Latest / Becker’s Payer Issues Podcast / Hasan Shanawani, Associate Chief Medical Officer at Horizon Blue Cross Blue Shield of New Jersey

Transcript

Hasan Shanawani, Associate Chief Medical Officer at Horizon Blue Cross Blue Shield of New Jersey · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone, and welcome to Becker's Healthcare Podcast.
• 0:02
  I'm Scott King. Thrilled today to be joined
• 0:04
  by a very special guest, doctor Hassan Shanawani,
• 0:07
  associate chief medical officer with Horizon Blue Cross
• 0:11
  Blue Shield New Jersey.
• 0:13
  Doctor, how are you doing today? Thanks so
• 0:14
  much for joining us. I'm well. I hope
• 0:16
  you are too. Thanks for having me. I
• 0:18
  am. You know, weather's actually getting nicer here
• 0:20
  in Chicago right in time for, for Little
• 0:22
  League. Hopefully, you're seeing some nice weather where
• 0:23
  you are as well.
• 0:25
  I we are. It's a little cool here
• 0:27
  in New Jersey.
• 0:29
  But, but, yeah, it's definitely been warming up
• 0:31
  over the last few days. Certainly better than
• 0:33
  it was this past weekend. That's not a
• 0:35
  bad thing. That sounds good. Hey. We have
• 0:37
  a lot of of big big topics and
• 0:39
  and some trending items I wanna definitely lean
• 0:41
  on your expertise for here with health plans
• 0:43
  and in health care. But before we do
• 0:45
  that, could you just share a little bit
• 0:46
  about your your background and your career journey?
• 0:49
  Sure.
• 0:50
  I'm relatively new to Horizon
• 0:52
  Blue Cross,
• 0:54
  of New Jersey. I started here in, late
• 0:56
  September, early October
• 0:59
  of this past year. So just coming on
• 1:00
  the six month, seven month mark with your
• 1:03
  organization as their associate CMO.
• 1:06
  I started,
• 1:07
  finished medical school back in the late nineties.
• 1:10
  I was a practicing pulmonary and critical care
• 1:13
  physician
• 1:14
  in Southeast Michigan.
• 1:16
  Mainly worked for
• 1:17
  the VA
• 1:19
  for a few years and moved relatively quickly
• 1:22
  into
• 1:22
  quality improvement and patient safety.
• 1:25
  Actually worked at the VA's National Center for
• 1:28
  Patient Safety, which was a leader in patient
• 1:31
  safety
• 1:32
  and quality improvement
• 1:34
  for a few years.
• 1:35
  Started working so much in patient safety with
• 1:38
  informatics that I actually
• 1:40
  became the deputy chief medical information officer for
• 1:43
  patient safety for the VA's
• 1:45
  transition
• 1:47
  from an the old VISTA CPRS based system
• 1:51
  to the off the shelf system, which was
• 1:52
  then Cerner, now Oracle.
• 1:54
  That's a pretty substantial $18,000,000,000
• 1:57
  project that started in 2017,
• 1:59
  2018.
• 2:01
  Did that work for a few years,
• 2:04
  left the federal service,
• 2:06
  in 2020
• 2:07
  to join Blue Cross of Michigan,
• 2:10
  where I was their medical director for quality
• 2:13
  improvement for their MA product. The Blue Cross
• 2:16
  of Michigan has a pretty sizable
• 2:18
  MA population, and I was the medical director
• 2:20
  on the Blue Cross side for the United
• 2:22
  Auto Workers Trust,
• 2:24
  the retiree trust. Served them for a few
• 2:26
  years, and you might remember, we had a
• 2:29
  little virus thing that happened right around then.
• 2:31
  So I actually managed a lot of the
• 2:33
  MA work for,
• 2:35
  everything for COVID enablement
• 2:37
  for a few years.
• 2:39
  Was called back into federal service under the
• 2:41
  Biden administration and under under secretary Elnahal,
• 2:45
  who was the under secretary for health in
• 2:47
  the VA,
• 2:48
  and came back to the VA where I
• 2:50
  became the chief medical information officer for the
• 2:52
  Midwest for three, four years and led the
• 2:55
  continued to lead that transition to the new
• 2:57
  EHR, which actually just went live this past
• 2:59
  week, funnily enough, in the VA. So good
• 3:02
  luck to my colleagues and friends who continue
• 3:04
  to serve veterans in the VA system in
• 3:05
  Michigan, Indiana, and Ohio.
