539 of I think that there's a lot of 275 00:09:31,539 --> 00:09:33,445 dynamics right now in the health, sorry, in 276 00:09:33,445 --> 00:09:35,144 the American political landscape 277 00:09:35,605 --> 00:09:37,705 Sure. That are incredibly polarized, 278 00:09:38,964 --> 00:09:40,485 that I think are at the root of 279 00:09:40,485 --> 00:09:42,085 a lot of this. Right? But at the 280 00:09:42,085 --> 00:09:44,404 very least, you know, having ways of thinking 281 00:09:44,404 --> 00:09:47,445 through longer term budgeting processes, ideally trying to 282 00:09:47,445 --> 00:09:48,664 have folks who are working, 283 00:09:49,019 --> 00:09:51,259 across the aisle more effectively to come up 284 00:09:51,259 --> 00:09:53,420 with a situation in which we're not kind 285 00:09:53,420 --> 00:09:55,660 of so polarized in what we expect generally 286 00:09:55,660 --> 00:09:58,139 and in health care policy. And, therefore, depending 287 00:09:58,139 --> 00:09:59,980 on who is in power, we're swinging pretty 288 00:09:59,980 --> 00:10:01,680 rapidly between those two pieces. 289 00:10:02,365 --> 00:10:04,205 Yeah. Absolutely. I mean, there's there's there's so 290 00:10:04,205 --> 00:10:05,965 many different things going on. It's hard to 291 00:10:05,965 --> 00:10:07,325 anticipate, so you kinda just have to be 292 00:10:07,325 --> 00:10:09,165 able to pivot and and, you know, have 293 00:10:09,165 --> 00:10:10,605 an awareness there of what you can do 294 00:10:10,605 --> 00:10:11,105 differently. 295 00:10:11,565 --> 00:10:13,165 I think that's a great point. Yeah. And 296 00:10:13,165 --> 00:10:15,245 there's conflict right now even between federal governments 297 00:10:15,245 --> 00:10:17,565 and state governments. Right? And so I think 298 00:10:17,565 --> 00:10:19,299 that's just oh, and and to be clear. 299 00:10:19,299 --> 00:10:20,980 Right? Like, I I think that that is 300 00:10:21,059 --> 00:10:23,220 it's just difficult for us to plan around 301 00:10:23,220 --> 00:10:23,879 and manage. 302 00:10:24,340 --> 00:10:26,039 I think that there are lots of opportunities 303 00:10:26,820 --> 00:10:28,679 for us to build and be successful, 304 00:10:29,139 --> 00:10:30,820 but it is hard when you have such 305 00:10:30,820 --> 00:10:32,980 large organizations to pivot as quickly as our 306 00:10:32,980 --> 00:10:35,674 regulation is changing. Of course. I think everyone 307 00:10:35,834 --> 00:10:37,195 a lot of people can identify with that 308 00:10:37,195 --> 00:10:38,014 a 100%. 309 00:10:38,235 --> 00:10:40,235 And, Emily, what issue do you think is 310 00:10:40,235 --> 00:10:42,575 putting the most pressure on health plan margins 311 00:10:42,634 --> 00:10:43,375 right now, 312 00:10:43,754 --> 00:10:44,254 and 313 00:10:44,634 --> 00:10:46,554 how are you responding differently to that in 314 00:10:46,554 --> 00:10:47,615 2026? 315 00:10:48,309 --> 00:10:50,550 Yeah. Absolutely. I mean, from our perspective, the 316 00:10:50,550 --> 00:10:51,910 rising cost of care is by far the 317 00:10:51,910 --> 00:10:53,190 biggest pressure for us. Right? 