Latest / Becker’s Payer Issues Podcast / Simplifying Healthcare Through Digital Transformation, Affordability and AI with Katie Catlender

Transcript

Simplifying Healthcare Through Digital Transformation, Affordability and AI with Katie Catlender · Becker’s Payer Issues Podcast

• 0:01
  - The payer provider relationship has never been simple,
• 0:04
  - but what's happening now is something different.
• 0:07
  - Value based models are maturing unevenly,
• 0:10
  - prior authorization reform is reshaping workflows on both
• 0:13
  - sides, and affordability
• 0:15
  - pressure is intensifying.
• 0:16
  - The organizations that figure out how to collaborate
• 0:19
  - genuinely, not just contractually,
• 0:21
  - are the ones that will set the terms
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  - for what comes next.
• 0:24
  - Becker's fifth annual fall payer issues roundtable brings
• 0:27
  - together more than 500 executive level attendees
• 0:30
  - and 70 plus speakers for two days of
• 0:32
  - focused senior level conversation on benefit design, network
• 0:36
  - strategy, transparency,
• 0:38
  - and the financial and regulatory
• 0:46
  - Hotel Chicago. For the agenda and event details,
• 0:49
  - visit beckerspayer.com
• 0:50
  - and click on the events tab in the
• 0:52
  - upper right.
• 0:54
  - Hello, everyone. This is Jacob Emerson with Becker's
• 0:57
  - Payer Issues podcast.
• 0:58
  - Thrilled today to be joined by Katie Katlander,
• 1:01
  - who serves as chief operating officer at Point
• 1:03
  - thirty two Health. Katie, thanks so much for
• 1:06
  - taking the time to be with me on
• 1:07
  - the podcast this morning. Hi, Jacob. Thanks for
• 1:10
  - having me. I'm really happy to be here.
• 1:12
  - Absolutely. Thank you for for taking the time.
• 1:15
  - So, Katie, before we dive into everything we
• 1:17
  - wanna talk with you about, some some recent
• 1:19
  - news from point thirty two l, Can you
• 1:22
  - first take a minute,
• 1:24
  - give our audience some background about yourself?
• 1:27
  - What led you up to this current role
• 1:28
  - in terms of your your health care career,
• 1:30
  - and what do you do today at point
• 1:32
  - thirty two health?
• 1:35
  - Thanks for the question, Jacob.
• 1:37
  - I am a lifer, so to speak, within
• 1:40
  - the payer space, and I am very privileged
• 1:43
  - to say that.
• 1:44
  - In my role as chief operating officer,
• 1:47
  - my mandate is basically
• 1:49
  - to deliver reliably today for our customers while
• 1:52
  - building the operating model, the service experience, digital
• 1:56
  - capabilities,
• 1:57
  - and technology enablement that ensures we stay affordable
• 2:01
  - and competitive
• 2:02
  - and really meet the needs of those we
• 2:04
  - serve.
• 2:05
  - So as the
• 2:06
  - parent company of Harvard Pilgrim Healthcare and Tufts
• 2:10
  - Health Plans, which are our brands,
• 2:12
  - that are nonprofit
• 2:14
  - and serving 2,000,000 members across Medicare, Medicaid,
• 2:18
  - commercial, individual, and employer markets.
• 2:21
  - I have the opportunity
• 2:23
  - to truly focus on execution.
• 2:25
  - And,
• 2:26
  - our focus right now is simplifying how the
• 2:29
  - organization
• 2:30
  - works,
• 2:31
  - reducing administrative
• 2:32
  - costs, improving affordability,
• 2:35
  - modernizing
• 2:36
  - platforms,
• 2:37
  - and putting the member and provider experience at
• 2:39
  - the center, which means meeting them where they
• 2:41
  - are, not where we are.
• 2:43
  - And this isn't just about operations or operational
• 2:47
  - improvement. It's how we become more competitive, resilient,
• 2:50
  - and easier to do business with. And as
• 2:52
  - I look back on my career, my trajectory,
• 2:55
  - I mentioned being in the payer space by,
• 2:58
  - entire career.
• 2:59
  - I've had the good fortune of being in
• 3:01
  - the New England market my entire career,
• 3:05
  - three of the major
• 3:07
  - competitors
• 3:08
  - to PointThirtyTwo
• 3:09
  - Health. So I have a lot of experience
• 3:12
  - really looking inside and outside and how we
• 3:14
  - need to partner, with providers in order to
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  - make this experience happen.
