Latest / Becker’s Payer Issues Podcast / Rebuilding Trust and Letting Consumers Drive Healthcare with Joseph Leach

Transcript

Rebuilding Trust and Letting Consumers Drive Healthcare with Joseph Leach · Becker’s Payer Issues Podcast

• 0:02
  Generative AI is driving the era of infinite
• 0:05
  healthcare abundance.
• 0:06
  At Hippocratic AI, we partner with more than
• 0:09
  60 innovative healthcare organizations
• 0:11
  across payers, providers, and life sciences
• 0:14
  to drive patient and member outcomes.
• 0:16
  Offering the safest clinical AI voice agents, Hippocratic
• 0:20
  AI is the first company to define comprehensive
• 0:22
  voice AI benchmarks for healthcare.
• 0:25
  Safety, clinical accuracy, empathy, consistency.
• 0:29
  Learn more at hippocraticai.com.
• 0:32
  This is Gracelyn Keller with the Becker's Healthcare
• 0:34
  podcast, and we are recording live at the
• 0:36
  fourth annual spring payer issues roundtable.
• 0:39
  I'm currently joined by Joseph Leach, who is
• 0:41
  the market president at Oscar Health. So, Joseph,
• 0:44
  thanks for being here. And I'm gonna have
• 0:46
  you start off by just introducing yourself a
• 0:49
  little bit further and sharing more about your
• 0:51
  role and organization.
• 0:52
  Yeah. Thanks for having me. Yeah. Yeah. So
• 0:54
  Joe Leach, I'm the market president for Ohio
• 0:56
  and Michigan for Oscar. I own the strategy
• 0:58
  and performance, in those markets, as well as,
• 1:01
  you know, out in the community building partnerships,
• 1:03
  attracting clients, trying to grow the business. So
• 1:06
  Awesome. Well, thank you for being here. And
• 1:09
  I'd love to start with, from your perspective,
• 1:11
  what is the most pressing operational challenge facing
• 1:14
  payers right now, and how are you addressing
• 1:16
  it? Yeah. So so I would assume the
• 1:18
  answer most people are gonna give is, you
• 1:20
  know, rising costs,
• 1:21
  and and all that. I think the biggest
• 1:23
  one for me is there's just this lack
• 1:25
  of trust
• 1:26
  from the consumer in the entire,
• 1:28
  you know, in health care infrastructure. And there
• 1:30
  never really was a ton, and that's you
• 1:32
  know, what little was there has eroded, and
• 1:34
  I think that's on both payer and provider
• 1:36
  sides. Right? So if you talk to any
• 1:38
  provider,
• 1:38
  you know, patients are almost outright hostile now.
• 1:41
  They're having to invest a lot of money
• 1:42
  in, you know, de escalation training and security,
• 1:45
  you know, trying to protect their staff, and
• 1:47
  that's contributing to staffing problem. And you see
• 1:49
  it on the payer side. Right? You know,
• 1:50
  Brian Thompson is, the most prolific example, but,
• 1:53
  you know, there's constantly protest death threats. You
• 1:55
  know, people people hate the health care industry.
• 1:57
  They're mad.
• 1:58
  So I think, you know, what are we
• 2:00
  doing about it? I think it has to
• 2:01
  be an operating model, not necessarily a campaign
• 2:03
  to try and build that trust back.
• 2:06
  I think foundationally, there are three things that
• 2:08
  we're we're trying to do. The first one
• 2:09
  is just do the right thing. Right? And
• 2:12
  from a payer perspective, I think that's, you
• 2:14
  know, siding with the consumer more in decision
• 2:17
  making. Right? That, you know, customer has is
• 2:19
  always right mentality, I think, is
• 2:21
  it it feels a little nostalgic now across
• 2:24
  all industries, but I think in health care
• 2:26
  especially.
• 2:26
  So, you know, make sure you're you're thinking
• 2:28
  about you're putting yourself in the consumer's shoes.
• 2:31
  Right? And realizing that they know what they
• 2:33
  want better than you do, so you should
• 2:34
  listen to them. I think that's step one.
• 2:37
  Step two is just be transparent. Right? It's
• 2:39
  an incredibly complex industry, but most industries are
• 2:42
  really complex. The problem is, like, we never
• 2:44
  translate it to the members. So be really
• 2:47
  or to the consumer, be really transparent.
• 2:50
  Do things that at Oscar, we leverage AI.
• 2:52
  I think AI is a great tool for
• 2:54
  this to help people interpret their benefits. Right?
