Latest / Becker’s Healthcare Digital Health + Health IT / AI-Driven Engagement: How Tech is Transforming Member Care Navigation

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AI-Driven Engagement: How Tech is Transforming Member Care Navigation · Becker’s Healthcare Digital Health + Health IT

• 0:00
  - Hello everyone.
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  This is Jacob Emerson with the Becker's Healthcare Podcast.
• 0:03
  Thanks so much for tuning in to us today.
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  I'm thrilled today to be joined by a very special guest.
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  Amanda Brewery is the Chief Commercial Officer
• 0:11
  at Informatica.
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  Amanda, welcome and thanks
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  so much for taking the time to be with us.
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  - Thank you so much, Jacob, for having me today.
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  - So Amanda, before we dive into our questions for you,
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  I'm hoping you can tell us a little bit more about your
• 0:22
  background in healthcare and what it is
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  that you do today at Informatica.
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  - Yeah, so my background in healthcare has been going on
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  for about the last 15 plus years.
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  I've been working with hospitals, health systems,
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  large payer organizations in the beginning,
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  really migrating them from offline to online activation
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  of their members and patients.
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  And in today's ecosystem, really focusing on engagement
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  and empowerment of those same patient
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  and member populations.
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  - Wonderful. So then it sounds like you know very well
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  that payers right now are very focused on their strategies
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  on how to advance value-based care, population health,
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  and of course overall member satisfaction.
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  Considering these pretty broad aims,
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  how does member engagement
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  and care navigation specifically play a role in those?
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  And what are you finding are some of the key challenges
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  that health plans across the country are
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  facing with these goals?
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  - Yeah. At, in Informatica, we're one
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  of the leading AI powered member engagement tool for payers,
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  providing clinically validated navigation
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  to help guide those members toward the most appropriate
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  and cost effective care.
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  And really what they're looking for today
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  and how they're looking to engage
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  and navigate these members is through technologies
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  that are creating automation, that are creating engagement.
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  And when we look at some of the key challenges
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  that they're facing is, number one, how do you identify
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  and really look towards, um, various tools
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  and technologies that are gonna help you get there,
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  but how do you also analyze those, knowing
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  how your members are going to react?
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  So we really wanna focus, um, on helping to educate
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  and empower patients
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  and members to really make sure that they're, um,
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  not only engaged in their plan,
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  but they are also taking steps forward to connect
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  with the right level of care at the right time.
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  - Understood. So not just engaged,
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  but engaged with the right kind of healthcare
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  and the right kinds of services.
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  Obviously implementing these new technologies like ai,
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  it's been a ubiquitous goal across the health plan industry.
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  Are, are you finding that there's opportunities
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  that you're seeing in terms of adopting these new tools
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  to drive better member engagement and,
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  and the care navigation tools that we just discussed?
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  And, and can you share a few examples of that
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  and how Informatica specifically is approaching this?
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  - Yeah, so I think people get really nervous.
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  We've just come off the course of a couple
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  of the first conferences of the season,
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  and AI has obviously been a topic and theme,
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  and I'm sure it will continue throughout the rest of the,
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  uh, conference season.
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  And what people are really looking at
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  and what the payers specifically that we work with and,
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  and we talk to are looking at is how do I take pieces of AI
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  and implement it into areas that are going to not only help
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  with operational efficiencies,
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  but also provide clinical guidance.
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  So at Informatica,
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  we're really focusing on this virtual care navigation
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  or virtual triage,
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  which takes members from the time they are feeling sick.
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  So think about it, Jacob, you have an ear infection,
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  it's 11 o'clock at night, you don't wanna leave the house.
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  What can you do? Well, you can use tools that are powered
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  by AI in the comfort of your living room to take you
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  through a symptom assessment, asking you questions and,
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  and personalizing it to your specific ailments.
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  So your right ear hurts, you know, um,
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  you've had a fever the last couple of days.
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  And then through that question and answer, the tools
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  and technologies are gonna then help guide you
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  to the appropriate level, uh, care endpoint.
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  Now we're taking, um, out of the equation,
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  somebody leaving their house in the middle
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  of the night going to the ED,
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  when in reality they can do a lot of this from their,
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  their device or their computer
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  and be connected with the right care,
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  and maybe they can go see their doctor tomorrow
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  or schedule a telemedicine appointment.
