1 00:00:00,160 --> 00:00:02,339 Hello, everyone, and welcome to Becker's Healthcare Podcast. 2 00:00:02,399 --> 00:00:04,400 I'm Scott King. Thrilled today to be joined 3 00:00:04,400 --> 00:00:07,679 by a very special guest, Gretchen Wagner, associate 4 00:00:07,679 --> 00:00:10,719 vice president, risk management with Humana. Gretchen, how 5 00:00:10,719 --> 00:00:12,160 are you doing? Thanks so much for joining 6 00:00:12,160 --> 00:00:14,375 us. Sure. Thanks for having me, Scott. 7 00:00:14,994 --> 00:00:16,274 Yeah. You know, we have a lot of 8 00:00:16,274 --> 00:00:18,755 big topics to get to here, you know, 9 00:00:18,755 --> 00:00:20,355 on the podcast in in health care and 10 00:00:20,355 --> 00:00:22,114 with health plans, and we're we're definitely looking 11 00:00:22,114 --> 00:00:23,954 forward to having you speak with us at 12 00:00:23,954 --> 00:00:25,414 our spring payer issues roundtable. 13 00:00:25,850 --> 00:00:27,810 But before we, before we get to that, 14 00:00:27,810 --> 00:00:28,810 I was wondering if you could just tell 15 00:00:28,810 --> 00:00:30,250 us a little bit about your background and 16 00:00:30,250 --> 00:00:30,989 your career. 17 00:00:31,769 --> 00:00:35,390 Sure. So I actually started out in education, 18 00:00:35,530 --> 00:00:37,609 a little bit nontraditional to get into health 19 00:00:37,609 --> 00:00:40,670 care, but then made my shift into internal 20 00:00:40,729 --> 00:00:43,094 audit. And that is how I ended up 21 00:00:43,094 --> 00:00:45,335 making my way into health care coming in 22 00:00:45,335 --> 00:00:46,875 from an internal audit perspective, 23 00:00:47,655 --> 00:00:49,335 and found that was a great way to 24 00:00:49,335 --> 00:00:52,315 really learn a company as a new associate 25 00:00:52,454 --> 00:00:54,534 and a young employee at that point in 26 00:00:54,534 --> 00:00:56,295 time because it gave me exposure to a 27 00:00:56,295 --> 00:00:57,780 lot of different parts of 28 00:00:58,159 --> 00:01:00,240 a company. Right? I got to learn different 29 00:01:00,240 --> 00:01:02,079 parts and pieces and how they work and 30 00:01:02,079 --> 00:01:02,820 meet leadership. 31 00:01:03,440 --> 00:01:04,420 And from there, 32 00:01:05,920 --> 00:01:08,000 I really moved up and found my niche 33 00:01:08,000 --> 00:01:09,859 from a clinical perspective, 34 00:01:10,905 --> 00:01:13,145 at Humana and have been with the the 35 00:01:13,145 --> 00:01:15,725 organization now for over fourteen years 36 00:01:16,344 --> 00:01:18,365 and lead our SNP governance. 37 00:01:18,825 --> 00:01:20,905 So work closely with our SNP models of 38 00:01:20,905 --> 00:01:22,745 care, serve as a first line risk and 39 00:01:22,745 --> 00:01:23,885 compliance partner, 40 00:01:24,739 --> 00:01:27,239 support a lot of our quality governance components. 41 00:01:27,780 --> 00:01:29,640 Doing a lot right now with our integrated 42 00:01:29,700 --> 00:01:32,180 D SNPs as we're seeing our Medicaid and 43 00:01:32,180 --> 00:01:34,680 Medicare programs come more closely together 44 00:01:35,060 --> 00:01:36,840 across that D SNP landscape, 45 00:01:37,314 --> 00:01:39,575 and also work very closely with our clinical 46 00:01:39,635 --> 00:01:41,094 operations team. So, 47 00:01:41,715 --> 00:01:43,254 excited to be here and, 48 00:01:43,635 --> 00:01:45,814 excited to talk about really kind of the 49 00:01:45,875 --> 00:01:47,474 the things we're seeing from a health care 50 00:01:47,474 --> 00:01:47,974 perspective, 51 00:01:48,834 --> 00:01:50,754 right now in the state of our our 52 00:01:50,754 --> 00:01:51,575 health players. 53 00:01:52,270 --> 00:01:54,030 Well, appreciate you sharing that background info there, 54 00:01:54,030 --> 00:01:55,549 Gretchen. And, you know, the first kind of 55 00:01:55,549 --> 00:01:57,170 big topic I wanted to get to 56 00:01:57,469 --> 00:02:00,209 is how are your relationships with providers changing 57 00:02:00,590 --> 00:02:02,829 as both sides face cost pressure and workforce 58 00:02:02,829 --> 00:02:03,329 shortages? 59 00:02:04,189 --> 00:02:06,209 Sure. So I would say 60 00:02:06,545 --> 00:02:09,745 we are seeing very significant changes in the 61 00:02:09,745 --> 00:02:10,805 last few years. 62 00:02:11,344 --> 00:02:12,965 Right? We're starting to see 63 00:02:14,384 --> 00:02:14,884 unprecedented 64 00:02:15,185 --> 00:02:16,004 cost pressures 65 00:02:16,544 --> 00:02:18,004 that are only continuing 66 00:02:18,879 --> 00:02:21,699 from especially an MA perspective and a Medicaid 67 00:02:21,759 --> 00:02:23,860 perspective as well as workforce shortages. 