Latest / Becker’s Payer Issues Podcast / Building Trust and Member Engagement in Medicare Advantage with Garfield Collins

Transcript

Building Trust and Member Engagement in Medicare Advantage with Garfield Collins · Becker’s Payer Issues Podcast

• 0:02
  - Generative AI is driving the era of infinite
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  - 60 innovative healthcare organizations
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  - to drive patient and member outcomes.
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  - Offering the safest clinical AI voice agents, Hippocratic
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  - AI is the first company to define comprehensive
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  - voice AI benchmarks for healthcare.
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  - Safety, clinical accuracy,
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  - 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 prayer issues roundtable.
• 0:39
  - I'm excited now to be joined by Garfield
• 0:41
  - Collins, who is the cofounder and chief administrative
• 0:44
  - and partnership officer at Xyng Health.
• 0:46
  - Garfield, thanks for being here. I'd love to
• 0:48
  - have you start by introducing yourself and sharing
• 0:50
  - a little bit more about your role and
• 0:52
  - Xyng Health. Sure. Yeah. You know, thanks for,
• 0:55
  - you know, allowing me to be here. You
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  - know, I'm the cofounder of Xyng Health. We're
• 0:58
  - a Medicare Advantage plan based here
• 1:01
  - in Chicago. It's where we started. We are
• 1:03
  - now in six states, about 42,000
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  - lives.
• 1:07
  - And Xyng's focus is on members with chronic
• 1:11
  - special needs, so members with diabetes and cardiovascular,
• 1:15
  - you know, ESRD, CKD type of so to
• 1:18
  - really sick people. You know? And my role
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  - currently
• 1:21
  - is I'm over clinical. I'm over network.
• 1:24
  - Our HR HR admin and also legal function.
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  - But, also, the majority of my time is
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  - over the clinical, and also network functions,
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  - today.
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  - Absolutely.
• 1:33
  - And so from your perspective,
• 1:35
  - starting our conversation here, what is the most
• 1:38
  - pressing operational challenge facing payers right now, and
• 1:41
  - how are you addressing it? So I'd say
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  - for payers and specifically us
• 1:46
  - in the space that we are in Medicare
• 1:48
  - Advantage, but also the demographic that we serve,
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  - you know, it it's it's good. So it's
• 1:53
  - MLR pressures. Right? So it is really affordability
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  - and, you know, ensuring that
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  - we're
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  - not just managing
• 2:01
  - those members, but also making sure that we're
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  - we're doing it. And, you know, with I'll
• 2:07
  - say with the right partners,
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  - but also doing it efficiently.
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  - And our biggest, you know, I'll say, our
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  - biggest challenge now is really,
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  - you know,
• 2:17
  - kind of managing the medical expense. Right? And,
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  - you know, what are the levers that we've
• 2:21
  - gotta pull
• 2:22
  - to manage the expense, but also ensure that
• 2:25
  - we're offering
• 2:26
  - the right kind of care,
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  - especially for the members that we serve. Right?
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  - So our members, as I said, they're chronically
• 2:32
  - ill members, so they're diabetics.
• 2:34
  - So we're the only plan in the country,
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  - as an example, that if you're a diabetic,
• 2:38
  - you get a GLP one drug at zero
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  - cost.
• 2:40
  - So
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  - that in in itself, just by saying that
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  - tells you that, you know, everybody knows, you
• 2:45
  - know, those things aren't cheap, but we've gotta
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  - manage
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  - you know, how how do you manage that
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  - cost for those members, you know, who have
• 2:53
  - that condition,
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  - but then ensure
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  - that the benefits that we design, you know,
• 2:58
  - for our members are in line. One, it's
• 3:00
  - sustainable. So we don't do something this year
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  - and take it away next year, you know,
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  - but then ensuring that, you know, it's something
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  - that we can do in the long run
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  - ongoing, you know, as as we acquire more
• 3:10
  - and more members, right, in our plan. So
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  - it's really
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  - facing those realities. It's so on the drug
• 3:17
  - side, it's making sure our PBM partners understand,
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  - hey. You know, what's the best way to
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  - set up our formulary
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  - that is
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  - not
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  - increasing the debt burden on our members,
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  - but also ensuring that the plan is sustainable
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  - right at the end of the day. So
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  - you can't just do it all for free,
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  - you know, to where you're going. You know?