• 2:56
  Because they, you know, look at an EOB
• 2:58
  or they look at an explanation of benefits,
• 3:01
  and they think, like, okay. How much is
• 3:02
  it gonna cost me? And they like, there's
• 3:04
  no idea. Right? There's a lot of math
• 3:05
  you have to do. If you can load
• 3:07
  all that into an AI tool like we
• 3:08
  have, and they can ask a simple question
• 3:10
  like, hey. I need an endoscopy. What's it
• 3:12
  gonna run me out of pocket?
• 3:13
  And spit out those answers. And the last
• 3:15
  one, I think you gotta meet consumers where
• 3:17
  they're at and make products that they want.
• 3:19
  Right? You gotta you gotta build the car
• 3:21
  that people wanna drive, not necessarily the car
• 3:23
  that you wanna sell. And, like, Lee Iacocca
• 3:25
  in the minivan back in the eighties is
• 3:26
  a great example of that. Right? Like, everybody
• 3:29
  wants to make sports cars, but people wanna
• 3:31
  buy minivans.
• 3:32
  So we've done we've done that too. Right?
• 3:34
  There's, you know, clinical,
• 3:36
  focused products around, you know, menopause.
• 3:39
  You can get a little more more initiate,
• 3:41
  with products in the individual market, but, you
• 3:43
  know, meet them where they're at. Right? They
• 3:44
  they want those kinds of things and put
• 3:46
  them together for them and people will buy
• 3:47
  them. So
• 3:48
  Absolutely.
• 3:49
  And there is a constant tension between keeping
• 3:51
  costs down and actually delivering a good member
• 3:53
  experience,
• 3:54
  especially as it comes to care coordination. So
• 3:57
  how is your organization
• 3:58
  balancing cost containment
• 4:00
  with improving member experience and quality outcomes, and
• 4:03
  where are you seeing the greatest opportunity for
• 4:05
  impact there? Yeah. I I think that even
• 4:08
  relates back to the first call. I think
• 4:09
  you gotta let consumers drive. Right? They know
• 4:11
  what they want better than you. They're savvier
• 4:14
  than I think people give them credit for.
• 4:16
  I think the best opportunity for that right
• 4:18
  now is ICCRA, which is the individual coverage
• 4:21
  health reimbursement account, a terrible
• 4:24
  long winded name. But, essentially, what it is
• 4:26
  is it's employers are giving you money and
• 4:28
  you go and buy your own coverage as
• 4:29
  opposed to them prescribing it you to you
• 4:31
  and subsidizing it, which is the way employer
• 4:33
  sponsored coverage works now where, you know, when
• 4:36
  you sign up during open enrollment, you have
• 4:38
  a choice or two, usually. It's usually a
• 4:40
  PPO or some kind of narrow a HMO
• 4:42
  or HPN type product. With ICRA, you know,
• 4:44
  you have the subsidy in your pocket, and
• 4:46
  you can go out and shop through, you
• 4:48
  know, 90 to a 100 plans, on the
• 4:51
  exchange. And that does allow payers to get
• 4:53
  a little bit more Michi in what they
• 4:55
  offer.
• 4:56
  You know, we have a menopause,
• 4:57
  HelloMino plan that has, you know, $0 bone
• 5:00
  scans. It has $0 gynecology visits, hormone replacement
• 5:03
  therapy. And then people wanna buy those things,
• 5:05
  and that's how you, I think, control costs
• 5:07
  by by meeting the consumers where they're at.
• 5:09
  And then the experience is better because they're
• 5:10
  picking out what they want. Right? You know,
• 5:13
  it's the one thing I don't think we've
• 5:15
  tried in health care in America is kinda
• 5:17
  letting the consumer
• 5:19
  drive the market. And I think ICRA,
• 5:21
  which, you know, Oscar has a real, you
• 5:22
  know, big vested interest interest in in being
• 5:24
  in the ACA market, is the best way
• 5:27
  to do that. Right? Let those market forces
• 5:28
  push payers,
• 5:30
  and providers really into spaces that are going
• 5:32
  to be, you know, better for consumers. If
• 5:34
  if they want it, if there's a market
• 5:36
  for it, somebody's gonna somebody's gonna make it.
• 5:38
  Right? So I think that's how we're approaching
• 5:40
  it. You know? I I think payers beat
• 5:42
  their head against the wall for too long,
• 5:44
  you know, trying to change,
• 5:46
  consumer behavior. Right? Trying to, like, get people
• 5:48
  to engage in programs when they don't trust
• 5:50
  you to begin with, right, relating back into
• 5:52
  that.
• 5:53
  So so this is the way to do
• 5:54
  it. Right? Put them in charge. Let them
• 5:56
  drive the market, and then all the, you
• 5:58
  know, producers. Right? The payers will meet them
• 6:00
  where they're at.
• 6:01
  Absolutely.