68 00:02:24,560 --> 00:02:27,379 You know, when we think about historically what 69 00:02:27,919 --> 00:02:30,719 relationships look like between payers and providers, we 70 00:02:30,719 --> 00:02:32,739 always had very transactional 71 00:02:33,199 --> 00:02:33,699 based 72 00:02:34,205 --> 00:02:36,924 relationships that were very fee for service type 73 00:02:36,924 --> 00:02:41,084 payments where providers were reimbursed for individual services 74 00:02:41,084 --> 00:02:41,824 or procedures, 75 00:02:42,364 --> 00:02:44,784 and payers really focused on that claims processing 76 00:02:44,844 --> 00:02:46,064 and cost containment. 77 00:02:46,480 --> 00:02:49,280 And we found that model created silos and 78 00:02:49,280 --> 00:02:50,580 at times really misaligned 79 00:02:50,960 --> 00:02:53,520 incentives. So one of the things we're really 80 00:02:53,520 --> 00:02:55,520 doing at Humana today is seeing a shift 81 00:02:55,520 --> 00:02:57,620 towards a much more collaborative approach 82 00:02:58,000 --> 00:03:00,180 where we think about partnership and accountability 83 00:03:01,265 --> 00:03:03,045 with a value based model. 84 00:03:03,585 --> 00:03:06,004 So in those arrangements, we're really incentivizing 85 00:03:06,305 --> 00:03:08,305 our providers to not just think about the 86 00:03:08,305 --> 00:03:10,645 volume of care, but really how are we 87 00:03:11,025 --> 00:03:12,405 delivering on quality 88 00:03:13,185 --> 00:03:14,485 and achieving outcomes. 89 00:03:15,419 --> 00:03:17,259 And it really is thinking about how can 90 00:03:17,259 --> 00:03:19,280 we align our goals together 91 00:03:19,819 --> 00:03:22,780 so that we can see our patients get 92 00:03:22,780 --> 00:03:23,280 healthier, 93 00:03:23,739 --> 00:03:24,879 avoid unnecessary 94 00:03:25,259 --> 00:03:25,759 hospitalizations, 95 00:03:26,780 --> 00:03:29,180 and, ultimately, we really wanna make sure our 96 00:03:29,180 --> 00:03:30,959 members are receiving care 97 00:03:31,555 --> 00:03:32,775 at the right time. 98 00:03:33,074 --> 00:03:35,474 We've also found, I think, through that as 99 00:03:35,474 --> 00:03:37,895 we think about that value based care model, 100 00:03:38,435 --> 00:03:41,175 that it allows more innovation and care delivery, 101 00:03:41,875 --> 00:03:44,115 and it really allows us to think about 102 00:03:44,115 --> 00:03:44,615 recognizing 103 00:03:44,995 --> 00:03:45,735 and rewarding 104 00:03:46,680 --> 00:03:47,419 our payers, 105 00:03:48,760 --> 00:03:50,540 when they have better coordination, 106 00:03:51,240 --> 00:03:53,319 fewer gaps in care, and a much more 107 00:03:53,319 --> 00:03:56,680 personalized approach. So really thinking about a much 108 00:03:56,680 --> 00:03:59,500 more holistic and streamlined experience. So 109 00:03:59,879 --> 00:04:01,180 as we think about 110 00:04:01,944 --> 00:04:04,685 how things have changed with this cost pressure, 111 00:04:05,305 --> 00:04:07,805 the workforce shortages that we're having, 112 00:04:08,105 --> 00:04:10,685 we've really got to rethink how we incentivize 113 00:04:11,305 --> 00:04:13,165 our payers and how we incentivize 114 00:04:13,544 --> 00:04:14,284 those relationships. 115 00:04:15,705 --> 00:04:18,060 So it's definitely been a shift as we 116 00:04:18,060 --> 00:04:20,379 make that shift and that change towards those 117 00:04:20,379 --> 00:04:21,199 value based 118 00:04:21,659 --> 00:04:22,240 care arrangements. 119 00:04:23,099 --> 00:04:24,240 But we are finding 120 00:04:24,779 --> 00:04:26,000 it truly is 121 00:04:26,379 --> 00:04:28,959 allowing us to be more effective and efficient 122 00:04:29,579 --> 00:04:31,519 and also make sure we've got better 123 00:04:31,899 --> 00:04:32,399 partnerships 124 00:04:33,954 --> 00:04:35,654 across our our payers, 125 00:04:36,035 --> 00:04:38,615 but also allowing to make sure that, 126 00:04:39,314 --> 00:04:41,254 we can put the member first 127 00:04:41,875 --> 00:04:43,714 when it comes to their health and their 128 00:04:43,714 --> 00:04:46,454 outcomes as well when we take that approach. 129 00:04:47,589 --> 00:04:49,269 Yeah. Absolutely. And I love the idea of 130 00:04:49,269 --> 00:04:51,269 of focusing on quality there. It's something to 131 00:04:51,269 --> 00:04:52,550 kind of put in the middle of that 132 00:04:52,550 --> 00:04:54,729 payer provider relationship to kind of get both 133 00:04:54,870 --> 00:04:56,069 sides to come to the table. I I 134 00:04:56,069 --> 00:04:58,229 think that's great. And I also wanna ask, 135 00:04:58,229 --> 00:04:59,449 where do you see the biggest 136 00:04:59,925 --> 00:05:01,064 gap today between 137 00:05:01,444 --> 00:05:03,544 payer strategy and operational execution? 