Latest / Becker’s Payer Issues Podcast / Rethinking Health Plan Design Through Access, AI, and Preventive Care with Adam Park

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Rethinking Health Plan Design Through Access, AI, and Preventive Care with Adam Park · Becker’s Payer Issues Podcast

• 0:02
  - Generative AI is driving the era of infinite
• 0:04
  - healthcare abundance
• 0:06
  - At Hippocratic AI, we partner with more than
• 0:08
  - 60 innovative healthcare organizations
• 0:11
  - across payers, providers, and life sciences
• 0:13
  - to drive patient and member outcomes.
• 0:16
  - Offering the safest clinical AI voice agents, Hippocratic
• 0:19
  - AI is the first company to define comprehensive
• 0:22
  - voice AI benchmarks for healthcare.
• 0:24
  - Safety, clinical accuracy,
• 0:26
  - empathy, consistency.
• 0:29
  - Learn more at hippocraticai.com.
• 0:32
  - This is Gracelyn Keller with the Becker's Healthcare
• 0:34
  - Podcast, and we are recording live at the
• 0:36
  - fourth annual spring payer issues roundtable.
• 0:38
  - I'm currently joined by Adam Park, who is
• 0:40
  - the director of network development at Curative Health
• 0:44
  - Plan.
• 0:45
  - Adam, thanks for being here today. Thanks for
• 0:47
  - having me. Yeah. I'd love if you could,
• 0:49
  - introduce yourself and share a little bit more
• 0:51
  - about your role in organization.
• 0:53
  - Sure. So well,
• 0:55
  - about me. I've been in the business of
• 0:57
  - health care my entire career.
• 0:59
  - Growing up in a clinician's family,
• 1:01
  - my father is a doctor and my mother
• 1:02
  - is a social worker. I always had an
• 1:04
  - affinity
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  - for the business of health care, so much
• 1:08
  - more fulfilling in than processing financial transactions or
• 1:11
  - selling fidget spinners.
• 1:12
  - At the end of the day, our product,
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  - our service is improving and saving people's lives.
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  - But unlike my parents, I never wanted to
• 1:19
  - be patient facing, so I dedicated my career
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  - to supporting patient care.
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  - My passion is aligning incentives so that we
• 1:26
  - get good
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  - care, not just more care.
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  - And that's why I'm so excited to be
• 1:31
  - with Curative.
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  - Curative is a
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  - employer sponsored health plan with a straightforward model,
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  - $0 co pays and $0 deductibles.
• 1:40
  - The philosophy is to remove friction and make
• 1:43
  - health care affordable so people can actually use
• 1:45
  - their benefits that they need.
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  - But there is a catch, a good one.
• 1:50
  - To unlock this $0,
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  - the patient needs to have a baseline visit
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  - their first hundred twenty days. It's a consultation
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  - with a clinician
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  - and a care navigator
• 2:00
  - to build a personal road map to meet
• 2:01
  - the patient where they are.
• 2:03
  - Well, thank you for being here.
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  - And to kick off our conversation, I'd love
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  - to know from your perspective, what is the
• 2:09
  - most pressing operational challenge facing payers right now,
• 2:12
  - and how are you working to address it?
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  - Well, for years, real only real innovation
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  - in health care financing has been the high
• 2:21
  - deductible health plan,
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  - and it mistook cost shifting for cost containment
• 2:26
  - and essentially
• 2:27
  - put access and care out of reach for
• 2:30
  - many US workers.
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  - At Curative, we learned the hard way that
• 2:34
  - if you put a $5,000 barrier between the
• 2:36
  - patient and their doctor,
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  - they don't become savvy consumers. They just stop
• 2:40
  - being patients.
• 2:41
  - That deferred care eventually turns into a late
• 2:44
  - fee in the form of an ER visit
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  - or a hospital stay that is far cost
• 2:48
  - from there and could have been avoided.
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  - There is a constant tension between keeping costs
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  - down and actually delivering a good member experience,
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  - especially as it comes to care coordination.
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  - So how is your organization balancing cost containment
• 3:02
  - with improving member experience and quality outcomes, and
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  - where are you seeing the greatest opportunity for
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  - impact?
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  - Well, for many health plans,
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  - especially high deductible health plans,
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  - the thinking is if if we make it
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  - expensive for people to go to the doctor,
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  - they'll only go when they really need to.
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  - But humans don't work like that.
• 3:20
  - If you put a $5,000 barrier in front
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  - of the average patient, they don't become a
• 3:24
  - savvy shopper. They just stop being a patient.
• 3:27
  - The market, the industry,
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  - sometimes looks at a $200 primary care visit
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  - as an expense that needs to be managed.
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  - At Curative,
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  - we look at it as an investment to
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  - prevent catastrophic claims.
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  - And digital engagement and transformation
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  - continues to accelerate across health care. So what
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  - technologies and AI are you prioritizing right now,
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  - and where are you seeing meaningful ROI as
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  - well as better engagement with members?
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  - Well, this is one of the most exciting
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  - things about working at Curative. They're doing some
• 3:57
  - things that I've never seen before, and I've
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  - been in this industry a long time. One
• 4:01
  - of the most amazing things to me is
• 4:03
  - the curative cash card.
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  - We actually provide our members with a credit
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  - card so that they can pay on the
• 4:09
  - spot for at approved providers, of course, but
• 4:12
  - those providers may not accept their insurance today.
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  - We can then track those payments and if
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  - need to, start actively negotiating with those providers.
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  - But until then, we pick up the tab
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  - right on the spot.
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  - And we also are doing a lot with
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  - AI.
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  - Internally, we have, Benny, the benefits bot, who,
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  - helps our teams answer complex questions about benefits
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  - and policies
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  - so we can get back to the patients
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  - quickly.
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  - We're also supporting our clinical teams with AI
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  - to increase
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  - some of the efficiencies and effectiveness of our
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  - prior authorization process.
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  - And we're this is the other thing I'm
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  - really excited about, is that we're using a
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  - lot of AI in our credentialing.
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  - I've seen the early results, and a large
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  - group of 200 physicians,
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  - I saw credentialed in days where
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  - the industry standard is can be months to
• 5:01
  - do that same thing.
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  - So,
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  - those are some of the very exciting things
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  - that I see here at Curtis.
• 5:08
  - Absolutely. And, my final question for you as
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  - we wrap this conversation up is how do
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  - you see AI supporting member facing interactions while
• 5:16
  - maintaining that trust and quality?
• 5:19
  - Well, again,
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  - embracing AI, our members have access to, AI
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  - agents that can help them navigate,
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  - the benefits in real time.
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  - We do have member services, human member services
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  - that are available twenty four seven, but we've
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  - seen people getting more comfortable with AI.
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  - And,
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  - when some of those processes can be easily
• 5:40
  - answered quickly by AI, such as
• 5:43
  - questions about benefits or finding an in network
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  - provider or even checking their prior authorization status.
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  - Similarly, we have AI
• 5:52
  - responding to member emails.
• 5:55
  - Approximately 60% of our emails today are being
• 5:58
  - responded by our digital assistant,
• 6:00
  - and this cuts the response time, from
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  - twenty four hours to minutes. So there's a
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  - lot of interesting things to be done with
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  - AI.
• 6:08
  - Absolutely.
• 6:09
  - Well, Adam, thank you so much for joining
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  - me today on the Becker's healthcare podcast and
• 6:13
  - sharing these thoughts and insights. Again, we are
• 6:15
  - recording live at the fourth annual spring payer
• 6:17
  - issues roundtable.
• 6:19
  - Thank you.