Latest / Becker’s Payer Issues Podcast / AI, Climate Risks, and the Future of Member Care with Dr. Daniel Knecht

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AI, Climate Risks, and the Future of Member Care with Dr. Daniel Knecht · Becker’s Payer Issues Podcast

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  - Click events in the upper right.
• 0:51
  - Hi, everyone. This is Elizabeth Caslow with the
• 0:53
  - Becker's Payer Issues podcast.
• 0:55
  - I'm really excited today to be joined by
• 0:58
  - doctor Dan Neckt, chief medical officer of EmblemHealth.
• 1:01
  - Doctor Neckt, thank you so much for chatting
• 1:03
  - with us today. Thanks for having me. So
• 1:05
  - before we jump in, I would love to
• 1:07
  - hear a little bit more about your role
• 1:08
  - as chief medical officer
• 1:10
  - and how you got into the health care
• 1:11
  - space.
• 1:12
  - Yeah. Absolutely.
• 1:13
  - So I am the chief medical officer of
• 1:15
  - EmblemHealth. And for those who don't know EmblemHealth,
• 1:18
  - we provide health benefits to,
• 1:21
  - over 2,000,000 New Yorkers
• 1:23
  - across multiple lines of business,
• 1:26
  - including Medicaid, Medicare,
• 1:28
  - the City Of New York, as well as
• 1:29
  - commercial line of business. And I have the
• 1:31
  - privilege of,
• 1:33
  - leading the clinical strategy and operations for the
• 1:35
  - organization,
• 1:36
  - which includes
• 1:37
  - utilization management, care management, pharmacy,
• 1:41
  - medical director, decision making, and clinical strategy.
• 1:44
  - I also am a physician, and I still
• 1:46
  - practice as a part time hospitalist in New
• 1:49
  - York City,
• 1:50
  - and I'm affiliated with Mount Sinai Hospital.
• 1:53
  - Thank you for giving us a little bit
• 1:54
  - of background there.
• 1:56
  - So today we're gonna chat about EmblemHealth's environmental
• 1:58
  - resilience program. So can you break down a
• 2:01
  - little bit of the history of that program,
• 2:02
  - when it got started,
• 2:04
  - the intention of it, and how it supports
• 2:06
  - members, and if there's any sort of, parameters
• 2:09
  - around which members
• 2:10
  - it's geared towards.
• 2:13
  - Absolutely. And so let me just set the
• 2:15
  - context a little bit. So why is a
• 2:17
  - health plan focusing on the environment and,
• 2:20
  - heat
• 2:21
  - waves? So first and foremost, heat waves kill
• 2:24
  - more people than any other environmental event,
• 2:27
  - including a hurricane, tornado, fires
• 2:30
  - combined each and every year.
• 2:33
  - Unlike those natural disasters,
• 2:35
  - heat waves don't leave behind
• 2:37
  - a trail of wreckage.
• 2:39
  - It is indeed the silent killer, and unfortunately
• 2:43
  - is most detrimental
• 2:44
  - to
• 2:46
  - folks who are,
• 2:48
  - socially vulnerable or have chronic conditions
• 2:51
  - that put them at particular risk.
• 2:54
  - So,
• 2:54
  - it's also clear that extreme heat events have
• 2:57
  - been demonstrated
• 2:58
  - to increase emergency room visits, hospitalizations,
• 3:01
  - and unfortunately,
• 3:03
  - mortality.
• 3:04
  - So
• 3:05
  - we thought it was,
• 3:07
  - a a very important initiative
• 3:10
  - to address,
• 3:11
  - high heat and heat waves. And as I
• 3:13
  - mentioned earlier, we're a New York City based
• 3:15
  - health plan, and New York City in many
• 3:17
  - ways is the tip of the iceberg related
• 3:20
  - to these issues.
• 3:21
  - For example, the urban heat island effect is
• 3:24
  - a phenomenon
• 3:26
  - for which,
• 3:27
  - ground temperature is 10 or almost potentially up
• 3:30
  - to 20 degrees hotter in the city than
• 3:33
  - more wooded or forested areas,
• 3:36
  - and as we all know, New York City
• 3:38
  - is incredibly diverse,
• 3:39
  - but also there are disparities
• 3:42
  - as it relates to socioeconomic
• 3:44
  - circumstances
• 3:45
  - and that that puts individuals at risk, for
• 3:48
  - poor health outcomes from heat waves.