138 00:05:03,925 --> 00:05:04,425 Yeah. 139 00:05:04,805 --> 00:05:05,305 So 140 00:05:06,084 --> 00:05:08,431 I honestly think the biggest bur 141 00:05:08,884 --> 00:05:10,185 burden that we see 142 00:05:10,725 --> 00:05:12,644 is how do we take that long term 143 00:05:12,644 --> 00:05:13,144 vision 144 00:05:13,524 --> 00:05:15,384 that we have as leaders 145 00:05:15,899 --> 00:05:18,399 and translate that into day to day operations. 146 00:05:18,939 --> 00:05:20,959 Right? Oftentimes, we have 147 00:05:21,339 --> 00:05:23,580 big big rocks that we all are working 148 00:05:23,580 --> 00:05:26,300 towards from a health care perspective as we 149 00:05:26,300 --> 00:05:28,240 think about innovation and quality, 150 00:05:28,540 --> 00:05:31,935 even think about things like utilization of AI 151 00:05:31,995 --> 00:05:33,455 from a strategy perspective. 152 00:05:33,835 --> 00:05:36,335 And it's how can we take that and 153 00:05:37,514 --> 00:05:38,654 realize that 154 00:05:39,035 --> 00:05:41,455 in the daily work of our frontline teams. 155 00:05:42,634 --> 00:05:45,629 That's something that is not a unique gap 156 00:05:46,029 --> 00:05:47,649 to Humana by any means. 157 00:05:48,270 --> 00:05:50,930 It's something that the entire industry is facing, 158 00:05:51,149 --> 00:05:53,410 particularly with this current pace of change. 159 00:05:54,029 --> 00:05:56,689 One of my favorite sayings that I continue 160 00:05:56,750 --> 00:05:59,410 to hear, both internal to Humana 161 00:05:59,964 --> 00:06:02,865 but external in the environment we're living in, 162 00:06:03,245 --> 00:06:06,144 is that the pace of change today 163 00:06:06,444 --> 00:06:08,865 is as slow as it will ever be. 164 00:06:09,564 --> 00:06:11,564 And that's kind of hard to take in 165 00:06:11,564 --> 00:06:14,285 because we are facing a rapid pace of 166 00:06:14,285 --> 00:06:14,785 change 167 00:06:15,319 --> 00:06:16,220 from a technology 168 00:06:16,759 --> 00:06:17,259 perspective, 169 00:06:17,639 --> 00:06:19,419 from a structure and infrastructure 170 00:06:19,879 --> 00:06:20,379 perspective, 171 00:06:21,240 --> 00:06:23,419 from a way in which we live perspective, 172 00:06:23,560 --> 00:06:24,379 from a, 173 00:06:24,839 --> 00:06:27,419 you know, a day to day function perspective. 174 00:06:27,879 --> 00:06:29,899 There is so much that is happening 175 00:06:30,824 --> 00:06:31,324 rapidly, 176 00:06:31,785 --> 00:06:34,024 and we are only gonna continue to see 177 00:06:34,024 --> 00:06:34,845 that progress. 178 00:06:35,225 --> 00:06:37,064 And that can be hard for a lot 179 00:06:37,064 --> 00:06:38,605 of our frontline associates, 180 00:06:39,785 --> 00:06:40,925 to adapt to 181 00:06:41,305 --> 00:06:42,685 as well as our members 182 00:06:43,064 --> 00:06:45,404 and our patients to adapt to, 183 00:06:45,960 --> 00:06:48,460 as we go through this this change acceleration. 184 00:06:49,480 --> 00:06:52,199 So with me saying that, right, of how 185 00:06:52,199 --> 00:06:53,259 do we take this 186 00:06:54,040 --> 00:06:55,100 strategic vision 187 00:06:55,639 --> 00:06:58,199 where we want to innovate, where we wanna 188 00:06:58,199 --> 00:06:59,180 drive quality, 189 00:06:59,884 --> 00:07:02,625 and make a better experience for our members 190 00:07:03,404 --> 00:07:03,904 is 191 00:07:04,365 --> 00:07:05,884 now how do we how do we go 192 00:07:05,884 --> 00:07:07,564 about doing that and doing that in the 193 00:07:07,564 --> 00:07:08,305 right way 194 00:07:08,605 --> 00:07:10,865 in this time of of growth and technology? 195 00:07:11,404 --> 00:07:12,845 So I think one is, like, how do 196 00:07:12,845 --> 00:07:15,105 we start thinking about digital innovation? 