Latest / Becker’s Payer Issues Podcast / Brian Janssen, Chief Information Officer for Medicare at WPS Health Insurance

Transcript

Brian Janssen, Chief Information Officer for Medicare at WPS Health Insurance · Becker’s Payer Issues Podcast

• 0:00
  Welcome everyone to the Becker's Healthcare podcast series.
• 0:02
  I'm Mariah Muhammad, writer and moderator with Becker's
• 0:05
  Healthcare. And I'm thrilled to have with me
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  today, Brian Jansen, chief information officer for Medicare
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  at WPS
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  Health Insurance.
• 0:13
  Ryan, welcome to the podcast. We're very excited
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  to have you join us today. To get
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  us started, would you mind please introducing yourself
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  and telling us a bit about your background?
• 0:21
  Sure. Thank you very much for having me
• 0:23
  today. I really enjoy the Becker's,
• 0:26
  daily updates and these podcasts.
• 0:29
  So my name is Brian Jansen, as you
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  mentioned, and I've been with just the health
• 0:34
  insurance industry for the last twenty years, you
• 0:38
  know, starting with EMR implementations
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  at hospitals and clinics with Epic systems
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  before going from the provider side to the
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  the payer side,
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  working both at a regional HMO
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  here in Southern Wisconsin
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  before moving to a PPO commercial
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  product,
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  spending time with technology
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  and operations here at Wisconsin's Physicians Insurance,
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  and now CIO of our Medicare
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  division,
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  currently overseeing six states across two,
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  CMS contracts, a
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  little over a hundred million claims a year
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  for 7,000,000
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  beneficiaries.
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  Wonderful. Thank you so much for giving us
• 1:25
  that information.
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  So what are some of the biggest issues
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  you're following in health care,
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  whether on the provider side, insurance side, for
• 1:34
  for 2025?
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  Yeah. I think 2025
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  is gonna be an exciting year.
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  When it comes to just the pace of
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  change, I don't know who whether your payer
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  or provider right now isn't really focused on
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  government policy
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  with a new administration,
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  better understanding
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  where
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  the entire market's gonna go when it comes
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  to Medicare Advantage,
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  reimbursement
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  rates.
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  Clearly, DOGE is now going to get more
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  involved with fraud, waste, and abuse as well
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  as likely some operational,
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  items at the government level.
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  I I think
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  government policy
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  is really gonna dictate where the industry is
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  going in the next few years, especially under
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  new CMS leadership,
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  and will really help guide both commercial
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  providers,
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  commercial payers,
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  and government entities readjust their their own strategies.
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  It's in addition to
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  government policy.
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  I think in the last two years,
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  we've had
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  speed
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  of technology
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  development
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  and implementation
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  that I think the entire industry
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  right now is really focusing on how to
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  best leverage,
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  you know, whether it's
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  changes in how we're able to use data
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  to better understand our customers,
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  or I I don't even think we can
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  answer
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  or have a response that doesn't include some
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  sort of mention of AI these days.
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  And
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  how is
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  AI within health care gonna be
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  used and used responsibly
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  in order to get better patient outcomes
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  and reduce our overall
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  cost
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  structure in
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  in the nation.
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  And we've got such a heart such a
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  large percentage of our GDP
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  focused on health care, and, hopefully, changes in
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  technology
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  can start to
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  bring health care outcomes
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  more in alignment with our overall expenditures.
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  So I think 2025
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  is gonna be pivotal
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  when it comes to
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  both government policy setting a direction
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  And how are some of these new technologies
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  going to help everyone achieve positive
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  outcomes,
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  for both our providers
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  and our patients?
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  Yeah. Definitely. Thank you so much for giving
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  us that that insight into kinda what you're
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  thinking about for this year. Is there anything
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  that's making you
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  the most excited or a little bit nervous,
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  and pertaining to,
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  the trends of 2025,
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  the news of 2025,
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  anything you're specifically doing at your organization?
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  Yeah. I would say
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  the things that make me excited
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  always have a flip side of the coin
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  and also make us nervous.
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  You know, one of the things when we
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  talk about the changing pace of technology,
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  I think 2025
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  in some respects,
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  our technological
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  capabilities have also,
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  in some ways, out paced
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  our ability to implement
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  policy
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  and
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  safeguards in the health care sector.
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  So I think
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  not only am I excited about our new
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  capabilities,
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  I'm a little bit nervous about
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  our ability as an industry
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  to
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  understand and stay stay ahead of those changes.
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  It's certainly gonna reshape organizational