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  - Because one, you know, you know, we always
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  - say there's no mission without marketing.
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  - But more importantly,
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  - we also can
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  - put those issues on the backs of our
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  - members as well as we're trying to, you
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  - know, get them to
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  - not have to make a choice over getting
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  - drugs versus paying, you know, electric bill or
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  - buying food. Right? So for us, it's really
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  - focusing on
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  - how do we align,
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  - you know, all those things, right, to ensure
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  - that, you know, I'm addressing the cost. Because
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  - I know if I address their drug cost,
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  - they take the drugs,
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  - and we'll see better outcomes. So if they're
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  - focused on other things and not being the
• 4:12
  - doctor, not taking medication,
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  - then that medical cost is gonna continue to
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  - rise. Right? So we've gotta just you know,
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  - that's those are the levers that we're pulling,
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  - you know, to ensure we're managing. Look at
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  - the cost as well.
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  - Absolutely.
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  - And there is a constant tension between keeping
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  - costs down and actually delivering a good member
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  - experience,
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  - especially as it comes to care coordination.
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  - So how is your organization balancing cost containment
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  - with improving member experience and quality outcomes, and
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  - where are you seeing the greatest opportunity for
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  - impact there? It is at the point of
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  - arrival for that member. So when a member
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  - joins Xyng,
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  - we have a team that does an outreach
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  - to them. And one, let's
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  - you know, just kinda says, hey. You know,
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  - welcome to Xyng, but here's what you signed
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  - up for, and here's the benefits that you
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  - get. So if you're diabetic, right, hey. Don't
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  - forget. Every month, depending on the plan or,
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  - you know, where you are, you get a
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  - food card, and it's
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  - $150.
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  - You know? So don't forget you got that
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  - benefit.
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  - If you're in this you know, if you're
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  - taking these drugs and it's on this tier,
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  - you know, don't be concerned
• 5:18
  - because it's zero cost to you. So when
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  - they're you know, if your doctor prescribes this,
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  - you know, don't go, oh my god. I
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  - can't afford it. No. It's, you know, free
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  - or call us. So for us, really, to
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  - engage in that member experience
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  - is educating
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  - the member
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  - when they join the plan. What we also
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  - do is we don't typically call the member
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  - as soon as, you know, they enroll, meaning
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  - we we do, like, a a touch base
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  - call, make sure they got their ID card,
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  - make sure they understand what it is.
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  - But they probably just,
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  - finished a call with the broker for two
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  - hours
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  - to get them enrolled. The last thing they
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  - wanna do is spend forty five minutes talking
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  - to one of our folks. So we kinda
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  - do the intro to make sure they get
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  - the basics, and then in about you know,
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  - we do it's called a a forty five
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  - day check-in. Then we do a check-in to
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  - go back through and really reeducate them, you
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  - know, and make sure they've, you know, they've
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  - done like a they've scheduled their first visit,
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  - you know, all those
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  - things. Because once you get the first thing
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  - is getting the member into the plan. The
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  - second
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  - part of the process is to get the
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  - member to engage
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  - and understand
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  - what the benefits are. You know? You know?
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  - Hey. You joined the client for a reason.
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  - Here's all the things that we have, you
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  - know, that are good for you. Our biggest
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  - concern whenever you lose a member and and
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  - we do, like, a dis enrollment survey,
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  - Every time I
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  - hear, oh, you know, you know, the plan
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  - didn't have a food cart. And we're like,
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  - wait. What do you mean we have a
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  - food? So that's an opportunity for us to
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  - go, hey. Where are we missing
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  - in the process to
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  - educate them? And there's a lot of information
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  - coming at them as well. So how do
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  - we be how are we gonna be most
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  - impactful,
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  - you know, for that member to be able
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  - to understand,
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  - hey. You know, if it's us or if
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  - it's even a partner that we have,
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  - is telling them upfront, hey. You're gonna get
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  - a call from
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  - this partner,
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  - you know, company x y z. Here's what
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  - they're gonna do. Here's what they're looking for,
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  - and that's from us. So when they get
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  - that call, you know, if it's one of
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  - our chronic condition partners or somebody else, they
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  - understand, oh, I heard from Xyng. Here's what
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  - they're gonna do. And, again,
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  - that's helping the member understand,
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  - okay.