197 00:07:15,860 --> 00:07:18,520 Because our our senior population 198 00:07:19,779 --> 00:07:20,839 is no longer 199 00:07:21,620 --> 00:07:24,279 a population that is just working on 200 00:07:24,740 --> 00:07:27,540 on telephone calls and and letters in front 201 00:07:27,540 --> 00:07:28,120 of them. 202 00:07:28,774 --> 00:07:31,014 They are someone who have started to adapt 203 00:07:31,014 --> 00:07:31,915 things like 204 00:07:32,615 --> 00:07:36,134 cell phones, mobile apps, online platforms. They want 205 00:07:36,134 --> 00:07:39,574 virtual care options. They want telehealth options. And 206 00:07:39,574 --> 00:07:41,035 so we've gotta find 207 00:07:41,495 --> 00:07:42,714 coordinated ways 208 00:07:43,339 --> 00:07:45,520 to bring multiple teams together 209 00:07:45,980 --> 00:07:48,860 across not only our operational teams, but our 210 00:07:48,860 --> 00:07:51,120 clinical teams and our provider functions 211 00:07:51,740 --> 00:07:53,420 to make sure that we're doing this and 212 00:07:53,420 --> 00:07:54,319 doing it appropriately. 213 00:07:55,100 --> 00:07:57,100 So I think that's one of the things 214 00:07:57,100 --> 00:07:59,735 that we really gotta find is how can 215 00:07:59,735 --> 00:08:01,595 we find ways as organizations 216 00:08:02,694 --> 00:08:05,035 to create cross functional implementation 217 00:08:05,814 --> 00:08:06,555 that includes 218 00:08:07,014 --> 00:08:09,035 feedback loops from providers, 219 00:08:10,019 --> 00:08:11,079 from members, 220 00:08:11,779 --> 00:08:13,620 and things like I think we've got some 221 00:08:13,620 --> 00:08:15,560 really good platforms at Humana 222 00:08:16,019 --> 00:08:16,680 that are, 223 00:08:16,980 --> 00:08:18,199 in many ways, regulatory 224 00:08:18,980 --> 00:08:21,139 requirements for us and things like our D 225 00:08:21,139 --> 00:08:22,360 SNP and our Medicaid 226 00:08:23,014 --> 00:08:25,995 enrollee advisory committees where we can seek out 227 00:08:26,455 --> 00:08:27,355 member feedback 228 00:08:27,975 --> 00:08:29,975 and try out some of our our new 229 00:08:29,975 --> 00:08:32,855 technology with them. But it's also making sure 230 00:08:32,855 --> 00:08:35,335 we're getting the feedback from associates and from 231 00:08:35,335 --> 00:08:36,554 our frontline teams 232 00:08:36,970 --> 00:08:38,970 to make sure that they are front and 233 00:08:38,970 --> 00:08:39,470 center 234 00:08:39,769 --> 00:08:40,990 when it comes to 235 00:08:41,370 --> 00:08:42,029 the execution 236 00:08:42,970 --> 00:08:45,950 and how they can execute on that strategy 237 00:08:46,490 --> 00:08:48,409 at a day to day level. So it's 238 00:08:48,409 --> 00:08:50,909 really bringing everyone to the to the table, 239 00:08:51,324 --> 00:08:53,725 closing that gap, and making sure that we're 240 00:08:53,725 --> 00:08:55,345 building systems and processes 241 00:08:56,125 --> 00:08:58,065 that consider continuous improvement 242 00:08:58,605 --> 00:09:00,144 and collaboration and communication. 243 00:09:01,565 --> 00:09:03,179 Yeah. And I like what you said about 244 00:09:03,259 --> 00:09:04,460 change. And, you know, it's kind of a 245 00:09:04,460 --> 00:09:05,899 it's kind of a bit jarring, isn't it, 246 00:09:05,899 --> 00:09:07,580 too? Like It is. Like emerging tech, and 247 00:09:07,580 --> 00:09:08,940 is it if this is not gonna slow 248 00:09:08,940 --> 00:09:10,779 down, so you No. You have to jump 249 00:09:10,779 --> 00:09:11,919 on board right now. 250 00:09:12,299 --> 00:09:14,159 Yeah. It it really is. Like, 251 00:09:14,539 --> 00:09:16,220 it's one of those that I feel like 252 00:09:16,220 --> 00:09:18,000 we are in such a time of transformation, 253 00:09:19,235 --> 00:09:21,475 both as a society, but for us in 254 00:09:21,475 --> 00:09:23,894 health care. This is our time to 255 00:09:24,754 --> 00:09:26,535 challenge what we have been doing 256 00:09:26,995 --> 00:09:30,134 and really think about the utilization of technology 257 00:09:30,195 --> 00:09:33,095 in new ways. Right. Because there are other 258 00:09:34,169 --> 00:09:34,669 industries 259 00:09:35,450 --> 00:09:37,710 who are doing things differently 260 00:09:38,330 --> 00:09:41,049 to think about that member experience in a 261 00:09:41,049 --> 00:09:41,950 unique way 262 00:09:42,330 --> 00:09:45,129 that we haven't yet executed on in the 263 00:09:45,129 --> 00:09:46,509 in the health care industry. 264 00:09:47,294 --> 00:09:48,894 And so I think this is this is 265 00:09:48,894 --> 00:09:50,034 really our opportunity 266 00:09:50,815 --> 00:09:51,875 as we are seeing 267 00:09:52,335 --> 00:09:53,634 technology advance 268 00:09:54,254 --> 00:09:56,575 advancement and just the changes that are happening 269 00:09:56,575 --> 00:09:58,115 from a regulatory perspective 270 00:09:59,054 --> 00:10:01,774 as well as a societal perspective, right, and 271 00:10:01,774 --> 00:10:02,914 the adoption of 272 00:10:03,269 --> 00:10:05,670 more people being open to the utilization of 273 00:10:05,670 --> 00:10:07,850 technology and those digital platforms 274 00:10:08,470 --> 00:10:09,210 coming together. 