• 3:08
  And then
• 3:09
  more recently,
• 3:11
  moved to Horizon
• 3:13
  to be in New Jersey for family reasons
• 3:15
  and have been having a great time here
• 3:18
  at Horizon Blue Cross in the last few
• 3:19
  years last few months. Excuse me.
• 3:22
  Wow. Thanks so much for sharing all that
• 3:23
  background info. I mean, you you you've you've
• 3:25
  worn a lot of hats as as they
• 3:26
  say. Really interested to get your perspective. Incredible
• 3:30
  trajectory. It's, you know, really interesting to hear
• 3:31
  a lot of the work you've done with
• 3:33
  patient safety, especially.
• 3:35
  From from your perspective and from all that
• 3:38
  experience, you know, right now, what do you
• 3:39
  think is the most pressing
• 3:41
  operational challenge facing payers, and and how are
• 3:44
  you addressing it?
• 3:46
  So so the biggest thing that really is
• 3:49
  coming up is simply put the rising cost
• 3:51
  of health care. When we see the rising
• 3:53
  cost of
• 3:54
  procedures, medications,
• 3:55
  new work,
• 3:57
  year after year costs are increasing anywhere between
• 3:59
  1020%,
• 4:02
  trying to get a handle on that is
• 4:04
  a real challenge. And the old tools
• 4:08
  of prior authorization
• 4:10
  and utilization management
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  really set the stage for,
• 4:14
  I feel, an adversarial relationship between the payer,
• 4:18
  the provider and the member.
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  And there's this sort of standoff that occurs
• 4:23
  that is continuing to rise. We're seeing the
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  number of prior authorizations go up year after
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  year, the number of denials going up year
• 4:30
  after year, and then then the number
• 4:32
  of of appeals that result from those denials
• 4:35
  going up. And so what we're doing is
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  is we're spending more and more time
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  sort of
• 4:41
  staring at each other and fighting over what
• 4:43
  should and shouldn't be delivered
• 4:45
  and less time actually
• 4:46
  delivering care and and working on important things
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  like steering the members to
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  the best in network, finding the most appropriate,
• 4:55
  whether it's advanced imaging, CT and MRI,
• 4:57
  or or new therapies like CAR T therapy
• 5:00
  for cancer,
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  or finding, you know, the best method to
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  lose weight in the era of the GLP
• 5:06
  ones. All of these things are,
• 5:09
  we're trying to get to a place where
• 5:11
  we can align the members, the providers and
• 5:14
  the payers so that we're all looking at
• 5:16
  this and managing it from the same side
• 5:18
  of the table.
• 5:19
  That's that's and how Horizon is addressing it
• 5:22
  is we're working with, of course, our members
• 5:25
  and their employers and with the providers and
• 5:27
  and really
• 5:28
  just assertively cultivating those relationships and saying, hey.
• 5:32
  This is what we're trying to do, as
• 5:33
  well as working with the members directly
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  and saying, here's our rationale. Here's why we're
• 5:38
  trying to do this so that even if
• 5:40
  they don't necessarily agree with
• 5:42
  some of the decisions that they're being made,
• 5:44
  at least they understand it. And most importantly,
• 5:47
  they have a path to success so that
• 5:49
  they can get the health care that they
• 5:50
  need and deserve. And we're able to continue
• 5:53
  to do that and and get away from
• 5:56
  this sort of yes, no.
• 5:59
  I call it the health care equivalent of
• 6:01
  the Seinfeld Soup Nazi, no authorization for you
• 6:04
  type of thing. And and that that's we
• 6:07
  talked about this a little bit at the
• 6:08
  at the payers roundtable last week. It's it
• 6:10
  we're trying to get away from that through
• 6:12
  a variety of paths.