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  - They told me about it, and they may
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  - forget, but then our partner says, hey. I'm
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  - Garfield. I'm calling you on behalf of Xyng,
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  - and it hopefully, it triggers the conversation that
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  - they had before because, you know, it is
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  - important as we're sort of managing
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  - the cost aspect
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  - with the engagement aspect because I'm pretty sure
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  - or I know I know for a fact,
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  - you know, seniors get called a lot just
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  - in general. So it's really for us to
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  - try to take out the noise and have
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  - them focus on,
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  - hey. If it's if it's a Zing member,
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  - you know, here's who's gonna be calling you
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  - and why. And if and if somebody else
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  - is trying to call you and tell you
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  - something else, feel free to call us, and
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  - we'll validate that for you. At the end
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  - of this, it's really letting them feel as
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  - if they're a a part of the plan,
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  - which they are, but to know that it's
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  - a safe space for them to call us
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  - and ask us any questions. And, you know,
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  - you know, that's really what
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  - our, you know, our frontline team, you know,
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  - is is doing.
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  - And those are, you know, real people making
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  - real calls. You know? Because one, the first
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  - interaction for us is extremely, extremely important.
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  - You know? So if they've got any other
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  - questions, that agent or that rep can,
• 8:33
  - help them with that.
• 8:34
  - And digital engagement and transformation continues to accelerate
• 8:38
  - across health care. So what technologies and AI
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  - are you prioritizing
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  - right now, and where are you seeing meaningful
• 8:44
  - ROI as well as better engagement with members?
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  - That's,
• 8:49
  - that's an interesting question. So
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  - on the digital side, for us, it's really
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  - ensuring that, like, you know, we have a
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  - member application.
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  - And even in that conversation that I talked
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  - about when we when we do the outreach,
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  - we try to help them understand, hey. You
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  - know, there's an app, and you can use
• 9:06
  - the app to do all these things. Right?
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  - And you can use the app to check
• 9:10
  - the balance on your food or on your,
• 9:13
  - you you get on your benefit card. You
• 9:15
  - can see where everything is, and it's really
• 9:17
  - helping them to be able to, sort of,
• 9:20
  - be self sufficient,
• 9:22
  - but also you know, because everybody uses their
• 9:24
  - phone. Everybody,
• 9:26
  - you know, I'll say for the most part,
• 9:27
  - has a phone, you know, has a smartphone.
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  - So it's really for us, how do we
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  - get them to engage, you know, as, you
• 9:33
  - know, as we're bringing them into the plan
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  - and keeping them on? What we try to
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  - limit
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  - is, you know, if we've got 10 partners
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  - is if every 10 partner has an app.
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  - It's like we're not we're not trying to
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  - overstimulate
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  - them with all these different places to log
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  - in. Our first goal is, can we take
• 9:49
  - your information
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  - and put it in our app so that,
• 9:53
  - you know, it's easier for the member to
• 9:55
  - transition. So if it's single sign on, once
• 9:57
  - they sign on to ours, they can log
• 9:58
  - in to yours, and we'll do that work
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  - with our partner. Those are the partners that
• 10:02
  - we look for. We don't we, you know,
• 10:04
  - it would it doesn't always work work that
• 10:06
  - way, but that's that's sort of our stuff
• 10:08
  - because we wanna reduce
• 10:10
  - the amount of time somebody's gotta go somewhere
• 10:12
  - to get information. You know, you know, that's
• 10:14
  - really the focus for us because, you know,
• 10:18
  - these are members with with serious
• 10:20
  - illnesses, you know, or they have the potential
• 10:22
  - to have serious illnesses. You don't want them
• 10:25
  - bumbling around three or four different apps to
• 10:27
  - log in to remember which app do I
• 10:28
  - use for this. We can bring them to
• 10:30
  - one landing page, and it's Brandon Zing. And
• 10:33
  - if they need to go to their PBM,
• 10:34
  - click it takes you right there and they
• 10:36
  - see their stuff. They need to go to
• 10:38
  - this partner. They click right there and it
• 10:40
  - go they wanna check a balance. It's all
• 10:42
  - in one ecosystem for them. So that's
• 10:45
  - that's our goal. We're not a 100% there
• 10:47
  - yet, but that's really the goal because what
• 10:48
  - that does
• 10:50
  - is it allows us we can push out
• 10:53
  - more technology
• 10:54
  - for the members to use, but then they
• 10:56
  - get very comfortable
• 10:57
  - in one space to kinda do as much
• 10:59
  - as they can do. Right? And there is
• 11:01
  - a there is an ROI for that in
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  - two ways.