• 3:19
  - So we're really looking forward to,
• 3:21
  - talking more about all the things we're doing
• 3:23
  - to to really prove that out.
• 3:26
  - Wonderful. I appreciate you giving us a quick
• 3:28
  - over there,
• 3:30
  - of your career, Katie. So you've been in
• 3:32
  - the industry for a long time.
• 3:34
  - And and earlier this summer, Point thirty two
• 3:36
  - Health, you announced,
• 3:38
  - that you're consolidating
• 3:40
  - two legacy member portals and two provider portals
• 3:42
  - into unified platforms
• 3:44
  - going along with what you were just talking
• 3:46
  - about, simplifying and modernizing
• 3:48
  - the experience for your members and for your
• 3:51
  - provider partners, of course.
• 3:52
  - So
• 3:53
  - for for the other plans, let's say, for
• 3:55
  - regional plans, for nonprofit plans,
• 3:59
  - who have similar legacy infrastructure
• 4:02
  - as you know oftentimes.
• 4:04
  - Walk us through the cost benefit analysis here
• 4:06
  - on on a multiyear
• 4:08
  - digital consolidation
• 4:09
  - like this
• 4:10
  - versus
• 4:11
  - more incremental fixes to existing systems. How how
• 4:15
  - should plans
• 4:16
  - be thinking about this? How did you all
• 4:18
  - go about this?
• 4:20
  - Yeah. This is a great question.
• 4:23
  - And technology
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  - debt
• 4:25
  - and really focusing on omnichannel experiences,
• 4:28
  - putting members at the center is really such
• 4:31
  - an important aspect of how health care can
• 4:34
  - be disrupted right now.
• 4:36
  - And the strategic question to ask here is,
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  - are you solving a narrow technology problem
• 4:43
  - or a broader
• 4:44
  - focus on experience or an operating problem?
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  - And starting there
• 4:50
  - really allows you to say, is the goal
• 4:53
  - digital transformation?
• 4:54
  - And so for us, our goal is not
• 4:56
  - digital transformation for its own sake.
• 4:59
  - It's for the purpose of creating a simpler,
• 5:02
  - more affordable healthcare experience,
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  - while building a stronger, more sustainable operating model
• 5:08
  - for the future.
• 5:10
  - And our healthcare system, as we know, is
• 5:13
  - facing unprecedented
• 5:14
  - pressure, rising medical costs, affordability
• 5:17
  - challenges,
• 5:19
  - fragmented experience,
• 5:21
  - increasing expectations from members and providers based on
• 5:24
  - experiences they have outside of healthcare.
• 5:27
  - So we are executing on a significant enterprise
• 5:30
  - transformation
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  - to reduce admin costs,
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  - roughly by about 30%
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  - and improve our medical cost trend by about
• 5:39
  - 3%
• 5:40
  - year over year.
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  - So what we're doing is focusing on a
• 5:44
  - member experience
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  - at the same time that we're transforming ourselves.
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  - It's like running a marathon while redesigning the
• 5:50
  - course mid run.
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  - And our experience through this has reinforced a
• 5:55
  - pretty simple lesson.
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  - Affordability,
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  - experience, and operational discipline are not separate agendas.
• 6:00
  - They're the same agenda.
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  - And every layer of complexity shows up somewhere
• 6:05
  - for a member, a provider, an employer, or
• 6:08
  - a broker at a higher cost, a lower
• 6:10
  - satisfaction,
• 6:11
  - or slower execution.
• 6:13
  - And so for us, we're consolidating
• 6:16
  - multiple legacy platforms
• 6:18
  - into what we call a unified digital experience,
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  - amplifying the notion of we need one digital
• 6:24
  - front door. We need to expand and meet
• 6:27
  - our customers and constituents where they are through
• 6:30
  - self-service.
• 6:31
  - We need to leverage AI responsibly
• 6:34
  - and redesign our own work around outcomes rather
• 6:37
  - than functions.
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  - So we're moving from fragmentation to simplification,
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  - from multiple portals and processes and handoffs to
• 6:46
  - one experience
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  - that is connected and cohesive,
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  - for all the constituents we serve. And as
• 6:53
  - importantly,
• 6:54
  - that really serves our own colleagues as well.
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  - Absolutely. No. It makes complete sense. So you're
• 6:59
  - you're trying to reduce administrative frictions, reduce administrative
• 7:03
  - costs by 30%.