• 6:14
  Well, I think everyone can identify with the
• 6:16
  soup Nazi. You say it's a good place
• 6:17
  to for everyone to meet at the negotiating
• 6:19
  table. Absolutely. So just to to combat
• 6:23
  rising costs, you think that it's the best
• 6:25
  way to kinda handle this through communication, keeping
• 6:27
  that open line, and also being transparent with
• 6:30
  with members and providers. Is that kinda what
• 6:32
  you're saying? Absolutely. That's precisely what it is.
• 6:35
  And and and, you know, the the Transparency
• 6:37
  Act is helping us with that and hurting.
• 6:39
  Right? Because now everyone knows what everyone's getting
• 6:42
  and and it's but that's something very similar
• 6:45
  to what you're seeing, you know, when you're,
• 6:47
  say, on Amazon or when you're buying a
• 6:49
  car.
• 6:50
  You're able to we're finally getting to a
• 6:52
  place where everyone understands the prices that they're
• 6:54
  paying, and that allows for a more robust,
• 6:57
  more thoughtful discussion between all of the stakeholders.
• 7:00
  Right. So you kinda mentioned that that tension
• 7:02
  and and, you know, trying it everyone's trying
• 7:05
  their best to keep costs down. And then
• 7:07
  you actually have to deliver a good member
• 7:09
  experience. Right? So
• 7:10
  especially as it comes to care coordination. So
• 7:12
  how is how is your org balancing cost
• 7:15
  containment
• 7:16
  with improving that member experience and quality outcomes?
• 7:19
  And and then also a second part to
• 7:21
  that, where are you seeing the greatest opportunity
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  for impact?
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  So so the first one is we are
• 7:28
  really trying to decentralize the ability to say
• 7:31
  yes, and we are trying to use,
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  for example,
• 7:37
  AI enablement
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  to put the power in the hands of
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  people who can actually say yes. I think
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  there's this big reputation out there that payers
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  are gonna be using AI to deny, deny,
• 7:48
  deny, and we are taking the exact opposite
• 7:50
  approach.
• 7:51
  We're actually trying to use AI to approve,
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  approve, approve. And only when
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  our AI cannot find any way to approve
• 7:58
  something and it's exhausted everything possible, does it
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  then put it in front of a person
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  and then say, hey. This is this now
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  gets pended for review.
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  What that is doing is is that is
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  really shortening the timeline
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  for approval. So you're not waiting forty five
• 8:13
  minutes when you're in clinic or three days.
• 8:15
  We're potentially looking to do that. We're also
• 8:17
  trying to make it easier
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  for the physicians, the providers who do the
• 8:22
  work to enter,
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  their stuff using portals. There's a big push,
• 8:28
  to make it easier for them so that
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  we still have we still have 40% of
• 8:33
  our providers sending things in via fax, Scott,
• 8:36
  which is Yeah. And I've heard this from
• 8:37
  other people. Yeah. Yeah. And and and so
• 8:40
  what can we do to make it easier
• 8:41
  for them? And then once they're able to
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  do it through a portal, we can make
• 8:44
  even real time support. And we'd say, hey.
• 8:46
  Listen. If you want this approved, you're missing
• 8:49
  items a, b, and c for, say, an
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  MRI of an e or or something like
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  that. And then finally,
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  we are trying
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  to,
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  take away things that, if you're in the
• 9:01
  business, you understand, but if you're not in
• 9:02
  the business, are counterintuitive.
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  So for example, site of service is a
• 9:07
  is a great example. Right? Where the same
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  procedure,
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  the you'll get charged different amounts of money,
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  depending on whether you have it done in
• 9:17
  the hospital, whether you're doing it in an
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  outpatient based hospital clinic or a stand alone.
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  We're trying to build more
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  programs
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  that allow to level that so that the
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  member doesn't have to spend all of this
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  time navigating all of that. And they can
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  just say, hey. Listen. I'm just gonna go
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  get my care where I'm gonna get my
• 9:33
  care. They don't have to worry about these
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  things. And and taking that problem
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  away from them and putting it in their
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  hands and saying, hey. Listen.