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  - There's an ROI on the time for the
• 11:05
  - member going up, but it's also for us
• 11:07
  - because the more we're managing that
• 11:10
  - you know,
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  - if a partner leaves,
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  - right, and I've gotta bring a new partner
• 11:15
  - in, it's almost seamless to the member if
• 11:16
  - it's in one place.
• 11:18
  - If it's now you gotta go log in
• 11:20
  - somewhere else to go do a task or
• 11:22
  - do something.
• 11:23
  - You know, the the risk is the member's
• 11:25
  - like, I'm frustrated. You guys keep changing or
• 11:27
  - whatever amount. You know? And then there's a
• 11:29
  - loss of that member and then everything else
• 11:31
  - that comes with that and all that time
• 11:32
  - that's invested, you know, there. So it's there's
• 11:35
  - there's savings for us by consolidating
• 11:38
  - on our side, but there's also savings in
• 11:41
  - time and also frustration for the member.
• 11:44
  - And health care workforce shortages continue to impact
• 11:47
  - payers and providers alike. So how are you
• 11:49
  - thinking about AI as a way to augment,
• 11:51
  - not replace care teams, especially in areas like
• 11:54
  - call centers, care management, and population health? Yeah.
• 11:56
  - We're doing this today. Right? So, you know,
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  - one of the things that we did was
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  - to see
• 12:02
  - where do we think we could have the
• 12:04
  - most impact
• 12:05
  - on our workforce, meaning not reducing workforce, but
• 12:08
  - to make them more efficient,
• 12:10
  - and also where,
• 12:12
  - you know, where we can use automation
• 12:15
  - to sort of shore that up. So for
• 12:17
  - us, it's like around a Medicare's calls.
• 12:19
  - Right? So for us today,
• 12:22
  - our first
• 12:23
  - two rounds of
• 12:25
  - of of of Medicare's calls members
• 12:27
  - are all automated.
• 12:28
  - Right? So,
• 12:30
  - you know, hey. Call me up at Garfield.
• 12:32
  - Don't forget you've got it's time for a
• 12:35
  - prescription renewal,
• 12:36
  - you know, and just kinda doing doing that.
• 12:39
  - Or, you know, we see opportunities
• 12:41
  - around, like, follow-up after hospitalization.
• 12:44
  - You know, simple simple tasks to just remember
• 12:48
  - just to remind a member of things they've
• 12:50
  - gotta do that
• 12:52
  - shouldn't require them to have to go down
• 12:55
  - a path where they're gonna need to talk
• 12:58
  - to a case manager or or a nurse.
• 13:00
  - You know, we'll preserve those things for when
• 13:03
  - we want a live person to call. Right?
• 13:05
  - So that's that's where, for us, it's really
• 13:07
  - the I'll say, though,
• 13:10
  - the higher easier or higher touch stays that
• 13:13
  - are just pretty easy for folks to do.
• 13:15
  - They don't forget take your meds. They don't
• 13:17
  - forget you've got a script.
• 13:19
  - You've got a refill. Nope. Things like that
• 13:21
  - where it doesn't take a lot of time.
• 13:23
  - It's not confusing.
• 13:24
  - Really easy for them to go, oh, yeah.
• 13:25
  - I gotta go get my you know, I've
• 13:27
  - gotta go pick up my prescription, or it
• 13:29
  - was ordered, or I've gotta go reorder it,
• 13:30
  - or don't forget to take it, right, at
• 13:32
  - the end of the day, or if you
• 13:33
  - got an appointment reminder. And don't forget you
• 13:35
  - got an appointment at 03:00 on on Wednesday.
• 13:39
  - Those are the things you know, for us,
• 13:41
  - it's the simple stuff to start with first
• 13:43
  - before we get
• 13:44
  - into the more complex stuff, and it's twofold.
• 13:48
  - It's to see how the members respond
• 13:50
  - to
• 13:51
  - that knowing that they're not talking to a
• 13:53
  - real person. Right? I mean, some people don't
• 13:55
  - know the difference,
• 13:56
  - but some people realize and they go, okay.
