Latest / Becker’s Payer Issues Podcast / Brad Riley, Vice President, Analytics and Reporting, Longevity Health

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Brad Riley, Vice President, Analytics and Reporting, Longevity Health · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy, care, and
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  benefit solutions.
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  Barriers to care can lead to gaps in
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  care, which can drive up the total cost
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  of care. Our capabilities work seamlessly together to
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  create innovative pharmacy care and benefit solutions for
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  today and tomorrow.
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  Our connected health services make the treatment, prediction,
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  and prevention of health care's most complex conditions
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  easier and more accessible as we drive organizations
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  and people forward.
• 0:29
  This is Haley Recker with the Becker's Payer
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  Podcast. And today, we're recording live at the
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  Becker's third annual spring payer issues roundtable.
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  I am thrilled today to be joined by
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  Brad Riley, vice president of analytics and reporting
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  at Longevity Health. Brad, thank you so much
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  for joining me today. Hey. Happy to be
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  here. So before we get started, can I
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  just have you go ahead and introduce yourself
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  and a little bit about your background? Sure.
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  Absolutely. So, appreciate the opportunity to be here.
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  I think this is the second time doing
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  it. So,
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  happy happy to be here and to take
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  part. So, like Haley said, I'm Brad Riley.
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  I'm the VP of analytics and reporting at
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  Longevity Health Plan. Longevity is the fastest growing
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  national I SNP plan, so we're a clinical
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  services organization and an I SNP plan.
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  We just crossed the 10,000 member threshold this
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  year, so we're really excited about that.
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  And we currently partner with,
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  over 300 SNPs
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  in roughly 13 different markets, and we're hoping
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  to expand that a little this year. So
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  excited to be here. Excited to talk about
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  tech, AI,
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  and and ways that, you know, I'm from
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  my perspective, I'm getting to see that impact
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  the industry and and longevity health. Well, that's
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  awesome. Thank you so much for sharing.
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  Now to begin our conversation today, I wanna
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  talk about balancing affordability and quality. So how
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  is your organization innovating to manage cost of
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  care while maintaining or improving member outcomes?
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  That's a good question. I mean, especially with
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  the rates the way the way they are
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  now and everything else. You know, '25 is
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  a tough year. '26 is ramping up to
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  be look a little better. But, with the
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  Medicaid stuff coming in, you know, nobody's ever
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  quite sure how that's gonna look. It's it's
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  you know, changes
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  month by month. So I think a couple
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  things. One,
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  obviously, at the forefront of everything else right
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  now is is both quality based care agreements
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  and quality based payment agreements.
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  I I think that's
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  absolutely where the industry is going. That's how
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  longevity is structured,
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  and how we, you know,
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  partner with with our partners. I think the
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  other piece, obviously, is leveraging technology, specifically,
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  the buzzwords AI, especially, you know, this past
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  at at Becker's, but, you know, everywhere else
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  too. And I think understanding how to
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  how
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  to do that is important. You know? With
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  with Longevity Health, we treat our members
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  in the facilities, and so we we only
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  partner well, our members are only in skilled
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  nursing facilities. And so we have nurse practitioners
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  and registered nurses and LPNs,
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  that dependent upon the market will go in
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  and and they they have a specific facility
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  with a specific panel. And, you know, we
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  found that,
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  that really impacts avoidable admissions, readmissions.
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  It lifts the residents' experience so they're not
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  constantly going back and forth. And so from
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  a model perspective, that absolutely avoids
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  inpatient costs.
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  But at the same time,
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  from an administrative perspective, corporate perspective, understanding how
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  we could
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  leverage different technology tools like AI,
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  to do things. I think it's definitely a
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  little early still on the clinical end of
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  using AI. There's a lot of proof of
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  concepts out there that are really cool,
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  but having
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  the ability to kind of leverage different tools,
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  whether it's,
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  machine learning tools to better stratify your population
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  or to augment or identify
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  fraud waste and abuse, anything like that that
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  we could use to kind of optimize
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  the existing workflows that aren't,
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  particularly clinical in nature, I think, is is
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  a low hanging fruit. And then I think
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  also just administrative
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  tasking,
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  equipping
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  employees with the proper tools that are available
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  in today's market,
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  to help them be more efficient.
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  And and, frankly, you know, everyone's tired of
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  hearing this, but do more with less. I
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  I think,
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  give them a really cool tool. Let them
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  let them use these tools to help them
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  optimize their work. You still have a person
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  involved there, so we're not talking pure Agentics
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  at this point. Right? But,
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  you have human level oversight
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  with a tool that can help them,
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  improve their day to day tasking and keep
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  them more efficient.
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  Absolutely.
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  Well, I'd like to keep that conversation going
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  about that quality of care. Mhmm. So what
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  best practices or tools does your organization rely
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  on to keep quality of care at the
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  forefront?
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  So, I mean, a couple things. I think
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  one,
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  quality of care is
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  there's different couple different angles. Right? You've got,
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  like, the HEDIS angle, but you also have
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  the the actual quality of the care. I
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  already touched on, the quality based agreements. I
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  think that's vital. Right? Moving away from fee
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  for service and and incentivizing people purely based
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  off of the quality of of care that
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  they're delivering to patients, I think, is is
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  key. That's with PCP groups. That's with with
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  skilled nursing facility. You know, every everything across
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  the board. I think,
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  at the same time,
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  understanding
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  broader
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  provider behavior
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  is important. Right? So when we look at
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  and we leverage
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  machine learning or predictive analytics to,
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  create these
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  more network driven
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  oversight tools that allow you to see, you
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  know, of your inpatient stays,
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  which inpatient stay is really you know, what's
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  the readmission rate based off of different inpatient
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  providers?
