Latest / Becker’s Payer Issues Podcast / Howard Weiss, Vice President of Government Affairs at EmblemHealth

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Howard Weiss, Vice President of Government Affairs at EmblemHealth · Becker’s Payer Issues Podcast

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This is where health insurance leadership comes together.
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Becker's fourth annual spring payer issues roundtable brings
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together over 400 payer and health plan executives
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and more than 100 speakers to Chicago April.
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This year's event includes keynote conversations with the
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industry's top leaders and former president George W.
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Bush. For the full agenda and event details,
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visit beckershospitalreview.com
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and click on the events tab in the
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upper right. We're looking forward to hosting you
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here in Chicago.
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Hello, everyone, and welcome to the Becker's Healthcare
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Podcast. I'm Scott King. Thrilled today to be
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joined by a very special guest, Howard Weiss,
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vice president, government affairs with EmblemHealth.
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Howard, how are you doing today?
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Just fine. Thanks for having me. Thanks so
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much for joining us. I I really appreciate
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it. You know, I know we're gonna get
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into a lot of kind of the big
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trends and topics,
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facing health care today. But before we get
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started, could you please just tell me a
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little bit about your background, Howard, and and
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how you started your career journey?
1:00
Sure. So,
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I work at EmblemHealth.
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We are a nonprofit health insurer
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headquartered in New York City and mostly serving
1:10
Downstate New York.
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I've
1:13
been working in government relations here for about
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nine years.
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Before that, I worked at the National Trade
1:20
Association
1:21
representing health insurers,
1:23
AHIP, for fifteen years in Washington DC,
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mostly focusing on Medicare and Medicaid issues. And
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before that, worked at another trade association
1:32
in DC,
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representing Chang pharmacies.
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Thanks so much for sharing that background info
1:38
there, Howard.
1:39
The first topic I wanted to get to,
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first question I have for you is how
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are your relationships with providers
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changing as both sides face cost pressure and
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workforce shortages?
1:50
Yeah.
1:51
It's a very, interesting question.
1:54
I think speaking at the system level,
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you know, that the American health care system
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is being challenged by consumers and government in
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unprecedented
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ways.
2:06
Despite all the good collaboration between plans and
2:08
providers
2:10
to develop arrangements rewarding value over volume, there
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remains
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strong levels of dissatisfaction
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about the quality and cost of care.
2:19
At EmblemHealth, we have a unique relationship with
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a physician practice called
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AdvantageCare
2:25
Physicians of New York or ACPMY
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that provides primary specialty care to about half
2:31
a million people in New York City and
2:32
Long Island.
2:34
We have seen from our arrangements with ACPMY
2:37
and others
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how developing value based arrangements
2:40
holding both the plan and provider accountable
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leads to better outcomes and more affordable care.
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However, in many cases, especially with some of
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the large hospital systems,
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we have had difficulty developing
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similar types of arrangements.
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We at EmblemHealth firmly believe that the best
3:00
solutions to
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the the growing dissatisfaction with the health care
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system
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will come from collaborations between plans and providers.
3:09
How however, we will need to meet each
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other halfway
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to create real changes for the people we
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serve.
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Now from a health plan perspective, that means
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fixing our systems that take clinicians
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away from treating patients and reduce the availability
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of services people really need.
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That includes taking a serious look at our
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utilization management processes,
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eliminating them to services where there is significant
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evidence of misuse,
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and making it as easy as possible for
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providers to work with us.
3:40
From a provider perspective,
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there needs to be a recognition that high,
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that the high prices they sometimes charge
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affect everyone.
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Health insurance usually protects consumers
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from,
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the high list prices
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for expensive services like hospital stays and some
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prescription drugs.
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And that's really important because that's the way
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people access care.
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However, these high price increases,
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these high prices
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increase the cost of health insurance,
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which means fewer people can afford the coverage
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that they need.
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We really hope that the pressures that we
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all we are all under
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from consumers and from policymakers
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will lead to more constructive collaborations
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on solutions that best serve our customers.
4:30
Howard, I I wanna follow-up some on something
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you said there. It's really interesting. You know,
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obviously, we we've heard about, you know, the
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this administration, how it's affecting health care, the
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regulations. But you you mentioned consumers, and I
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thought that was interesting. How are you
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seeing consumer and maybe consumer demands kind of
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challenge,
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the system and and the work health plans
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are doing?
