Latest / Becker’s Payer Issues Podcast / AI, Simplicity, and Collaboration: Redesigning Medicare Advantage Care Delivery with Dr. Saria Saccocio

Transcript

AI, Simplicity, and Collaboration: Redesigning Medicare Advantage Care Delivery with Dr. Saria Saccocio · Becker’s Payer Issues Podcast

• 0:02
  Generative AI is driving the era of infinite
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  At Hippocratic AI, we partner with more than
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  60 innovative healthcare organizations
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  to drive patient and member outcomes.
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  Safety, clinical accuracy,
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  empathy, consistency.
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  Learn more at hippocraticai.com.
• 0:32
  Hi, everyone. This is Liz Caslow with the
• 0:34
  Becker's Pear Issues podcast. I'm thrilled today to
• 0:36
  be joined by Surya Sacosio,
• 0:39
  chief medical officer of Essence Healthcare.
• 0:41
  Saria, thank you so much for chatting with
• 0:43
  us today. It's great to be here. Wow.
• 0:45
  There's so much excitement at this Becker's meeting.
• 0:48
  Yes. We're filming this right at our April
• 0:50
  2026 roundtable. So I would love for you
• 0:52
  to introduce yourself and share a little bit
• 0:54
  more about your role and what you do
• 0:56
  at Essence Healthcare.
• 0:57
  It'd be my pleasure, Liz. So I am
• 0:59
  the chief medical officer
• 1:01
  at Essence Healthcare.
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  We are a Medicare Advantage regional health plan,
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  and we live by a mission. And our
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  mission is to improve the well-being of our
• 1:12
  members and their communities.
• 1:14
  And we do that by providing the highest
• 1:16
  level quality of care that's affordable, but most
• 1:18
  importantly, personalized for each and every member that
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  we serve. So from your point of view,
• 1:23
  what is the most pressing operational challenge that
• 1:26
  payers are facing right now, and what are
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  you doing to address it?
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  Let's keep it simple.
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  Clinicians
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  are overwhelmed.
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  They're overwhelmed with the amount of information that's
• 1:35
  available.
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  They're overwhelmed with the numerous priorities, and everything
• 1:40
  is number one. And, of course,
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  the patient, the member comes first.
• 1:45
  So the way we approach this is by
• 1:47
  a true collaboration
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  with our partners. We start with,
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  how do you do things?
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  How does your system or your medical group
• 1:56
  work? What's your process? What are your workflows?
• 1:58
  And we do our best to align with
• 2:00
  what they're already doing. Let's just amplify what's
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  already in place. They know how to be
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  good doctors,
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  and that partnership with the PCP
• 2:08
  is critical so that our members receive, again,
• 2:11
  the highest quality care. And when we do
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  that, we know it's
• 2:15
  appropriate
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  utilization as well, and that patient has the
• 2:18
  opportunity
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  to have the best experience that's navigated through
• 2:22
  health care.
• 2:23
  So there's a constant tension with keeping costs
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  down and delivering a good member experience,
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  especially when it comes to care coordination. So,
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  how is your organization balancing that cost containment
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  element with improving member experience and quality outcomes,
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  and where are you seeing the greatest opportunity
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  for that right now?
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  We'll stick with the concept simple
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  because we know that's something we can do
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  every day. Simple math.
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  Right place, right care, right time.
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  That
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  equals always the right cost,
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  the right experience with the right outcomes you
• 2:58
  expect.
• 2:59
  So when we connect PCPs
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  and patients together, the magic happens.
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  The quality of care is delivered and the
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  cost is contained,
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  and what we care most about is the
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  navigation or the path that that member is
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  on. So when they have a PCP holding
• 3:16
  their hand through the process,
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  be it a healthy individual who's looking for
• 3:20
  just healthy lifestyle modifications or someone with chronic
• 3:23
  disease who's juggling between medications
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  and doctor's offices and finding their way to
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  where they need to be. So simple math,
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  just connect the people who matter.
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  So building off of that, digital engagement and
• 3:37
  also transformation continues to accelerate across health care.
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  So what technologies and AI are you deploying
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  and prioritizing
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  right now, and where are you seeing the
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  most meaningful ROI as well as the strongest
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  engagement with members?
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  Well, where we're probably like everyone else, Liz,
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  is that AI is engaging in so many
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  different ways. I think we have a tremendous
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  opportunity
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  to look for all areas, be it operations
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  or connection with members themselves or the health
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  care.
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  Where we're different
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  are unique as how we're connecting with members.
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  We have a partnership with Oura.
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  You see my ring I'm wearing?
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  It's a wearable device
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  that is highly accurate when it comes to