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  What what type of costs are we seeing
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  coming from them? Is the is it qualitative
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  in nature? And I and I think there's
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  a lot of opportunity there in,
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  optimizing network, understanding and this is across the
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  industry, right, not just at longevity health, but
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  understanding
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  what providers are delivering quality care versus just
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  delivering care. And I think when you optimize
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  your network to focus specifically on the quality
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  care,
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  I think that's a big big next step
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  because you can only control what you can
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  control.
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  And if you're not
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  being proactive in that space and identifying your
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  network
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  and,
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  trying to encourage
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  proactivity
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  amongst
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  the providers that are that are delivering that
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  that high quality.
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  Whatever KPI is gonna reflect that, I think
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  that's probably that's key.
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  Absolutely.
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  We've talked about the imperative to reduce costs,
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  improve quality, and advance health equity, none of
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  which are small tasks.
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  How do you approach aligning these priorities in
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  your organization's strategic vision?
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  So I think the theme of the day
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  is gonna be, you know, technology and tools.
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  And I think the biggest thing,
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  one, is allowing
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  the use of technology. I think over the
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  last three years, right, generative AI has blown
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  up, but
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  artificial intelligence is the big buzzword, but it's
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  really existed since the nineteen fifties.
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  So you have machine learning, predictive analytics, different
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  types of things like that. And I think
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  making sure that we are
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  implementing
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  efficiencies
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  and, by leveraging technology, but at the same
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  time,
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  not reducing
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  the quality and governance of the oversight we
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  have to make sure that we're remaining compliant
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  and to make sure that we're doing it
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  the right way within, you know, CMS standards
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  and whatever other types of standard standards that
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  we operate within. I think that's key. Right?
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  So,
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  driving forward
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  with technology while ensuring that there's governance and
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  oversight,
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  and I think that
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  that also includes ethical oversight as well. I
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  think some of these really cool models that
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  are coming out with
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  are being shown and found to have,
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  some maybe nonethical
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  steps and and and bias that inherently,
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  was inadvertently
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  added to the model because of of human
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  data that that was ingested and and used
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  to train it. Right? And I think
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  so taking those resources that we're getting from
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  creating efficiencies and implementing these type of tools
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  and taking a portion of those to be
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  more efficient and and create cost savings, but
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  also leveraging some of those savings, not just
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  pocketing it all and investing a little bit
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  more in the governance and the oversight into
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  the types of tools that you're using is
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  probably a a more
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  robust and long term strategy
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  to make sure that
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  that through leveraging these new tools, we don't
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  introduce new risk.
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  Well, before we wrap up here, is there
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  anything else that you'd like to share with
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  our listeners today that we haven't already discussed?
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  Yeah. I think my big thing and what
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  I would encourage everybody listening and,
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  especially leaders of teams and executives is
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  if your staff don't become literate
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  with the new tools that are available to
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  them,
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  they're going to get behind and you'll get
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  behind. And,
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  I think that that means
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  it's important for us to find ways,
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  risk free, while keeping risk and and governance
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  in mind
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  of getting our staff,
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  familiar
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  and used to and exposed to tools, not
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  just in their personal lives. Right? Like, I
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  think everyone's like, oh, I've got Chad GPT
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  on my phone or I've got this. And,
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  you know, when I when I press Google,
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  Gemini pops up at the top. But at
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  the end of the day, if if people
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  aren't thinking of how to use these tools
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  in a professional manner,
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  they're gonna miss out. Right? We've got a
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  lot of really smart people, and something I
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  believe,
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  in is, you know, I wanna hire people
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  smarter than me. Right? That's that's how you
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  do do well.
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  And and so
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  empowering that staff
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  to do that, is something that I think
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  is is an opportunity. There's a lot of
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  people that are engaged and excited to do
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  it themselves, but at the same time, there's
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  people that might need a little bit of
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  a push. And so one of the things
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  I actually did for this, I realized on
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  on my team is that I had a
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  lot of really good technical skills, but my
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  staff
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  had an opportunity to learn a little bit
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  more. I like to say how the machine
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  works, but, like, the managed care like, what
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  is managed care? What's a claim? How does
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  a claim process? How does an authorization process?
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  And so I actually created a a customized
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  large language model. And it's just trained. It's
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  a chatbot. Right? But it's trained on stuff.
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  You can actually it's it's open source, so
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  anybody can can go and look at it
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  and use it. You can go to
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  app.managedcare101.ai.
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  But ask it anything about managed care. Right?
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  Get people used to navigating
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  large language models, NLP, and encourage your staff
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  and empower your staff to operate at the
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  top of of what they're capable of doing.
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  And I think that's gonna take us a
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  long way over the next few years as
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  continue to see technology,
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  you know, go down the path it's going.
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  Absolutely. Well, thank you so much for joining
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  me today. Again, this is Haley Rutger with
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  the Becker's Payer podcast
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  recording live at the Becker's third annual spring
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  Payer issues roundtable. Brad, thank you so much.
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  Thank you.