• 3:50
  - And
• 3:51
  - each and every year, approximately five hundred New
• 3:54
  - Yorkers die prematurely because of hot weather in
• 3:56
  - the city. So it's with that background that
• 3:59
  - we launched the Environmental Resilience Program about a
• 4:01
  - year ago,
• 4:02
  - and so essentially what this program is is
• 4:06
  - we ingest
• 4:07
  - environmental and weather data, including
• 4:09
  - temperature and humidity and air quality
• 4:12
  - and what we're able to do using AI
• 4:15
  - is identify
• 4:16
  - our members who are particularly
• 4:18
  - at high risk for poor health outcome
• 4:22
  - related to a heat wave and we have
• 4:24
  - trained and deployed an AI agent. We call
• 4:27
  - her Rachel, she speaks English, she speaks Spanish,
• 4:30
  - and what she's able to do is reach
• 4:32
  - out telephonically to our members and provide personalized
• 4:35
  - guidance,
• 4:36
  - information around the heat wave and various personalized
• 4:40
  - recommendations to keep those individuals safe.
• 4:43
  - Can you elaborate on what personalized means here?
• 4:46
  - Is it about geography or just the history
• 4:49
  - you have on the member?
• 4:51
  - Great point. It's it's
• 4:53
  - both geography, where those individuals live,
• 4:57
  - as well as their clinical set of circumstances,
• 5:00
  - and Rachel asks a series of questions in
• 5:03
  - a very empathetic way to understand,
• 5:06
  - the live the living conditions of those individuals,
• 5:09
  - if they have air conditioning, can they afford
• 5:11
  - to pay for air conditioning,
• 5:13
  - any clinical conditions Rachel's
• 5:16
  - able to provide coaching, but also address social
• 5:19
  - issues as well. I also like to talk
• 5:21
  - about pets.
• 5:22
  - You know, pets are part of the family,
• 5:24
  - so Rachel does ask about,
• 5:26
  - pets and pet safety as well. And I
• 5:28
  - think it's really important to call out is
• 5:30
  - that we have a human in the loop.
• 5:32
  - So in the event there's an escalated or
• 5:35
  - complex
• 5:36
  - circumstance,
• 5:37
  - Rachel will ensure that our human,
• 5:40
  - nurses on the EmblemHealth care management team are
• 5:43
  - looped in so they can reach out and
• 5:45
  - and support with an additional layer of sophistication.
• 5:49
  - And then can you break down what some
• 5:50
  - common next steps might be? Like, what are
• 5:53
  - scenarios that you see most often when Rachel's
• 5:56
  - engaging with members, and what are the follow
• 5:58
  - ups? What's the timeline for follow-up?
• 6:01
  - Absolutely.
• 6:02
  - So oftentimes, we call and we, alert these
• 6:05
  - individuals that there's an impending heat wave and
• 6:07
  - oftentimes,
• 6:09
  - our members are not even aware that there's
• 6:11
  - a heat wave coming or they don't understand
• 6:13
  - the connection between high heat and their health.
• 6:16
  - Many times they think it's a good excuse
• 6:18
  - to go to the beach or just relax,
• 6:19
  - but they don't really understand it's a, a
• 6:22
  - health threat. So raising that
• 6:24
  - level of,
• 6:25
  - awareness is first and foremost.
• 6:28
  - Many of our members have air conditioning.
• 6:30
  - For those who do not, we provide information
• 6:33
  - around,
• 6:34
  - cooling centers in their neighborhood and explain the
• 6:37
  - importance of a cooling center.
• 6:39
  - Oftentimes, we provide education on changing their behavior
• 6:43
  - during a heat wave, so certainly do not
• 6:45
  - go out midday,
• 6:47
  - if at all possible,
• 6:50
  - and, educating around sort of clinical risks as
• 6:53
  - well, right? Some medications
• 6:56
  - can blunt the body's ability to mount a
• 6:59
  - thermo
• 7:00
  - an appropriate thermal response, so just highlighting
• 7:04
  - the health risks, and of course pet safety
• 7:07
  - as well. So those are a number of
• 7:10
  - recommendations,
• 7:11
  - but oftentimes the conversations
• 7:13
  - can,
• 7:14
  - last several minutes
• 7:16
  - and
• 7:17
  - Rachel
• 7:18
  - can unearth some social determinants of health needs,
• 7:21
  - whether it be,
• 7:22
  - the need for
• 7:24
  - financial support or food insecurity,
• 7:27
  - and then that information is provided,
• 7:30
  - to our care management team who will have
• 7:32
  - a follow-up in the subsequent day or so.