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Yeah. I mean, I think,
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what we're hearing from policymakers
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in large part reflects the real concerns of
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consumers.
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And we've heard loud and clear,
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and I think in more intense ways than
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we have in the twenty five years that
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I've been doing this,
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that
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there's dissatisfaction
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with the high cost of health care and,
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yes, from some of the utilization
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managements,
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techniques that plans use, which people
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see as
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denying them access to the care they need.
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So
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not only from a micro sort of market
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level
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perspective, from a broader perspective,
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these are the real pressures that, you know,
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ICR industry is under,
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and how we navigate those pressures
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can really dictate the industry's future.
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Absolutely.
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And moving along to the next topic, where
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do you see the biggest gap today between
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payer strategy
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and operational execution?
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Yeah.
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Well, I wanna preface my response because you
5:57
might think I won't be getting to the
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answer, but I promise you I will.
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The I am really fortunate to work for
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a company that understands how active participation
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in communities
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is not only good practice, it's good business
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strategy.
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For example, EmblemHealth really made,
6:15
recently made significant
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investments
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in addressing food insecurity in the areas we
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serve.
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My colleague, Heather Tamberrino, our chief financial officer,
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recorded
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a Becker's podcast on this initiative not too
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long ago that I would really encourage others
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to listen to to better understand the business
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case for doing good.
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And in addition, EmblemHealth operates 15 neighborhood care
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centers
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throughout New York City where we offer free
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services to all members in the community, so
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not just our members.
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And these services include wellness classes,
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help with social service navigation,
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and nutritious food, giveaways.
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However, as we have pursued this approach, we
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have often found that there's a gap between
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strategy and successful execution
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at the community level
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where these well intentioned strategies
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meet real world barriers.
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When the programs we operate don't reflect how
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members and communities access care,
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it can create a a sense of disconnect
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or distrust
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in many of the entities that are responsible
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for their care.
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We saw this recently play out in our
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community diabetes wellness program,
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a free community based initiative focused on prevention,
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education,
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and ongoing
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support,
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which we piloted in The Bronx, a part
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of our city that is home of diverse
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communities with high levels of chronic disease.
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One key takeaway,
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from this project was that sustained participation
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required an engagement strategy that was designed around
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trust, culture, and convenience.
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That meant understanding that offering classes in multiple
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languages, flexibility
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in class design,
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whether it be in person, virtual, or hybrid
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options,
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and timing to fit our, our neighbor schedules
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early morning, evening, and weekend classes
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and bringing care to,
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directly to the community we serve
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in non traditional spaces
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like places of worship or community centers
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or local block parties.
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We learned these lessons and,
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after one year, the program demonstrated that a
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neighborhood based model could measurably improve access, engagement,
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and clinical outcomes.
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We held more than a 100 diabetes
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related events,
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across The Bronx with,
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almost 1,500
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community
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participants who
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were able to get get screened
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or get advice on,
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lifestyle changes,
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that they could make to be,
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healthier.
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So
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to me, the success of this program reinforces
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that
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closing the gaps between strategy and successful execution
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depends on meeting communities on their terms,
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in their languages,
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and in their neighborhoods
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to build the kind of trust that improves
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health care outcomes.
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Yeah. I I think that that sounds like
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tremendous work done in the community there, Howard.
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You know, great job to everyone.
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When you're able to plan and execute that
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way and and you and you see the
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impact it has in the community, do do
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you think about what it takes to scale
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something like that, or or or do you
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kinda work on another initiative?
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Yeah. I I mean,
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we specifically chose The Bronx
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to do a pilot program. I think that
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those
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of my colleagues,
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are now thinking about ways to
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more broadly offer these,
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types of programs throughout the rest of the
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city.
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So,
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for us, right, I mean, I I think
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we,
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not to toot our own horn, but we
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approached in a very smart way,
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understanding that we are trying something new,
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and we want to learn from what we
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were doing,
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before we,
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more broadly offered this type of,
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this type of program.
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Well, yeah, I I think that's incredible. I
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think programs like that obviously make a huge
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difference.
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And now, Howard, if I can get you
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to put on your, health plan fortune telling
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hat and look into your, health plan crystal
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ball, what's one investment or initiative you believe
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will most reshape how health plans operate over
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the next two to three years?
10:27
Well, Scott, I'm gonna surprise you with this
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answer, but I'm I'm gonna mention
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AI or artificial intelligence.