• 6:02
  And digital engagement and transformation continues to accelerate
• 6:06
  across health care. So what technologies and AI
• 6:09
  are you prioritizing
• 6:10
  right now, and where are you seeing that
• 6:12
  meaningful ROI
• 6:14
  as well as better engagement with your members?
• 6:16
  Yeah. So so, you know, Oscar's a tech
• 6:19
  first company. We're one of the only payers
• 6:21
  at single stack IT infrastructures.
• 6:23
  Whereas every other, you know, legacy payer is
• 6:26
  kind of these, you know, built by acquisitions.
• 6:27
  So you have systems stacked on top of
• 6:29
  systems,
• 6:30
  and, you know, 50 different translations that need
• 6:32
  to happen between all your data, and you
• 6:34
  end up with, like, duplicative data and it's
• 6:36
  a mess. With us, everything's integrated within one
• 6:38
  place. Right? So our provider data, our claims
• 6:41
  data, you know, the member enrollment data, all
• 6:43
  everything we have is here. So we really
• 6:45
  have a leg up in this.
• 6:47
  One of the things that we've we've pushed
• 6:49
  is our super agent tool,
• 6:51
  which, you know, is an AI chatbot, but
• 6:53
  it has all of the members relevant, like,
• 6:55
  history and information in it. Right? So it'll
• 6:57
  know, like, hey. This person has, you know,
• 6:59
  chronic
• 7:00
  illnesses. And people are doing this anyway. Right?
• 7:02
  They're low everybody's loading everything into chat g
• 7:04
  p t and so what the hell does
• 7:06
  this mean? Right? Every from your, you know,
• 7:07
  when you get your car fixed to when
• 7:09
  you get a medical bill to, you know,
• 7:10
  your medical history, should I worry about this?
• 7:12
  Like, everybody's getting a second opinion from chat
• 7:14
  g p t. So, again, like, they're doing
• 7:17
  it. Let's build a better tool for them
• 7:18
  to do that. What ours does is it
• 7:20
  integrates all that history, all of our, you
• 7:23
  know, data provider data, all that other kind
• 7:25
  of stuff, and it gives them, you know,
• 7:26
  answers and context. So when they ask, like,
• 7:28
  you know, whether it's a again, how much
• 7:31
  is an endoscopy gonna cost me and where
• 7:32
  should I go? It'll give you some options
• 7:34
  in your area. Hey. These guys are in
• 7:36
  network. It's, you know, this guy is lower
• 7:37
  priced than this guy or what have you.
• 7:40
  Or if you ask it, you know, medical
• 7:41
  questions, as well, which is another AI tool,
• 7:44
  it'll give to, you know, hey. My toe
• 7:46
  hurts. That means something very different from, you
• 7:48
  know, somebody with type one diabetes to just,
• 7:50
  you know, a 17 year old. Right? A
• 7:52
  teenager or something like that.
• 7:54
  So so, again, like,
• 7:55
  leveraging all that stuff, making a better member
• 7:58
  experience, you know, giving people answers when they
• 8:00
  want them because health anxiety is I mean,
• 8:03
  it's how people end up in the ER.
• 8:06
  You know, build building those tools to help
• 8:08
  enable them to do the things that they're
• 8:09
  already doing, right, with the the AI tools
• 8:12
  and the digital tools that are already out
• 8:13
  there.
• 8:15
  Absolutely.
• 8:16
  And health care workforce shortages continue to impact
• 8:19
  payers and providers alike. So how are you
• 8:22
  thinking about AI as a way to augment,
• 8:24
  not replace care teams, especially in areas like
• 8:27
  call centers, care management, and population health? Yeah.
• 8:30
  I I think, you know, we've used it
• 8:31
  to start automating routine tasks, right, so people
• 8:34
  can focus on more important work. And my
• 8:36
  favorite example isn't a payer example. It's a
• 8:38
  provider one. But almost every hospital now is
• 8:41
  using AI Scribes. Right? So when you're in
• 8:43
  the room, the doctor will say, hey. I'm
• 8:45
  gonna use, you know, my my friend here,
• 8:47
  and they'll turn their phone on and it'll
• 8:48
  record the conversation and put it in the
• 8:50
  clinical notes for the provider.
• 8:52
  And that's a huge administrative burden that's been
• 8:54
  lifted. Right? Normally, when you talk to your
• 8:56
  doctor, heads down, you know, trying to scratch
• 8:58
  notes as fast as possible, and then they
• 9:00
  spend what they call pajama time at home,
• 9:02
  like, trying to translate all this stuff.