• 9:41
  We get that you really wanna have your
• 9:43
  MRI done here, but there's a place that's
• 9:45
  just as good. It's got the same number
• 9:46
  of Tesla coils. It's the same imaging. It's
• 9:49
  gonna be the same read. But,
• 9:52
  these people are being more cooperative, and they're
• 9:54
  able to get you the same level high
• 9:57
  quality imaging and care at a much lower
• 9:59
  cost,
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  and and and helping the members steer that
• 10:04
  so that it's as painless as possible.
• 10:07
  Have you have you seen any kind of
• 10:09
  metrics that you can share on on how
• 10:11
  much more efficient
• 10:12
  using AI has been for approvals? Like, is
• 10:14
  it is it so much faster or or
• 10:16
  you're able to do so many more
• 10:18
  approvals as opposed to before? So we are
• 10:21
  right in the middle of all of that
• 10:23
  work. So right now, I don't have Verizon
• 10:25
  specific numbers. But I can tell you on
• 10:28
  a personal level
• 10:30
  that,
• 10:31
  just some of the enablement work that we're
• 10:33
  doing for documentation
• 10:34
  can reduce the time
• 10:36
  to say I mean, you can imagine if
• 10:38
  someone so, you know, Horizon is we are
• 10:41
  the largest health insurer in the state, and
• 10:43
  and we have,
• 10:46
  most of the Medicaid
• 10:48
  platform and and, and a lot of the
• 10:50
  state work. So we do a lot of
• 10:53
  private duty care, private duty nursing work. These
• 10:55
  are incredibly
• 10:56
  complex cases. Often, hundreds, sometimes I saw one
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  case, literally 6,000
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  pages of documentation
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  came
• 11:05
  with the prior authorization application.
• 11:08
  That's just simply overwhelming, Scott. And and and
• 11:11
  so, you you you know, if if you
• 11:13
  can use
• 11:16
  AI to essentially Google search
• 11:19
  the document and say, help me find these
• 11:21
  key elements,
• 11:23
  then, you know, that's the member experience. So,
• 11:25
  anecdotally, we can say we can you know,
• 11:28
  that one document
• 11:29
  took that physician, I think it was five
• 11:31
  hours to review all of the content.
• 11:34
  We would be able to reduce something like
• 11:36
  that down to an hour. We are working
• 11:38
  really hard now to do it safe and
• 11:40
  protect member privacy.
• 11:42
  So right now, we are not putting PHI
• 11:44
  into any bots.
• 11:46
  And this is this gets to, you know,
• 11:48
  I think the the big thing that people
• 11:50
  don't think. I think everyone is really thinking
• 11:52
  about large language models and AI as this
• 11:55
  shiny new object.
• 11:57
  Horizon is taking a very thoughtful, careful approach
• 12:00
  to protect member security, to protect member privacy.
• 12:03
  There's a big black box element with all
• 12:05
  of these, and and so doing this in
• 12:08
  a way that is safe
• 12:10
  and protects the member experience as well as
• 12:13
  the providers,
• 12:15
  is is what we're doing, which is why
• 12:17
  it's gonna take us a little bit before
• 12:18
  we get the good numbers,
• 12:20
  I think, to answer your original question. No.
• 12:22
  But thank you for sharing all that about
• 12:23
  the process. It's very interesting.
• 12:26
  Digital engagement, I wanna get to that. You
• 12:28
  know, digital engagement and transformation
• 12:31
  continue to accelerate across health care.
• 12:33
  What technologies
• 12:35
  in a r AI are you prioritizing right
• 12:37
  now? I know you touched on it a
• 12:38
  little bit. And but and where are you
• 12:40
  seeing the meaningful
• 12:42
  ROI
• 12:43
  as well as better engagement with members?
• 12:45
  So besides what we've just talked about with
• 12:48
  utilization management, let me talk about, I think,
• 12:52
  a couple other places where we're seeing
• 12:56
  some effective work,
• 12:58
  across the blues and I think nationally.
• 13:01
  The biggest one that I'm really seeing is
• 13:04
  with the voice interactions,
• 13:07
  IVR work with members. When they call in
• 13:09
  and they're struggling to navigate
• 13:12
  are the
• 13:13
  the the old days of press 1 to
• 13:15
  get to this, press 2 are
• 13:18
  are quickly going away,
• 13:20
  and we are able to offer a much
• 13:22
  more personalized
• 13:24
  experience.