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I'm sure you haven't heard that answer,
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from
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anyone
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else. Right.
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But we do think it has a a
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a great potential,
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in several different ways.
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Again, I'm going to,
10:48
recommend a recent Becker's podcast with EmblemHealth's,
10:52
executive chair, Karen Ignani, and our chief medical
10:55
officer,
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doctor Dan Net, in which they explain how,
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our company is establishing
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AI based initiatives that identify our enrollees who
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are most affected by climate events like heat
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waves or snowstorms
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and help them connect with the resources they
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need.
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We also have used AI to encourage our
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enrollees to get their flu vaccines
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and are concerning other ways to help them
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get this the services they need.
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From my perspective and hitting on some of
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the issues that, we discussed earlier,
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my hope is that responsible use of AI
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will improve health plan relationships with providers,
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whether that means creating more uniform clinically based
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utilization management tech standards
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across the industry
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or improvements to administrative processes,
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AI has the potential to eliminate many consumer
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concerns about the health care system.
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And if you could change one regulatory or
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industry practice
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tomorrow to improve affordability and and access,
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what would it be and why?
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Yeah. Scott, as you can imagine, I'm sort
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of a pie in the sky type of
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person.
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But I consulted with colleagues, and they recommended
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that we talk about things that were actually
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doable.
12:08
And as we
12:10
look at the, existing environment,
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there are several achievable reforms that will reduce
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cost for health plans and providers
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and allow clinicians to focus on patients rather
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than paperwork.
12:23
The one that always comes to our mind
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is
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the issue about
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provider directories,
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right, and the accuracy of provider directories, which
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we all agree that health plan enrollees need
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accurate information about the providers in our networks.
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However, that means that provider offices spend hours
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and hours responding to the same questions
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from different health plans looking to update their
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directories.
12:48
We know now that the Federal Centers for
12:50
Medicare and Medicaid Services
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is working on solutions that will allow providers
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to send
12:56
or may update it information
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once to a database that health plans would
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consult without having to,
13:03
contact their offices.
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These solutions could also be a source of
13:07
credentialing information,
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limiting the need for providers to submit different
13:12
forms to multiple health plans.
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So that's just one if I can be
13:17
granted one and a half. You know, we
13:19
would also mention,
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scope of practice reforms,
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which we think also has a way of
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alleviating,
13:27
pressures on
13:29
advanced clinicians so that they can focus on
13:31
what they do best and increase
13:33
satisfaction amongst other,
13:35
providers.
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We're very hopeful that these changes will improve
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plan provider relationships
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and support more collaboration on solutions to improve
13:44
affordable access to health care services
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for everyone.
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And the last question I have for you,
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Howard,
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what issue is putting the most pressure on
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health plan margins right now, and how are
13:56
you responding responding differently or are going to
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respond differently in in 2026?
14:02
Yeah. I mean, I think we know that
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each insurer is developing
14:05
strategies for what promises to be another challenging
14:08
year.
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You know, I think that includes
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dealing with high hospital and drug costs,
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plus the changes to Medicaid and other public
14:17
health programs
14:18
that were put into the into place by
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HR one.
14:22
As I you know, the issue that I
14:24
tend to focus on and dwell on, I
14:26
think my colleagues would probably say, is the
14:29
increased scrutiny of federal state governments
14:32
that are all focused on reducing health care
14:34
costs.
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You know, as I mentioned before, I don't
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think that this is an issue that we
14:39
can address alone,
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and I'm very satisfied that the level of
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dissatisfaction
14:45
pardon me, that we are seeing industry efforts,
14:48
to reestablish
14:50
trust
14:51
such as the national effort to voluntarily reform
14:53
prior authorization practices
14:56
led by AHIP and the Blue Cross Blue
14:57
Shield as association.
14:59
We think that that's a really significant step.
15:03
However,
15:04
in order to address
15:06
the real,
15:07
issues affecting our health care system, we need
15:10
significant cooperation from health care facilities and drug
15:13
companies
15:14
to make health insurance more affordable and increase
15:17
accountability for outcomes.
15:19
Otherwise, all of us are at risk for
15:22
creating an even larger role for government in
15:24
the health care system.
15:27
Well, I think a lot of us can
15:28
certainly agree on that, Howard, and thanks so
15:30
much for joining us on podcast and and
15:31
for a great conversation. I look forward to
15:33
working with you again in the future. Thank
15:35
you very much.