• 7:35
  - Later on, I wanna ask a little bit
• 7:37
  - more about the social determinants and how y'all
• 7:40
  - are engaging there. But I would love to
• 7:42
  - hear from year one to year two, what
• 7:44
  - has the outreach
• 7:45
  - looked like? How has it changed? How many
• 7:47
  - more members are you reaching?
• 7:50
  - Yeah. So it's a terrific question. So last
• 7:52
  - year, I would describe it as a nascent
• 7:54
  - pilot program,
• 7:56
  - test and learn,
• 7:57
  - understand what's working, what what's not, where opportunities
• 8:01
  - we can
• 8:02
  - change the program and improve it. So we
• 8:04
  - were really happy with last year's outreach,
• 8:08
  - so we decided to scale it more broadly.
• 8:11
  - So I think one one insight was,
• 8:14
  - how do we go
• 8:16
  - upstream of these environmental threats?
• 8:18
  - So back in April,
• 8:20
  - we were able to reach out to about
• 8:22
  - 15,000 of our members,
• 8:24
  - and educate them about cooling benefit benefits offered
• 8:28
  - by the state of New York. For example,
• 8:30
  - HEAP
• 8:31
  - and the Essential Plan Cooling Program.
• 8:34
  - So these are programs for which the state
• 8:36
  - will actually pay for,
• 8:38
  - either electricity
• 8:40
  - bills or,
• 8:41
  - air conditioners for those really needy individuals.
• 8:45
  - So we launched that in April, and
• 8:48
  - a large number of our members were surprised
• 8:50
  - and pleased to learn about this opportunity, and
• 8:52
  - they went ahead and applied for,
• 8:55
  - these assistance programs.
• 8:57
  - So that's one opportunity that we enhanced our
• 9:00
  - program in.
• 9:02
  - I think moreover,
• 9:04
  - an important learning from last year was that
• 9:06
  - a number of social determinants of health
• 9:09
  - unmet needs were surfaced, and I think us
• 9:12
  - reaching out during a heatwave really opened that
• 9:15
  - door for that richer discussion of needs and
• 9:17
  - support, and so our care managers
• 9:20
  - are
• 9:21
  - really poised
• 9:22
  - to help navigate
• 9:24
  - these social determinants of health needs and help
• 9:27
  - close those gaps in care.
• 9:29
  - And finally, you know, I'm a I'm a
• 9:30
  - doctor, I'm also,
• 9:32
  - I love science and I love research, So
• 9:35
  - what we're doing this year is we're running
• 9:37
  - a randomized
• 9:39
  - clinical trial to really better understand
• 9:42
  - the impact from in the most rigorous way.
• 9:45
  - So the plan this summer
• 9:47
  - is to call up to 250,000
• 9:50
  - at risk members in our population
• 9:52
  - and alert them, and then we'll go ahead
• 9:55
  - and study,
• 9:56
  - long term outcomes related to utilization of health
• 9:59
  - services
• 10:01
  - and,
• 10:02
  - overall member satisfaction.
• 10:05
  - So going back to the social determinants,
• 10:08
  - I feel like I have this conversation sometimes
• 10:10
  - with managed Medicaid plans.
• 10:12
  - What advice do you have for insurers that
• 10:14
  - are navigating the line between
• 10:16
  - what they're responsible for as they learn more
• 10:19
  - about their members versus
• 10:21
  - when is it appropriate for a partnership with
• 10:23
  - another organization? Or in this case, it sounds
• 10:26
  - like there's a lot of referrals to state
• 10:27
  - resources.
• 10:29
  - How is EmblemHealth navigating that line with this
• 10:31
  - program and also just more broadly?
• 10:34
  - Yeah. I would say as a chief medical
• 10:36
  - officer, fundamentally, we're in the business of keeping
• 10:39
  - our people and members healthy, and it truly
• 10:42
  - takes an ecosystem approach. So we're
• 10:45
  - constantly,
• 10:46
  - making connections with,
• 10:47
  - social care networks, various other vendors,
• 10:51
  - certainly working with the state,
• 10:53
  - to find ways to close that sort of
• 10:56
  - final mile in in care related to social
• 10:59
  - or economic,
• 11:00
  - unmet needs.
• 11:02
  - And as a physician,
• 11:04
  - I find this as a really,
• 11:06
  - novel way a health plan can step in
• 11:09
  - and really support
• 11:10
  - our members in need, at a really sort
• 11:13
  - of, vulnerable time related to these heat waves.
• 11:18
  - So what sorts of data points are you
• 11:20
  - seeing in terms of,
• 11:22
  - outcomes when it comes to this outreach?