318 00:10:54,070 --> 00:10:55,350 There are so many different things that are 319 00:10:55,350 --> 00:10:57,830 actually driving that. There's chronic conditions. There's specialty 320 00:10:57,830 --> 00:11:01,269 pharmaceuticals. There's rising diagnoses of things around behavioral 321 00:11:01,269 --> 00:11:03,115 health, etcetera. Right? There's there's so many different 322 00:11:03,115 --> 00:11:04,875 pieces that are driving that rising cost of 323 00:11:04,875 --> 00:11:07,274 care. But I think that that is and 324 00:11:07,274 --> 00:11:08,875 has been one of the biggest pressures for 325 00:11:08,875 --> 00:11:09,375 us. 326 00:11:09,754 --> 00:11:11,274 To be honest, I'm not sure that we're 327 00:11:11,274 --> 00:11:12,654 changing something super 328 00:11:13,034 --> 00:11:15,355 large in 2026 as much as we're continuing 329 00:11:15,355 --> 00:11:18,090 to accelerate that work. Right? We've always been 330 00:11:18,090 --> 00:11:19,529 in a space where we are trying to 331 00:11:19,529 --> 00:11:20,029 quantify, 332 00:11:20,410 --> 00:11:22,250 you know, where our costs rising and where 333 00:11:22,250 --> 00:11:24,809 our costs rising significantly more than outcomes are 334 00:11:24,809 --> 00:11:26,110 benefiting for our members, 335 00:11:26,490 --> 00:11:28,330 and then figure out solutions that we can 336 00:11:28,330 --> 00:11:30,730 find that will actually improve the ROI on 337 00:11:30,730 --> 00:11:33,394 that care. Right? So improve the outcomes that 338 00:11:33,394 --> 00:11:35,715 our members are experiencing while ideally decreasing the 339 00:11:35,715 --> 00:11:36,215 cost, 340 00:11:36,754 --> 00:11:37,735 of those outcomes. 341 00:11:39,154 --> 00:11:41,495 I think that that work has been true 342 00:11:41,634 --> 00:11:43,235 for the last five years since I've been 343 00:11:43,235 --> 00:11:44,294 part of this organization. 344 00:11:44,639 --> 00:11:46,240 At the same time, I also think that, 345 00:11:46,240 --> 00:11:48,160 like, this is something that we are continuing 346 00:11:48,160 --> 00:11:51,120 to hire more folks and accelerate of, like, 347 00:11:51,120 --> 00:11:52,960 how can we continue to drive better and 348 00:11:52,960 --> 00:11:55,200 better, data analysis on what we need to 349 00:11:55,200 --> 00:11:57,200 target. And then how do we get even 350 00:11:57,200 --> 00:11:59,120 more creative about the different steps that we 351 00:11:59,120 --> 00:12:01,634 can take to solve those problems. And both 352 00:12:01,634 --> 00:12:04,115 thinking about solutions internally of, you know, where 353 00:12:04,115 --> 00:12:04,774 can we 354 00:12:05,154 --> 00:12:06,915 reach out with a care manager or have 355 00:12:06,915 --> 00:12:08,995 a different, data flow or have a different 356 00:12:08,995 --> 00:12:10,754 alert for someone. Right? 357 00:12:11,555 --> 00:12:13,350 And also the external side of, you know, 358 00:12:13,350 --> 00:12:15,429 are there solutions that are moving the needle 359 00:12:15,429 --> 00:12:15,929 here? 360 00:12:16,389 --> 00:12:18,309 And can we bring those into part of 361 00:12:18,309 --> 00:12:21,190 that, you know, workflow for us? And so 362 00:12:21,190 --> 00:12:23,190 I think fundamentally just continuing to try to 363 00:12:23,190 --> 00:12:25,029 figure out how we can manage those rising 364 00:12:25,029 --> 00:12:26,470 cost of care is a top priority for 365 00:12:26,470 --> 00:12:27,465 us in 2026 366 00:12:27,545 --> 00:12:29,965 or the top priority in 2026. 367 00:12:30,585 --> 00:12:32,585 Well, Emily, thank you for joining us on 368 00:12:32,585 --> 00:12:34,745 a podcast and for a great conversation. We're 369 00:12:34,745 --> 00:12:36,425 look we're really looking forward to having you 370 00:12:36,425 --> 00:12:38,745 speak at our spring payer issues roundtable. So 371 00:12:38,745 --> 00:12:40,825 thanks so much. Awesome. Thank you so much, 372 00:12:40,825 --> 00:12:41,956 Scott, for having me.