275 00:10:09,990 --> 00:10:11,509 No. I I agree. I think you're you're 276 00:10:11,509 --> 00:10:12,570 right 100%. 277 00:10:12,790 --> 00:10:15,509 I also wanna ask what's one investment or 278 00:10:15,509 --> 00:10:18,245 initiative you believe will most reshape how health 279 00:10:18,245 --> 00:10:20,404 plans operate over the next two to three 280 00:10:20,404 --> 00:10:22,965 years? Yeah. Honestly, it goes back as what 281 00:10:22,965 --> 00:10:25,684 we've been talking about, and that's that's digital 282 00:10:25,845 --> 00:10:27,065 it's digital analytics. 283 00:10:27,764 --> 00:10:30,004 And getting even more specific, I think it's 284 00:10:30,004 --> 00:10:30,665 the analytics 285 00:10:31,540 --> 00:10:34,179 and the interoperability, but it's across the health 286 00:10:34,179 --> 00:10:35,000 care ecosystem. 287 00:10:35,379 --> 00:10:36,440 Right? Right now, 288 00:10:37,059 --> 00:10:38,679 there is a lot of data, 289 00:10:39,059 --> 00:10:40,279 and there is a lot 290 00:10:40,660 --> 00:10:41,480 of information 291 00:10:41,940 --> 00:10:43,000 that we have 292 00:10:44,024 --> 00:10:45,324 across health plans, 293 00:10:45,944 --> 00:10:47,404 across health systems, 294 00:10:48,184 --> 00:10:49,164 but it's fragmented. 295 00:10:49,944 --> 00:10:51,245 And when it's fragmented, 296 00:10:51,784 --> 00:10:54,664 we aren't seeing a holistic view of a 297 00:10:54,664 --> 00:10:57,884 patient's health journey or a member's health journey. 298 00:10:58,509 --> 00:11:00,029 And so one of the things that I 299 00:11:00,029 --> 00:11:02,190 think we need to invest in and one 300 00:11:02,190 --> 00:11:04,049 of the things we're focusing on at Humana 301 00:11:04,110 --> 00:11:06,289 is investing heavily in data infrastructure 302 00:11:07,070 --> 00:11:08,370 and advancing analytics 303 00:11:08,909 --> 00:11:10,909 so that we can really bring all of 304 00:11:10,909 --> 00:11:13,570 that information together from multiple sources. 305 00:11:13,950 --> 00:11:15,545 So So think about things like 306 00:11:15,925 --> 00:11:16,904 clinical records, 307 00:11:17,605 --> 00:11:20,884 pharmacy data, member interactions. So when did we 308 00:11:20,884 --> 00:11:23,125 call a member? Who called a member? When 309 00:11:23,125 --> 00:11:25,045 did they pick up the phone? And even 310 00:11:25,045 --> 00:11:26,904 things we might know about them, 311 00:11:27,445 --> 00:11:29,545 such as social determinants of health, 312 00:11:29,970 --> 00:11:31,110 right, based upon 313 00:11:31,649 --> 00:11:33,829 maybe they have food insecurity, 314 00:11:34,769 --> 00:11:37,409 maybe they have a transportation need. So it's 315 00:11:37,409 --> 00:11:39,269 really how can we build comprehensive 316 00:11:39,570 --> 00:11:40,070 views 317 00:11:41,009 --> 00:11:42,070 of our membership 318 00:11:42,924 --> 00:11:43,665 to know 319 00:11:44,125 --> 00:11:45,904 how to be more pro proactive 320 00:11:46,764 --> 00:11:50,065 in outreaching members and especially outreaching members 321 00:11:50,684 --> 00:11:51,904 at the right time. 322 00:11:52,764 --> 00:11:55,165 Right? We've gotta make sure that we can 323 00:11:55,165 --> 00:11:55,985 take data 324 00:11:56,365 --> 00:11:58,065 and utilize it for good 325 00:11:58,389 --> 00:12:00,089 and not just take data 326 00:12:00,629 --> 00:12:01,690 to have data 327 00:12:02,070 --> 00:12:03,610 and report on data. 328 00:12:04,070 --> 00:12:06,409 We've gotta make sure we're using data 329 00:12:07,190 --> 00:12:09,370 in the right way and pulling it together 330 00:12:09,509 --> 00:12:10,409 through analytics, 331 00:12:10,789 --> 00:12:11,610 through interoperability, 332 00:12:12,629 --> 00:12:13,850 sharing that data 333 00:12:14,154 --> 00:12:16,875 to make sure we're really tailoring it to 334 00:12:16,875 --> 00:12:17,695 drive efficiency 335 00:12:18,794 --> 00:12:21,274 in the payer system, but across the broader 336 00:12:21,274 --> 00:12:23,914 health care system and really focusing on that 337 00:12:23,914 --> 00:12:25,615 member experience through it. 338 00:12:26,289 --> 00:12:27,269 If you could change 339 00:12:27,649 --> 00:12:30,690 one regulatory or industry practice tomorrow to improve 340 00:12:30,690 --> 00:12:33,250 affordability and access, what would it be and 341 00:12:33,250 --> 00:12:34,549 why? Sure. 342 00:12:35,090 --> 00:12:37,009 Well, I feel like I'm I keep talking 343 00:12:37,009 --> 00:12:38,774 about the same thing a little bit, but 344 00:12:39,254 --> 00:12:41,014 I I think it also shows how important 345 00:12:41,014 --> 00:12:42,475 out it is, and that's interoperability. 