• 13:25
  What's more is our care managers and our
• 13:28
  case managers are having
• 13:31
  AI enablement where they're going into the chart,
• 13:33
  and they're able to look, and they're able
• 13:34
  to cultivate
• 13:36
  more sophisticated
• 13:38
  case management and care management strategies
• 13:41
  in real time
• 13:42
  and provide much more sophisticated and much more
• 13:45
  member centric,
• 13:47
  care in a timely, effective, and I would
• 13:50
  argue equitable fashion, right? It's really leveling the
• 13:53
  playing field
• 13:54
  such that,
• 13:55
  because I think
• 13:57
  I spend a lot of time thinking about
• 13:59
  equity. And if you have the wherewithal to
• 14:01
  be on the phone and be the squeaky
• 14:03
  wheel because you can sit there and aggressively
• 14:06
  call your insurance company for two hours
• 14:08
  because you're not a wage earner,
• 14:10
  because you don't have to be at work,
• 14:13
  that sort of thing.
• 14:14
  You're going to get better care, and I
• 14:18
  believe very strongly that that high quality member
• 14:20
  experience should be available to everybody,
• 14:23
  which means that if we can reduce the
• 14:25
  amount of time that a member needs to
• 14:26
  be on the phone from forty five minutes
• 14:27
  to fifteen,
• 14:29
  then that's thirty minutes that they can be
• 14:31
  a mom or a dad or go back
• 14:33
  to work or do the other things because
• 14:35
  you don't want them on the phone. That's
• 14:37
  the first one. The second one is, which
• 14:40
  I also believe is a strong factor for
• 14:42
  equity,
• 14:42
  is the digital front door. Everyone is now
• 14:45
  is really looking at
• 14:47
  trying to create primary care and specialty
• 14:50
  services
• 14:51
  where your first experience is, you know, essentially
• 14:54
  via a Zoom call and a lot of
• 14:56
  the care that you can get delivered and
• 14:58
  a lot of that member experience. And then
• 15:00
  when you actually need a procedure,
• 15:02
  say, an an image, a heart cath, a
• 15:04
  stress test,
• 15:05
  or a procedure like infusion,
• 15:08
  then you can work locally.
• 15:10
  What this is doing is it's putting primary
• 15:12
  care and specialty care in making it accessible
• 15:16
  to a lot of people,
• 15:19
  in a lot of ways. And I think,
• 15:21
  COVID taught us that how that this works.
• 15:25
  And, you know, the the pandemic really taught
• 15:28
  us how we can, I think, decouple
• 15:30
  high quality care from physical proximity?
• 15:34
  And I think we're gonna see much more
• 15:37
  of that. And what I'm hoping to see
• 15:40
  with that is more I don't wanna use
• 15:43
  the word competition, but a lot of people
• 15:45
  vying for
• 15:46
  the best, the most effective, the most efficient,
• 15:48
  the most member centric,
• 15:50
  the most timely, and the most equitable care
• 15:53
  for these people. And I think the digital
• 15:55
  solutions are going to
• 15:57
  do that. And and and what I'm seeing
• 15:58
  at all of the payers, they're all and
• 16:01
  some of the providers now, they're all aligning
• 16:03
  and getting away from that brick and mortar
• 16:05
  experience.
• 16:06
  A 100%.
• 16:07
  And the last question I have for you,
• 16:10
  how do you see AI supporting member facing
• 16:12
  interactions while maintaining
• 16:14
  trust and quality?
• 16:16
  I think some of that, honestly, is just
• 16:18
  going to be growth.
• 16:20
  I think people are going to trust AI.
• 16:22
  We,
• 16:23
  I saw a statistic
• 16:25
  that something
• 16:27
  like 50,000,000
• 16:28
  chat GPT queries are health care related,
• 16:31
  where they're putting in their symptoms. People are
• 16:33
  already using AI
• 16:37
  to figure out what's wrong with them. Right?
• 16:39
  And then
• 16:40
  they're they're going to
• 16:42
  their AI. And, of course, they're getting a
• 16:45
  lot of low quality stuff. But what that's
• 16:48
  doing is is I think that's leveling
• 16:51
  the experience. I believe that the Internet in
• 16:54
  general and AI in particular
• 16:56
  are kind of like the Gutenberg Bible in
• 16:58
  in the sense that the the you know,
• 17:01
  not everyone had a copy of the Bible.