• 11:25
  - So looking back at that highlight we ran
• 11:27
  - last year,
• 11:29
  - we were able to,
• 11:30
  - model out
• 11:32
  - more than 40%
• 11:34
  - fewer inpatient admissions
• 11:36
  - versus members who were not called or we
• 11:38
  - were unable to connect with.
• 11:40
  - In terms of member satisfaction, it was nine
• 11:42
  - out of 10. In terms
• 11:45
  - of average call length,
• 11:47
  - it was several minutes long.
• 11:50
  - And, you know, with this technology, we're allowed
• 11:52
  - to and we're able to, and we oftentimes
• 11:55
  - audit many of these calls
• 11:57
  - and observe the content and the subject
• 12:00
  - and the sort of topics discussed. And it
• 12:03
  - was just very obvious that we are really
• 12:06
  - intervening at a
• 12:08
  - vulnerable moment,
• 12:10
  - and our members really appreciate
• 12:12
  - that individualized empathetic outreach.
• 12:15
  - So as we wrap up, I'm just curious
• 12:18
  - what's next for the program. I know,
• 12:20
  - I was reading that there's been some expansion
• 12:22
  - beyond just heat specific outreach.
• 12:25
  - So maybe in regards to that, but also
• 12:28
  - are there any sorts of other innovations when
• 12:30
  - it comes to accessing members, that you are
• 12:33
  - foreseeing pursuing in the future?
• 12:35
  - Absolutely.
• 12:36
  - So we're entering an era of,
• 12:39
  - I guess you could call it precision population
• 12:42
  - health, where where we are able to look
• 12:44
  - at the entirety of our population,
• 12:47
  - apply machine learning and risk stratification to identify
• 12:50
  - those
• 12:51
  - subsets or cohorts of members who would benefit
• 12:54
  - for a from a particular outreach. So, like,
• 12:58
  - for example, heat waves,
• 13:00
  - but extreme cold, we also reached out
• 13:03
  - to a number of members this past January,
• 13:06
  - during the blizzard.
• 13:08
  - And we're able to go deep in our
• 13:10
  - populations
• 13:11
  - with AI agents such as Rachel to
• 13:14
  - engage those members proactively and predictably.
• 13:18
  - So, we're going to continue to expand the
• 13:20
  - program,
• 13:21
  - certainly focus on heat waves and poor air
• 13:24
  - quality,
• 13:25
  - but even infectious disease and various other environmental
• 13:29
  - or health threats.
• 13:30
  - This is just a new era of
• 13:33
  - deploying AI, but I really have to emphasize
• 13:36
  - it's important to have that clinical person in
• 13:38
  - the loop to ensure there's appropriate oversight and
• 13:41
  - an ethical approach,
• 13:43
  - and it's also important to measure the impact
• 13:46
  - to be able to study it in a
• 13:47
  - rigorous way to know what's working and what's
• 13:50
  - not. And then I'll also say, we're really
• 13:52
  - hopeful other health plans will see what we're
• 13:54
  - doing and be inspired and develop their own
• 13:58
  - approach because really, as I said earlier, it
• 14:01
  - it really takes an ecosystem of players in
• 14:03
  - this space to, you know, address the the
• 14:06
  - health status of the communities we serve.
• 14:09
  - Do you have any final advice for those
• 14:11
  - other health plans?
• 14:13
  - I like to say we need to be
• 14:15
  - students of the business. So, I still practice
• 14:18
  - medicine
• 14:19
  - and I think back to my training as
• 14:21
  - a physician and there were no lectures on
• 14:24
  - environmental
• 14:24
  - risks or environmental
• 14:26
  - threats and certainly not on the impacts of
• 14:28
  - high heat on the body. And so,
• 14:31
  - being a student of the businesses,
• 14:33
  - stay staying on top of new trends, constantly
• 14:36
  - reading, connecting with other thought leaders, because health
• 14:39
  - care is such a dynamic space and to
• 14:41
  - be really effective at serving our members, we
• 14:44
  - need to stay on top of these trends
• 14:46
  - and continually
• 14:47
  - innovate and share information and, you know, engage
• 14:50
  - in great conversations including the one with you.
• 14:53
  - Well, thank you so much for taking the
• 14:55
  - time. I really appreciated you going into depth
• 14:57
  - with some of the numbers there and filling
• 14:59
  - us in a year into the program. Thanks
• 15:01
  - for your interest, Liz. Of course. And to
• 15:04
  - our listeners, if you would like to hear
• 15:05
  - some more podcasts from Becker's Healthcare, you can
• 15:08
  - visit beckershospitalreview.com.
• 15:10
  - Thank you.