346 00:12:43,415 --> 00:12:46,055 Right? And that is something we have got 347 00:12:46,055 --> 00:12:48,075 to change and speed up even 348 00:12:48,535 --> 00:12:50,154 more so than we have today. 349 00:12:50,695 --> 00:12:52,055 We have got to 350 00:12:53,450 --> 00:12:55,710 I think about this from my own perspective 351 00:12:55,850 --> 00:12:56,350 frequently 352 00:12:56,889 --> 00:12:57,950 both as 353 00:12:58,970 --> 00:13:01,149 a a patient and as a caregiver, 354 00:13:02,250 --> 00:13:05,049 for my mother who has complex conditions and 355 00:13:05,049 --> 00:13:07,850 sees a number of specialists and doctors across 356 00:13:07,850 --> 00:13:11,165 networks and networks and provider groups, and how 357 00:13:11,165 --> 00:13:11,665 frequently 358 00:13:12,845 --> 00:13:14,524 we don't see the full picture of a 359 00:13:14,524 --> 00:13:16,865 member because we don't have that information, 360 00:13:17,884 --> 00:13:21,585 and how frequently we we have inefficiency 361 00:13:22,125 --> 00:13:23,585 in the work that we do. 362 00:13:24,419 --> 00:13:28,019 How often do we create duplicate tests? How 363 00:13:28,019 --> 00:13:29,480 often do we miss something? 364 00:13:30,259 --> 00:13:32,360 How often do we have the chance to 365 00:13:32,740 --> 00:13:35,139 take action we can't because we don't have 366 00:13:35,139 --> 00:13:36,120 the right information, 367 00:13:36,740 --> 00:13:39,159 but it's sitting in another payer's health system, 368 00:13:39,545 --> 00:13:40,925 or it's sitting in another 369 00:13:41,625 --> 00:13:44,264 health system system at a hospital or at 370 00:13:44,264 --> 00:13:45,325 a doctor's office. 371 00:13:46,425 --> 00:13:49,065 Think about how how many hours just we 372 00:13:49,065 --> 00:13:49,565 as 373 00:13:50,184 --> 00:13:52,504 patients would say if we didn't have to 374 00:13:52,504 --> 00:13:54,665 fill out the same form every time we 375 00:13:54,665 --> 00:13:57,589 went to the doctor's office because that information 376 00:13:57,730 --> 00:13:59,429 was up to date and timely. 377 00:14:00,449 --> 00:14:03,029 We could save ourselves, could save hours 378 00:14:03,569 --> 00:14:05,750 over the course of years in doing that. 379 00:14:05,889 --> 00:14:08,129 And so we really have a chance to 380 00:14:08,129 --> 00:14:09,909 rethink about data 381 00:14:10,835 --> 00:14:12,295 and bringing that together 382 00:14:12,835 --> 00:14:13,415 to create 383 00:14:14,274 --> 00:14:16,055 a better member experience, 384 00:14:16,754 --> 00:14:17,815 but truly 385 00:14:18,115 --> 00:14:19,095 having the chance 386 00:14:19,634 --> 00:14:20,375 to create 387 00:14:20,915 --> 00:14:23,555 a more complete picture for our providers, for 388 00:14:23,555 --> 00:14:25,095 them to make better decisions 389 00:14:25,639 --> 00:14:27,580 and create a better treatment plan. 390 00:14:27,960 --> 00:14:30,120 And for health plans, it's gonna mean that 391 00:14:30,120 --> 00:14:32,759 we can improve the accuracy of what we 392 00:14:32,759 --> 00:14:33,259 do 393 00:14:33,639 --> 00:14:35,259 and make sure we're supporting, 394 00:14:36,679 --> 00:14:39,240 our populations in a more effective manner. And 395 00:14:39,240 --> 00:14:41,419 so going back to where we started, 396 00:14:42,014 --> 00:14:44,095 talking about some of the cost pressures we're 397 00:14:44,095 --> 00:14:44,595 feeling. 398 00:14:45,134 --> 00:14:47,615 The more that we can streamline data and 399 00:14:47,615 --> 00:14:50,334 have the right data, that's only going to 400 00:14:50,334 --> 00:14:51,714 help us as health plans 401 00:14:52,174 --> 00:14:54,975 in a time where we're facing more from 402 00:14:54,975 --> 00:14:56,434 a a margins perspective 403 00:14:57,450 --> 00:14:59,470 and and the cost pressure from a regulatory 404 00:14:59,610 --> 00:15:01,929 aspect that we're seeing right now. So this 405 00:15:01,929 --> 00:15:03,629 is definitely a place where 406 00:15:04,330 --> 00:15:04,830 while 407 00:15:05,210 --> 00:15:06,990 a lot is moving quickly 408 00:15:07,370 --> 00:15:09,690 from a regulatory aspect for us to get 409 00:15:09,690 --> 00:15:11,230 there from an interop aspect, 410 00:15:11,725 --> 00:15:14,044 there's an opportunity for us to move even 411 00:15:14,044 --> 00:15:14,865 quicker here. 412 00:15:15,644 --> 00:15:17,164 And that kinda ties into the last thing 413 00:15:17,164 --> 00:15:18,684 I wanted to ask you, Gretchen, along the 414 00:15:18,684 --> 00:15:20,284 lines of margins. And you you might have 415 00:15:20,284 --> 00:15:22,125 touched on this already, but what issue do 416 00:15:22,125 --> 00:15:23,970 you think is putting the most pressure on 417 00:15:23,970 --> 00:15:26,289 health plan margins right now, and how how 418 00:15:26,289 --> 00:15:28,789 are you responding differently in 2026? 