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  sleep along with heart rate variability
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  and with physical activity.
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  And this we know, the evidence shows
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  that when people sleep well,
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  they live well.
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  So through this partnership, we have recognized that
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  sleep disturbance
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  impacts these individuals in so many different ways.
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  So we're particularly
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  focused on obstructive sleep apnea.
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  And by connecting
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  with the member
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  to their PCP with this information,
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  I do believe we've hit a magic formula
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  here. And we have partnered with our physicians
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  to inform the process, make sure we're giving
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  them the information in a way that they
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  receive it best that's clinically relevant and meaningful,
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  and then the outreach occurs.
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  So we have identified individuals at risk for
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  obstructive sleep apnea.
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  We get them screened
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  and get them into testing when appropriate.
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  So serving as a help to physicians in
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  this process rather than making their life more
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  difficult with the noise,
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  Because most of us walk into a doctor's
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  office and into the exam room with a
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  wearable advice.
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  So what are we doing with the wearable
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  device, and how is this different,
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  or is the way that works for us?
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  So when it comes to implementing
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  AI solutions and having stronger member engagement, building
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  trust is a core part of that. So
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  how do you see AI supporting member facing
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  interactions
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  while ensuring trust and quality?
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  Well, stick with the theme of the obstructive
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  sleep apnea example.
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  The connection to cardiometabolic.
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  It affects their entire lives,
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  first of all.
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  How we're using AI
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  is when we recognize these disturbances.
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  We have Tom through Lumeris, our parent company,
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  an AI agent that is connecting back to
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  the member to say, hey. I see maybe
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  you're having some difficulty sleeping. Do you mind
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  if I ask you some questions?
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  The stop bang survey
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  is the standardized screening tool to identify those
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  individuals who are at risk for OSA, obstructive
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  sleep apnea.
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  And so AI
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  allows us to free up the care team
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  so they can focus on care in the
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  exam room with the patient,
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  identify those who are at high risk. That
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  information that
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  AI, Tom,
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  our agent, connects with the members and discovers,
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  then is immediately routed over to the PCPs
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  for further follow-up.
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  So we're using it as traffic directing
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  and connecting in an empathetic way right out
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  of the gate, but with objective information.
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  So we keep the PCP at the middle
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  of the conversation.
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  Well, thank you so much for joining us,
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  Surya. And so can you tell us anything
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  else that might be on your mind with
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  health payers,
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  and anything with AI that they should be
• 7:06
  keeping in mind going forward?
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  Well, a a story that resonates with me,
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  I've heard from our physician leaders and health
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  systems that we work with,
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  is nothing should happen with the patient without
• 7:16
  the physician and the care team when it
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  comes to AI.
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  And I am
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  so impressed
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  and grateful to work with such phenomenal physician
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  leaders
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  who are putting ethics forward
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  and ensuring as we partner that the right
• 7:32
  engagement is occurring with the right members at
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  the right time to provide the best experience
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  and best quality of care. Well, thank you
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  so much for joining us again. Thanks, Liz.
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  It's great to be here. Looking forward to
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  the next couple of days and learning best
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  practices from others.
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  And to our listeners, if you wanna listen
• 7:49
  to more podcasts, you can check out peckershospitalreview.com.
• 7:52
  Thank you.