• 7:05
  - And I I believe you've all cited
• 7:08
  - reducing avoidable provider calls as well in terms
• 7:12
  - of
• 7:13
  - core issues you're hoping to address through this
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  - through this overhaul.
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  - So from your seat,
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  - Katie,
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  - how do you how do you quantify the
• 7:22
  - return on reducing those frictions?
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  - What what internal metrics are going to tell
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  - you that this transformation
• 7:30
  - actually moved the needle
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  - for for your provider community and for your
• 7:34
  - members, of course, rather than just simply changing
• 7:37
  - the interface they all interact with?
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  - It's a great question. And let me start
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  - by saying, incremental fixes in the short term,
• 7:45
  - can be more affordable
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  - for the payer.
• 7:49
  - But if they preserve fragmentation, they become expensive
• 7:52
  - over time and you're basically
• 7:55
  - paving a cow path for lack of a
• 7:56
  - better way to say it. My point of
• 7:58
  - view is that the next era of healthcare
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  - won't be won by the organizations with the
• 8:03
  - most technology.
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  - It's going to be won by organizations
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  - that really thread the needle across multiple partners
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  - to remove the most complexity.
• 8:13
  - And so our measures of success aren't necessarily
• 8:16
  - about adoption. While that's important initially,
• 8:19
  - it's truly whether members and providers can accomplish
• 8:22
  - what they need with less effort, and we
• 8:24
  - see our job as,
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  - and our purpose to create that.
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  - And so the ROI
• 8:30
  - is strongest when digital work
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  - reinvents
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  - relationships and how time is spent.
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  - The real test is whether members and providers
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  - can get something done more easily, more quickly,
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  - more reliably.
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  - They don't have to contact us multiple times.
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  - We eliminate
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  - rework or multiple points of contact,
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  - and self-service
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  - is more prominent than the need to contact
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  - us reactively.
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  - In that, we lower costs as a measure,
• 9:02
  - and we also look at improving experience at
• 9:05
  - the same time. So that's the operating model
• 9:07
  - we're building towards.
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  - Less friction, clearer accountability,
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  - better data, measurable
• 9:13
  - outcomes, ultimately meeting members and providers where they
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  - are.
• 9:17
  - 100%. And I hear you loud and clear.
• 9:19
  - This this isn't gonna be one by who
• 9:21
  - has the most tech, but who partners better
• 9:23
  - across the industry. I do wanna ask though
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  - because I know you all have been leaning
• 9:28
  - further into AI driven personalization
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  - services.
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  - Of course, the entire industry has.
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  - So so how are you thinking about the
• 9:35
  - right level of tailoring here enough to be
• 9:38
  - genuinely useful to to your members, to your
• 9:41
  - employer clients, but without
• 9:44
  - overstepping
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  - into a territory that might feel intrusive to
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  - them or or further
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  - even erodes trust in in,
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  - the trust that they have in you.
• 9:54
  - Yeah. And in health care, personalization
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  - has to earn trust, whether that's through technology
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  - or people.
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  - And that has to be earned at every
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  - single interaction.
• 10:06
  - We are really excited
• 10:08
  - to leverage,
• 10:09
  - artificial intelligence. And AI can be powerful
• 10:13
  - when it helps people understand their benefits, close
• 10:16
  - care gaps,
• 10:17
  - find the right provider, prepare for care,
• 10:20
  - or avoid unnecessary
• 10:22
  - friction. And that's how we're focused,
• 10:24
  - but it has to feel like
• 10:27
  - support, not surveillance. And I think that's a
• 10:30
  - big aspect of the trust comment that you're
• 10:32
  - mentioning.
• 10:33
  - Our principles are pretty simple.
• 10:36
  - AI use must be useful.
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  - It must provide transparency.
• 10:41
  - We need to ensure it's permission based and
• 10:43
  - governed, human in the loop at all times.
• 10:47
  - Members should understand,
• 10:49
  - and feel a sense of transparency
• 10:51
  - towards that trust about why they are seeing
• 10:54
  - something, what data is being used, and how
• 10:57
  - they can manage their own preferences as an
• 10:59
  - example.
• 11:00
  - And so the opportunity is to move from
• 11:03
  - a reactive model to really putting a member
• 11:06
  - constituent in control.