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  budgets.
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  How do we
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  view insourcing versus outsourcing?
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  It's gonna dynamically change how we're able to
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  interact with our customers.
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  And the question is gonna be, are we
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  using it
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  in a responsible
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  way for positive outcomes,
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  or are we gonna kinda get behind
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  behind the eight ball on this?
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  That's a conscious effort, I think, at most
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  organizations,
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  ours included.
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  Another thing that makes me excited this year,
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  really
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  coming off of 2024,
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  I think we've got a an opportunity
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  really to focus more on health care literacy.
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  I think some of the tragic events of
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  2024
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  really showed us
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  areas that we can better educate
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  our customers,
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  better educate
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  the population
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  on
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  who are the actors, who are the responsible
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  parties
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  when it comes to the administration of health
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  care
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  from your providers to your PBMs
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  to
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  your your payers.
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  I think there's a real opportunity
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  that we can all come together in the
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  industry to help
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  educate
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  and
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  inform,
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  ultimately, the consumers of of health care. I
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  think I'm a little nervous if we don't
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  take this opportunity
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  to really advance the industry and help inform
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  our our consumers.
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  I think probably the last thing that really
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  makes me nervous
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  is I think the fragility of the health
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  care environment has really kinda started to pop
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  up more and more in 2024.
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  We're starting to understand
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  impacts if, say, a clearinghouse goes down
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  or we have issues at a PBM.
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  When
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  the health care sector becomes more and more
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  concentrated
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  with fewer players,
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  I think we need to better understand
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  how that can impact the stability of of
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  the health care system as a whole. I
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  know it's something that
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  we're certainly
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  taking into consideration over the next year and
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  just to better understand where
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  where some of those, like, opportunities
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  or fail safes exist.
• 7:41
  Yeah. That completely makes a lot of sense.
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  I definitely agree with you on a lot
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  of things that you said.
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  In your your opinion and, you know, you
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  touched a little bit on this about, having
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  the responsibility,
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  to kinda teach others, but what would the
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  most effective health care leaders need in order
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  to be successful in the next two to
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  three years do you think?
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  Yeah. I think this is gonna be a
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  challenging time for health care leaders.
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  When we have such rapid
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  changes in a sector,
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  you know,
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  the ability to really
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  pivot on strategic plans
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  is going to be
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  necessary for any health care leader. I remember
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  years ago, we used to talk about three
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  year and five year plans.
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  I I I think most organizations
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  have certainly
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  shrunk those time frames
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  just given the rapid pace of health care
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  change, and successful leaders are gonna have to
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  really have a plan a and a plan
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  b
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  with strategic goals and outcomes
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  based on changes that could
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  really happen with
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  federal,
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  policy changes,
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  when it comes to
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  reimbursement rates, when it comes to
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  technological changes that
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  really shift
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  where work happens.
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  You know, the ability to
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  understand
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  where a market is going
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  and
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  pivot accordingly
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  to
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  really leverage that and turn headwinds into tailwinds,
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  I think is gonna be critical for health
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  care leaders,
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  both
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  from the financial
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  aspects of their organizations
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  as well as
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  the health outcomes of
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  patients or or plan members.
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  You know, I I look at those two
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  things as
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  not mutually exclusive.
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  I think that's gonna be
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  key and better understanding
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  what the customers are looking for and how
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  you can profitably
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  deliver great customer expectations,
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  experience,
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  and positive health outcomes.
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  Yeah. Yeah. Definitely. Thank you so much for
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  those final thoughts. It's definitely been,
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  a formative discussion. So, again, I wanna thank
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  you so much for coming on at Becker's
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  Healthcare,
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  especially for the first time.
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  And I look forward to connecting with you
• 10:10
  again soon.
• 10:11
  Yeah. Thank you very much for the opportunity.
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  It was great speaking with you. You as
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  well.