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Speaker 1: This is Gracelyn Keller with the Becker's Healthcare Podcast, and we are recording live at the fourth annual spring payer issues roundtable. I'm currently joined by Sharon Williams, who is the CEO at University of Michigan Health Plan and also a management consultant. So, Sharon, thanks for being here. I would love to have you start off by introducing yourself a little bit more and sharing more about your role in organization.

Speaker 2: Hi, Grace. Thanks for having me. This has been an incredible conference. I'm a management consultant who spent her entire career in health care and, a CEO with, several, health plans as well as, provider sponsored, organizations. I, was a consultant with, GuideHouse, as well as Booz Allen Hamilton before hanging out my own shingle and have, the privilege of working with a number of hospitals, health plans, and digital health, platforms that are coming out now.

Speaker 1: Absolutely. Well, thank you for being here. And let's get our conversation started with from your perspective, what is the most pressing operational challenge facing payers right now, and how are you addressing it?

Speaker 2: Well, I think the most pressing issue is, demanding utilization. Consumers are demanding more and more drugs. They're also sick, and require, more, hospitalizations and greater utilization. And the revenue and risk assessments are not supporting their utilization. So there's more need and less money, not only for the health plans, but for the hospitals that we are contracting with.

And that's creating, I think just both opportunity as well as tension.

Speaker 1: And there's a constant tension between keeping costs down and actually delivering a good member experience, especially as it comes to care coordination. So how's your organization balancing cost containment with improving member experience and quality outcomes, and where are you seeing the greatest opportunity for impact?

Speaker 2: Yeah. So I can share with you. The University of Michigan is a 4.5 star organization. We deliver fantastic, customer service consistently, and I'm amazed by our ability to do it because our systems are not the best. So it's very manual work, when it should be more automated, And I think there's tremendous opportunity there and doesn't necessarily have to be AI, but, the use of technology, I think, is gonna be critical going forward to enhance the member experience and to demonstrate we actually know who the member is.

So not just using claims data, but social determinants of health data, financial data, consumer, utilization, and then trends. All of that should be used to enhance the the member experience going forward.

Speaker 1: And digital engagement and transformation continues to accelerate across health care. So what technologies and AI are you prioritizing right now, and where are you seeing that seeing that meaningful ROI as well as better engagement with our members?

Speaker 2: Yeah. So I'm gonna put ROI aside just just for a moment, but in in my role, particularly as a management consultant, I've curated a small group of tech companies that I think can deliver, value. Now the first is Care Ally. They do a lot of work with end to end, communication and integration. So it's with hospitals, community based organizations, even caregivers who need access to this digital information, but all of it on one platform.

And they're, agnostic in terms of all the various, interfaces. But I think it's it's incredible what what they're doing in terms of creating actual insights and, making it user friendly. It's culturally responsive, access to several different, languages, as well as, their ability, to to have, and promote transparency among all the different parties that a patient or their family would have to deal with. Their other tool is a global, pharmacy pricing tool because The US is subsidizing pharmacy costs for the rest of the world. And so they can actually show employers and health plans and consumers how much more we're spending than we should be.

So we need to drive some of those costs down. And last, I think it's just big data. So partnering with another, OpEx, for example, uses a lot of that consumer data, retail experience, shopping, in addition to claims to really provide, a better, tool, to give kind of plain English risk assessments for where patients are.

Speaker 1: And final question as we wrap up our conversation, what steps do you think The US needs to take to provide cradle to grave coverage to make Americans healthy?

Speaker 2: Now I like the way you said that. You said cradle to grave as opposed to universal health care because that phrase scares people, and I can't say Medicare for all because that scares people. But, essentially, especially what we're seeing with the ACA population is we have people coming on and off health care insurance, and they're sick. So they're only paying for health insurance when they really need it, and that's not health insurance. Right?

And we're not paying for WellCare. We're not paying for health care. It's just sick care. And I think America could do better. And if we provide that cradle to grave coverage, we can reduce some of the health disparities, and we can provide a better experience.

I think Americans are nickel and dimed, and they don't even know it, especially if they don't travel out of the country and see what better developed countries have. And we can reduce cost if we expand the risk pools and, provide a better safety net. The other thing, as I talked about in a previous session, is we need to decouple, health care from employment. AI is going to have more people uninsured. Most people don't necessarily wanna work the twenty five year job and get a gold watch at the end, so we really need to provide that basic health insurance for everyone.

If you're wealthy, you can always buy up, But I I think we can do better and have healthier Americans. We can make America healthy again, by taking care of health insurance for everyone.

Speaker 1: Absolutely. Well, Sharon, thank you so much for joining me today on the Becker's Healthcare Podcast and sharing these thoughts and insights. Again, we are are recording live at the fourth annual spring payer issues roundtable.

Speaker 2: Thanks, Grace.