• 11:08
  - And when members have to figure out
• 11:11
  - what to ask,
• 11:13
  - which is the current model, and instead move
• 11:16
  - to a proactive model that helps them anticipate
• 11:19
  - and navigate care and benefits, it puts us
• 11:21
  - in the background and them in the foreground.
• 11:24
  - And that's a high standard,
• 11:26
  - and that's what we think AI can help
• 11:28
  - with. It should improve trust, not put it
• 11:31
  - at risk.
• 11:32
  - AI is not our strategy,
• 11:34
  - but really it's being leveraged to create a
• 11:36
  - simpler healthcare experience for our members and providers.
• 11:39
  - That's the intent.
• 11:41
  - And AI, we feel, is the accelerator to
• 11:43
  - get there.
• 11:45
  - Well, clearly, a lot of important work going
• 11:47
  - on under your leadership at point thirty two
• 11:49
  - health, Katie. So we've touched on a lot
• 11:52
  - here.
• 11:52
  - What else are we missing? You know, you
• 11:54
  - you've got the ears right now of a
• 11:56
  - lot of other
• 11:57
  - colleagues and leaders within the industry from around
• 11:59
  - the country, and you have so many important
• 12:02
  - insights to share with them given your breadth
• 12:03
  - of experience in the industry.
• 12:06
  - So what else would you offer them before
• 12:08
  - we go to
• 12:10
  - that? Thanks, Jacob, for that question. It it's
• 12:12
  - such a good one. And I'd I'd ask
• 12:15
  - for advice also, from anyone who's listening who'd
• 12:18
  - like to reach out and three perspectives
• 12:20
  - I'd leave people with,
• 12:22
  - from my own opinion and my own experience.
• 12:26
  - The first is to treat experience, affordability
• 12:29
  - and technology
• 12:30
  - as one agenda.
• 12:32
  - Members and providers
• 12:34
  - don't experience our organizations
• 12:36
  - in silos.
• 12:38
  - They experience a system.
• 12:40
  - And if that system, whether it be us
• 12:42
  - or a provider system feels fragmented,
• 12:45
  - it usually means our operating model underneath it
• 12:49
  - is too fragmented and that's ours to control
• 12:52
  - for.
• 12:53
  - Our work has to be cross functional and
• 12:55
  - cohesive.
• 12:56
  - So whether it's, leaders from operations or technology,
• 13:00
  - clinical finance, compliance, customer experience, we all need
• 13:03
  - to be aligned around the same outcome. So
• 13:06
  - first
• 13:07
  - goal is treat experience, affordability and technology as
• 13:10
  - one agenda.
• 13:12
  - Second is be clear on the value you're
• 13:15
  - creating,
• 13:16
  - whether that's lower cost, faster resolution, better self-service,
• 13:20
  - stronger trust, or improved care navigation,
• 13:23
  - and measure the heck out of it. Because
• 13:25
  - without that, there's no real value being delivered
• 13:28
  - based on the outcomes important to the organization,
• 13:31
  - but as importantly to the constituents served.
• 13:34
  - And then the third is, and probably the
• 13:37
  - most important,
• 13:38
  - is put the member at the center of
• 13:41
  - all we do.
• 13:43
  - I don't think it's important
• 13:45
  - to wait for perfect infrastructure
• 13:48
  - or perfect technology
• 13:49
  - to mature.
• 13:51
  - What we do need to do is not
• 13:53
  - underestimate
• 13:54
  - the cost of delaying simplification
• 13:58
  - and how much waste we create when we
• 14:00
  - don't put the member at the center. So
• 14:02
  - those would be my pieces of advice. And
• 14:05
  - I truly believe the plans that will be
• 14:07
  - successful
• 14:08
  - into the future
• 14:09
  - are the ones that make health care easy
• 14:12
  - to navigate, more affordable,
• 14:13
  - and are always thinking on behalf of the
• 14:15
  - people they serve.
• 14:17
  - Fantastic. Well, Katie, I can't thank you enough
• 14:19
  - for the detailed advice
• 14:21
  - for our listeners and for taking the time
• 14:23
  - this morning to join us here on the
• 14:25
  - podcast. Really appreciate you doing so. Thank you
• 14:28
  - so much, Jacob. Appreciate your time.
• 14:31
  - And to our listeners, if you'd like to
• 14:33
  - hear more podcasts from Becker's Healthcare, you can
• 14:35
  - visit beckershospitalreview.com.