• 17:03
  But once once you have
• 17:05
  the once everyone could get a copy of
• 17:07
  it, then everyone could start talking
• 17:11
  to their religious authorities, and that made a
• 17:14
  fundamentally less coercive relationship.
• 17:17
  I believe that AI is going to do
• 17:19
  the same thing. And what it actually is
• 17:22
  doing, I think that the issue with trust,
• 17:26
  is less on the member side. It's actually
• 17:28
  more on the provider side and on the
• 17:30
  payer side. It's it's on our side. Like,
• 17:32
  how do we trust
• 17:33
  the content
• 17:34
  that it's be being given to us? The
• 17:37
  the the because people are showing up with
• 17:40
  stuff and saying, hey. I, you know, I
• 17:42
  I I went to
• 17:44
  ChatGPT, and it told me that I might
• 17:46
  have cancer. What do we do? And we
• 17:48
  say, yeah. Let's talk about that. And I
• 17:49
  think that that's what's happening. I think we
• 17:53
  are going to create
• 17:55
  more
• 17:56
  sophisticated,
• 17:58
  what they call agentic governance models where,
• 18:02
  and there's already a few of them out
• 18:03
  there on the market that are super cool
• 18:05
  and super sophisticated.
• 18:07
  Once that happens,
• 18:09
  you know, I saw a thing where during
• 18:11
  a hurricane,
• 18:12
  they were able to contact something like 25,000
• 18:15
  members
• 18:16
  quickly, or it was a heat wave, it
• 18:18
  wasn't a hurricane, I apologize, to make sure
• 18:20
  that they had access.
• 18:21
  And and and these were not live calls.
• 18:24
  These were all AI based bot calls. And
• 18:26
  and I think
• 18:28
  with more of that, you're going to see
• 18:30
  more
• 18:31
  sophisticated
• 18:33
  and more comfort with the work
• 18:36
  that
• 18:40
  that we do in service to our members
• 18:42
  and the patients.
• 18:43
  And I think with that over time,
• 18:46
  we're gonna I think people are gonna be
• 18:48
  more comfort the the quality is the big
• 18:50
  question. How do we eliminate the hallucinations?
• 18:53
  How do we govern the work?
• 18:55
  And who is the most qualified? Do we
• 18:57
  use a person to double check, or do
• 19:00
  we use AI to double check the AI
• 19:02
  work?
• 19:04
  We're seeing the work is getting so good
• 19:05
  now that it really raises the question, who
• 19:07
  should be checking whom?
• 19:09
  I think I think this is a really
• 19:11
  exciting time to be a doctor. It's really
• 19:13
  exciting time to take care of people.
• 19:15
  And what I'm hoping for coming full circle
• 19:18
  to the questions, I really hope that AI
• 19:20
  allows us to really reimagine
• 19:23
  the relationship
• 19:25
  between
• 19:26
  members,
• 19:26
  providers, and payers. I'm I'm absolutely optimistic and
• 19:30
  and hopeful
• 19:31
  that we're going to reimagine this and not
• 19:33
  use it as some sort of arms race
• 19:35
  and and spiraling escalation
• 19:38
  of the bad adversarial behavior that we've that,
• 19:41
  unfortunately, we got used to.
• 19:43
  And I think we can this is gonna
• 19:45
  help us get away from that in a
• 19:46
  way that really takes care of our members
• 19:48
  and and their medical issues and needs.
• 19:50
  No. That sounds great. I think it's very
• 19:52
  well put, and that's just a great example
• 19:53
  that that heat wave example of a payer
• 19:56
  going above and beyond for members during some
• 19:58
  dire circumstances. So thanks so much for sharing
• 20:00
  that. And doctor Shahnawani, thanks so much for
• 20:02
  for being at the Spring Payer Roundtable and
• 20:04
  for being here for this podcast episode. Looking
• 20:06
  forward to working with you again soon. It's
• 20:08
  a pleasure. Looking forward to seeing you guys
• 20:09
  again soon.