• 13:58
  - So if we decide to extend that further,
• 14:02
  - they're already comfortable with
• 14:03
  - that experience. Right? So it's not like,
• 14:06
  - oh my goodness. I'm in, you know, I'm,
• 14:08
  - you know, I'm in this in this loop
• 14:10
  - that in this loop I can't escape out
• 14:12
  - of. They're comfortable with sharing automation
• 14:15
  - and interacting. And then if they need to
• 14:16
  - opt out, we've got a way for them
• 14:17
  - to opt out as well. So that's, you
• 14:20
  - know, that's a real thing for us that
• 14:21
  - that we're doing today.
• 14:24
  - And my final question for you today is
• 14:26
  - surrounding AI voice technology is this has changed
• 14:29
  - pretty dramatically.
• 14:31
  - We're not talking about robocalls or IVR menus
• 14:33
  - anymore. There's now AI that can hold real
• 14:35
  - conversation,
• 14:36
  - show empathy, ask follow-up questions, and know when
• 14:39
  - to bring that human in. So do you
• 14:41
  - think we're at the point where a patient
• 14:43
  - or member can have that kind of interaction
• 14:45
  - with an AI and actually trust it? And
• 14:47
  - what has to be true for that to
• 14:48
  - work? Yeah. It's like a follow-up to the
• 14:50
  - last question is yeah. For us, trust is
• 14:52
  - a big deal. Right? So we don't wanna
• 14:54
  - break that circle of trust by making them
• 14:56
  - think we just, you know, out you know,
• 14:59
  - you know, kinda push them off.
• 15:02
  - You know?
• 15:03
  - And we get I'll speak for myself. I
• 15:05
  - get
• 15:06
  - all the lot about opportunities to use AI,
• 15:09
  - and we do listen and see. And some
• 15:11
  - still some are you know, some still have
• 15:12
  - that
• 15:13
  - voice,
• 15:14
  - but I think we're we're pretty close. You
• 15:16
  - know? I I think I think they're pretty
• 15:18
  - close. And that's why, you know, when I
• 15:19
  - said before,
• 15:21
  - for us starting out getting
• 15:23
  - the member comfortable with, I'll say, the easy
• 15:26
  - stuff,
• 15:27
  - right, with the metaherence, with the follow-up, with
• 15:30
  - those things allows us to transition into
• 15:33
  - deeper conversations
• 15:35
  - to where then if we truly I, you
• 15:37
  - know, even benefit questions. Right? Hey. What's my
• 15:40
  - oh, no.
• 15:42
  - The AI the automation can do that. So
• 15:44
  - I think for
• 15:45
  - us, we're setting that stage to when we're
• 15:47
  - really comfortable to have really meaningful
• 15:50
  - clinical conversations
• 15:52
  - that the member will feel comfortable and not
• 15:54
  - just feel like I'm just talking to something
• 15:56
  - that
• 15:57
  - sounds like a computer but doesn't understand.
• 16:00
  - And then it's also about
• 16:02
  - making sure we're feeding in the information
• 16:05
  - that allows that conversation to seem almost natural.
• 16:08
  - Right? But I think I think we're
• 16:10
  - I think the technology
• 16:12
  - to do it is there. I think it's
• 16:14
  - it it'll it'll differ by what the inputs
• 16:16
  - are to be able to give that partner
• 16:18
  - the right information. So if the member has
• 16:20
  - a question, they're getting the right answer. Right?
• 16:23
  - It's not answering a question that's not being
• 16:25
  - asked. Right? But also giving them an opportunity
• 16:27
  - to opt out to get to a live
• 16:29
  - person if needed at the end of the
• 16:30
  - day. So, yeah, I mean, I think we're
• 16:32
  - we're
• 16:33
  - we're working on the trust part because that's
• 16:35
  - for us to sort of build that trust
• 16:37
  - in how we use use it now in
• 16:39
  - these small steps. So when we make the
• 16:42
  - bigger steps, it's it's an easier transition for
• 16:44
  - the member. You know? So that's that's that's
• 16:46
  - how we look at that, you know, that
• 16:48
  - piece.
• 16:50
  - Wonderful. Well, Garfield, thank you so much for
• 16:51
  - joining me today on the Becker's healthcare podcast
• 16:54
  - and sharing these thoughts and insights. Again, we
• 16:56
  - are recording live at the fourth annual spring
• 16:58
  - payer issues roundtable.
• 17:00
  - Oh, no. Thank you for having me. I
• 17:02
  - appreciate it.