• 9:04
  So they can spend more time with patients
• 9:06
  if you have an AI tool doing something
• 9:07
  like that. We've done the same thing in
• 9:09
  cost centers to make sure you're routing people
• 9:11
  to the right place. I'd like, everybody's been
• 9:13
  frustrated with the, like, algorithmic
• 9:16
  chat bots that existed in the past. Even
• 9:18
  some you know, I think the airlines still
• 9:19
  use them in a lot of cases where
• 9:20
  you're like, hey. You know, my flight I'm
• 9:22
  not gonna make my and you just cannot
• 9:24
  get through to this thing.
• 9:25
  AI is a lot better at that, so
• 9:27
  you can use it in place of that.
• 9:29
  We we greatly reduce turnaround times while keeping
• 9:33
  staff stagnant or even reducing staff in some
• 9:35
  cases using AI chatbots to try and, you
• 9:37
  know, answer the really easy questions. So you
• 9:39
  don't have human interventions,
• 9:41
  like you either had, you know, at the
• 9:42
  front door or after, you know, somebody fought
• 9:44
  through the algorithmic,
• 9:46
  chat bots. But yeah. Like, I they they
• 9:48
  can automate all these routine tasks, ask the
• 9:51
  really or answer the really easy questions and
• 9:53
  help you route folks in the right direction
• 9:55
  so you can you you know, the humans
• 9:56
  can spend more time on very important
• 9:59
  work.
• 10:00
  And kind of going off of that as
• 10:02
  we wrap up our conversation,
• 10:04
  AI voice technology
• 10:06
  has changed pretty dramatically.
• 10:08
  We're not talking about robocalls or IVR menus
• 10:11
  anymore, and there's AI now that can hold
• 10:14
  a real conversation,
• 10:15
  show empathy, ask follow-up questions, and know when
• 10:18
  to bring a human in like you have,
• 10:20
  mentioned.
• 10:21
  So do you think we're at the point
• 10:23
  where a patient or member can have that
• 10:25
  kind of interaction with AI and actually trust
• 10:27
  it? And what has to be true for
• 10:29
  that to work?
• 10:30
  It's scary. Right? Because now we're getting to
• 10:33
  the point where it's hard to tell
• 10:35
  when you're talking to a human.
• 10:36
  You know, I I think you have to
• 10:38
  be really mindful of the answers it's giving
• 10:40
  and making sure you're training and setting the
• 10:42
  right guardrails. We're starting to get to the
• 10:45
  territory of, like, you know, sci fi, like
• 10:47
  the iRobot, like, do no harm as the
• 10:49
  first rule. I I think that has to
• 10:51
  be in place, but I I think we're
• 10:52
  really close. I think people do it again
• 10:54
  already. I know a lot of people that
• 10:56
  use, you know, even just chat GPT baseline
• 10:58
  AI tools as like a therapist.
• 11:00
  And it it's not bad at it.
• 11:03
  UC San Francisco did this study where it
• 11:05
  was,
• 11:06
  you know, people got, you know, medical results
• 11:08
  from a real doctor or from a chatbot,
• 11:10
  and it's they're trying to test the level
• 11:12
  of empathy.
• 11:13
  And, you know, this blinded study where they
• 11:15
  ask people, like, hey. Which answer do you
• 11:17
  prefer? Overwhelmingly,
• 11:18
  they like the chatbot. They're more empathetic than
• 11:20
  a human being sometimes. And it's so so
• 11:23
  I think we're getting really close. Again, like,
• 11:26
  I don't think there's gonna be any real
• 11:27
  substitute for, like, true human interaction. But if
• 11:30
  it's, you know, three in the morning, you
• 11:32
  have an infant, the infant's sick, and you
• 11:34
  need an answer right away,
• 11:36
  I I think with the right guardrails in
• 11:38
  place,
• 11:39
  we're getting really, really close to where we
• 11:40
  can trust it. And if it's not a,
• 11:42
  you know, end all be all, which I
• 11:43
  don't think it's a replacement for anything that
• 11:45
  exists, like, the problems that exist are still
• 11:47
  gonna exist. You know, AI is an optimizing,
• 11:49
  you know, efficiency type of tool more than
• 11:51
  just, you know, a brand new replacement for
• 11:53
  everything.
• 11:54
  I think if you can find the right
• 11:55
  places to use it, it it can be
• 11:57
  you know, you can trust it. It can
• 11:58
  be really,
• 11:59
  really, really useful tool to people in those
• 12:01
  situations.
• 12:02
  Absolutely. Well, Joseph, thanks so much for having
• 12:04
  this conversation with me today, and sharing your
• 12:07
  thoughts and insights here. Again, we are recording
• 12:10
  live at the fourth annual spring payor issues
• 12:13
  roundtable.
• 12:14
  Thank you so much for having me. It's
• 12:15
  been a pleasure.