419 00:15:29,250 --> 00:15:31,490 Yeah. It's it's interesting. I feel like it's 420 00:15:31,490 --> 00:15:34,629 such a timely question as we've been seeing 421 00:15:35,490 --> 00:15:36,549 all of the, 422 00:15:37,970 --> 00:15:38,949 the end of year 423 00:15:39,705 --> 00:15:40,205 financial 424 00:15:40,904 --> 00:15:43,065 reports come out from the large health plans 425 00:15:43,065 --> 00:15:44,125 and just how 426 00:15:44,585 --> 00:15:46,904 things from the industry perspective that are coming 427 00:15:46,904 --> 00:15:48,925 out right right now about what is happening 428 00:15:49,225 --> 00:15:51,384 in the health care industry. So it's an 429 00:15:51,384 --> 00:15:53,085 interesting time for us. 430 00:15:53,659 --> 00:15:56,299 And there definitely is pressure that we have 431 00:15:56,299 --> 00:15:57,039 not seen, 432 00:15:58,379 --> 00:16:00,620 especially in the MA space or the Medicaid 433 00:16:00,620 --> 00:16:01,120 space. 434 00:16:01,659 --> 00:16:03,179 And I don't think it's gonna slow down. 435 00:16:03,179 --> 00:16:04,399 And I think there are really 436 00:16:04,940 --> 00:16:06,079 three large contributors 437 00:16:06,379 --> 00:16:08,865 to that. So one is just rising health 438 00:16:08,865 --> 00:16:09,684 care cost. 439 00:16:11,105 --> 00:16:11,605 Primarily, 440 00:16:12,144 --> 00:16:14,804 we're seeing that through the price of specialty 441 00:16:14,865 --> 00:16:16,644 medications and advanced treatments. 442 00:16:17,424 --> 00:16:19,345 But in general, we're just seeing the cost 443 00:16:19,345 --> 00:16:21,540 of health care go up. Everything from a 444 00:16:21,540 --> 00:16:23,000 cost perspective is rising. 445 00:16:23,700 --> 00:16:25,639 Two, I think we're seeing greater utilization. 446 00:16:26,660 --> 00:16:28,759 Our boomer population is aging. 447 00:16:29,220 --> 00:16:31,879 We're seeing chronic conditions become more prevalent. 448 00:16:32,259 --> 00:16:34,360 But I also think we've created 449 00:16:34,944 --> 00:16:37,125 where people are becoming more proactive 450 00:16:38,144 --> 00:16:38,964 and seeking 451 00:16:39,904 --> 00:16:42,625 care, which is positive, but that drives up 452 00:16:42,625 --> 00:16:43,365 that utilization. 453 00:16:44,225 --> 00:16:45,824 And then really the last piece is just 454 00:16:45,824 --> 00:16:48,304 the administrative costs, so the cost to do 455 00:16:48,304 --> 00:16:50,164 business is going up everywhere. 456 00:16:50,759 --> 00:16:53,080 That doesn't matter what industry you're in. That's 457 00:16:53,080 --> 00:16:55,399 not unique to health care, but it's something 458 00:16:55,399 --> 00:16:56,860 we're seeing across industries. 459 00:16:57,320 --> 00:16:58,759 And I think the last piece, as we 460 00:16:58,759 --> 00:16:59,740 know, is the regulatory 461 00:17:00,279 --> 00:17:02,460 requirements. Right? We've seen cuts in Medicaid. 462 00:17:03,000 --> 00:17:03,820 We have 463 00:17:04,279 --> 00:17:04,859 the proposed 464 00:17:06,944 --> 00:17:08,784 you know, payment that came out on the 465 00:17:08,784 --> 00:17:12,865 MA space with the reimbursement rate standing pretty 466 00:17:12,865 --> 00:17:14,484 flat with a slight increase, 467 00:17:15,424 --> 00:17:17,664 that's been a lot of the stocks dropping 468 00:17:17,664 --> 00:17:18,964 massively last week. 469 00:17:19,265 --> 00:17:19,765 So 470 00:17:20,509 --> 00:17:21,570 this is not something 471 00:17:21,950 --> 00:17:24,670 that's gonna go away for sure. And so 472 00:17:24,670 --> 00:17:25,330 I think, 473 00:17:25,869 --> 00:17:27,470 you know, when we think about this, we 474 00:17:27,470 --> 00:17:29,710 have to definitely think from a health plan 475 00:17:29,710 --> 00:17:30,210 perspective. 476 00:17:30,830 --> 00:17:32,210 We've got to be 477 00:17:33,525 --> 00:17:34,025 thinking 478 00:17:34,884 --> 00:17:35,625 about efficiency, 479 00:17:36,884 --> 00:17:38,025 innovation, and value. 