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  So leveraging tools like ai, um, in this specific setting
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  are ways in which not only we can create member engagement,
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  but also appropriate care navigation so
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  that those members stay in network and are
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  provided the most optimal experience based on
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  their plan benefits.
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  - Okay. So let me get to the key question here then. Amanda.
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  What is the ROI here for payers?
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  What kind of outcomes can organizations expect when they
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  leverage this technology in the way that you're describing?
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  Any, any outcomes, case studies, success stories
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  that really, uh, are sticking in your mind?
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  - Yeah, and I think case studies
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  and this idea of how do we learn from each other in ai,
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  I think a lot of what we have
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  to take into account is we have to be patient
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  and learn from each other and,
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  and really absorb what's happening.
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  And so knowing that 57% of patients, Jacob usually, um,
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  what we're hearing go to the doctor's appointment only
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  to discover it's not the right one for their condition.
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  And on the flip side, the providers are saying,
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  we're seeing patients that don't fit our, our scope
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  of work 24% of the time.
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  So we actually have a case study, um,
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  with the Reliant group, uh, an East coast base, uh,
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  medical group where when they had about 10,000 members
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  that we did this case study on,
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  we saw a couple really interesting pieces to this.
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  Number one, they wanted to increase appropriate use
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  of virtual care for their members via e-visit
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  or telephone calls.
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  By starting this process
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  inside their Epic MyChart application, what we were able
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  to do is through the series of questions, based on
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  how they were feeling, we were able
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  to increase telemedicine a appointments through this, uh,
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  a benefit for their members by 111%.
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  Not only did this provide the convenience to the members,
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  but it also alleviate a lot of the burden
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  of the in-office doctors, um, during the day, um,
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  for appointments that could have been handled much easier
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  via teleco, uh, telecommunication or telephone call.
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  The other part that I really liked was this idea that
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  during this study we knew that about 67%
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  of the members didn't know the appropriate
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  care for their needs.
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  And what we were able to do was we were able to not only
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  change the behavior
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  and care seeking behavior by those members, about 35%
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  of the time, they actually switched their recommendation.
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  So Jacob, think about it, you go through this, um, uh, uh,
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  triage, you're talking about your ear infection,
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  and you don't know really what you're gonna do.
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  You think you're gonna go to the ED
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  or you're gonna schedule an appointment 35% of the time.
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  We were able to divert, um, those members
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  to lower care care acuity acuities
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  and also leading to 26% fewer in-person visits.
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  Huge numbers, being able to take almost 30%
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  of your patient population
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  and in lower acuity settings,
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  have them either self-care at home
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  or treat in a couple days opening up those slots
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  for more important or potentially more urgent, uh, members
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  that need care at that time.
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  - Wow. Yeah, those are some incredible numbers.
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  Really appreciate you sharing that.
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  And I, I love that little anecdote about the epic
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  integration and the outcomes
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  you're, you're seeing there as well.
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  Before we go though, Amanda, anything else I'm missing?
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  Any final thoughts
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  or anything else our listeners should know?
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  - No. At Informatica, we're really excited
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  to attend our first Becker's round
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  table in a couple of weeks.
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  You can stop by Booth one 18 C, uh,
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  to learn more about our AI powered market leading
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  engagement tool for payers.
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  Um, I would also mention that in a lot of the work
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  that we're doing, we're also looking at a lot
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  of early detection work.
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  And so I think it's important as well for payers to identify
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  that triaging their members earlier on in their care cycle
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  could also help reduce, um, some of the, you know,
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  five most leading causes of death that we see,
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  which are heart attack, stroke, asthma, pneumonia,
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  pulmonary embolism.
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  So it's not just about treating people when
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  and where they need care, but also looking, um,
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  at some early detection work to make sure that
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  as their member populations are either aging
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  or their health might be deteriorating, they're able
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  to identify those issues earlier on,
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  getting them the care they need
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  to help not only reduce cost,
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  but also improve clinical outcomes.
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  - Well, I know I speak for all of us here at Becker's.
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  We're so excited to have Informatica
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  with us at the Becker's payer event here in Chicago.
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  But until then, Amanda, I just want to thank you
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  for taking the time to be with us
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  and for sharing your insights with our audience.
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  We truly appreciate it.
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  - Thank you so much. - We'd also like
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  to thank our podcast sponsor for this episode, Informatica.
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  You can tune into more podcasts from Becker's Healthcare
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  by visiting our podcastPage@beckerhospitalreview.com.
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  I.