480 00:17:39,045 --> 00:17:41,605 And this really is our chance to think 481 00:17:41,605 --> 00:17:42,105 differently 482 00:17:43,205 --> 00:17:45,305 about how we show up, 483 00:17:46,009 --> 00:17:47,710 who we are as a company, 484 00:17:48,169 --> 00:17:50,649 and how we're gonna serve our members. It 485 00:17:50,649 --> 00:17:53,389 really is our chance to distinguish ourselves from 486 00:17:53,450 --> 00:17:54,190 each other 487 00:17:54,569 --> 00:17:56,990 and really think about that member experience 488 00:17:57,625 --> 00:18:00,585 if we ground ourselves in the efficiency, innovation, 489 00:18:00,585 --> 00:18:01,244 and value, 490 00:18:02,105 --> 00:18:03,085 from an organization 491 00:18:03,384 --> 00:18:05,625 perspective. And that's something we're really focused on 492 00:18:05,625 --> 00:18:06,444 here at Humana. 493 00:18:07,144 --> 00:18:07,644 So 494 00:18:08,265 --> 00:18:09,784 I I would say when I think about 495 00:18:09,784 --> 00:18:10,284 this 496 00:18:10,960 --> 00:18:12,019 operational efficiency, 497 00:18:12,559 --> 00:18:14,980 we've all gotta think about leveraging automation 498 00:18:15,680 --> 00:18:17,539 right now, process optimization. 499 00:18:18,400 --> 00:18:19,779 How can we reduce administrative 500 00:18:20,080 --> 00:18:20,580 cost? 501 00:18:20,960 --> 00:18:22,980 Right? We've gotta think about things like 502 00:18:23,625 --> 00:18:25,085 automated claims processing, 503 00:18:25,545 --> 00:18:27,305 analytics. This is a place where I think 504 00:18:27,305 --> 00:18:29,484 we have a chance to think about AI 505 00:18:29,945 --> 00:18:31,164 and how we can utilize 506 00:18:31,625 --> 00:18:33,484 that in the right way to support 507 00:18:34,265 --> 00:18:36,525 some efficiency in our especially in our administrative 508 00:18:36,664 --> 00:18:37,164 processes. 509 00:18:38,080 --> 00:18:40,240 And then I think innovation is something that's 510 00:18:40,240 --> 00:18:40,980 really exciting. 511 00:18:41,360 --> 00:18:42,960 I talked about this is a chance to 512 00:18:42,960 --> 00:18:44,019 do things differently. 513 00:18:44,559 --> 00:18:45,860 How can we think about 514 00:18:46,559 --> 00:18:48,340 things like virtual care, 515 00:18:48,720 --> 00:18:49,860 remote monitoring, 516 00:18:50,720 --> 00:18:52,340 new care management practices? 517 00:18:53,375 --> 00:18:54,275 How can we think 518 00:18:55,215 --> 00:18:58,255 about improving outcomes differently than we have in 519 00:18:58,255 --> 00:18:59,934 the past. So I think the more that 520 00:18:59,934 --> 00:19:02,835 we can think about cost containment over time 521 00:19:02,975 --> 00:19:04,515 by improving health outcomes, 522 00:19:04,894 --> 00:19:07,789 that's gonna help us from an innovation perspective, 523 00:19:08,009 --> 00:19:09,869 but also from a member perspective. 524 00:19:10,409 --> 00:19:11,769 And then the last piece I would ask 525 00:19:11,769 --> 00:19:14,250 is just that value based partnership piece. You 526 00:19:14,250 --> 00:19:16,829 know, the more we can incentivize our providers 527 00:19:17,450 --> 00:19:18,190 with quality, 528 00:19:18,569 --> 00:19:19,069 partnership, 529 00:19:19,450 --> 00:19:19,950 efficiency, 530 00:19:21,134 --> 00:19:23,375 that's gonna help all of us as we 531 00:19:23,375 --> 00:19:25,075 we work through these cost pressures. 532 00:19:25,535 --> 00:19:27,875 But it definitely is gonna be something that 533 00:19:28,174 --> 00:19:31,875 we see and continue to have as payers 534 00:19:32,494 --> 00:19:34,255 going into 2026. 535 00:19:34,255 --> 00:19:36,015 I don't see that something that is going 536 00:19:36,015 --> 00:19:38,309 to change, And so we've all really gotta 537 00:19:38,309 --> 00:19:39,769 think about how we can focus 538 00:19:40,230 --> 00:19:41,289 on member engagement. 539 00:19:41,990 --> 00:19:43,750 Like I said, going back to how do 540 00:19:43,750 --> 00:19:44,650 we think about 541 00:19:45,190 --> 00:19:48,329 efficiency, innovation, and really driving that value 542 00:19:48,789 --> 00:19:49,609 both for 543 00:19:49,945 --> 00:19:50,684 our members, 544 00:19:51,065 --> 00:19:52,984 our payers, and our providers that we work 545 00:19:52,984 --> 00:19:53,484 with. 546 00:19:54,105 --> 00:19:55,945 Well, Gretchen, thanks so much for a great 547 00:19:55,945 --> 00:19:58,025 conversation and for joining the podcast, and I'm 548 00:19:58,025 --> 00:19:59,465 looking forward to you speaking with us in 549 00:19:59,465 --> 00:19:59,965 April. 550 00:20:00,424 --> 00:20:02,365 Absolutely. Thank you so much, Scott.