Latest / Becker’s Payer Issues Podcast / Reducing Administrative Friction & Advancing AI Driven Care with Dr. Benjamin Kornitzer

Transcript

Reducing Administrative Friction & Advancing AI Driven Care with Dr. Benjamin Kornitzer · Becker’s Payer Issues Podcast

• 0:02
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  Learn more at hippocraticai.com.
• 0:32
  This is Gracelyn Keller with the Vectrus Healthcare
• 0:34
  Podcast, and we are recording live at the
• 0:36
  fourth annual spring payer issues roundtable.
• 0:39
  I'm thrilled to be joined by doctor Benjamin
• 0:41
  Kornitzer this morning, who is the chief medical
• 0:44
  at Aetna. So, doctor Kornitzer, thanks for being
• 0:47
  here. I'm gonna have you start off our
• 0:49
  conversation by introducing yourself and telling us a
• 0:51
  little bit more about your role and organization.
• 0:54
  Sure. So I'm a primary care physician by
• 0:57
  training. I've been with Aetna for about a
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  year now. I oversee our medical affairs team.
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  And, you know, in case you're not familiar
• 1:04
  with Aetna, one of the largest national payers,
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  we're in essentially all the major lines of
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  business, commercial, Medicare, Medicaid,
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  serving approximately
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  27,000,000
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  Americans.
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  We work, with stakeholders across the spectrum, so
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  health systems,
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  providers directly,
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  plan sponsors,
• 1:24
  consultants, and a comprehensive network
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  to really deliver what we consider to be
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  the highest quality care available nationally.
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  Awesome. Well, thanks for being here. And let's
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  start our conversation
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  with from your perspective,
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  what is the most pressing operational challenge facing
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  payers right now, and how are you addressing
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  it?
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  Yeah. So the first thing you have to
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  do to really take a look at challenges
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  is listen. So we send out surveys, and
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  our most recent survey came back. And, you
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  know, the greatest point of abrasion is really
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  administrative abrasion.
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  Members wanna be able to go through and
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  navigate their health care seamlessly. Providers wanna be
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  able to spend their time focusing on better
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  outcomes for themselves and getting well.
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  So a couple of things that we've been
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  doing is really thinking through our prior authorization
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  process. So there are a couple of things
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  that we're particularly proud of. We have the
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  smallest,
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  NPL list in the industry, about half
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  of the,
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  next two largest national payers.
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  We also,
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  have been streamlining that list. In fact, this
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  past summer, we reduced it by another 20,
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  nine procedures.
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  And then we're trying to make it as
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  easy as possible for people to navigate that
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  system. So if you think about it, you
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  know, right now, 80%,
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  of procedures have no requirement for pre authorization
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  whatsoever. And those that do,
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  95%
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  of them can get processed in twenty four
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  hours or less.
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  When it comes to electronic
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  submissions, we're really taking a lead nationally. We're
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  developing
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  fire based interoperable
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  standards.
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  There were approximately 70%,
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  77%
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  actually are now done in real time,
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  and our goal is eighty percent or greater
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  by the end of the year. And if
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  you think about it, our goal would really
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  be when a patient needs a certain level
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  of care, they actually know in real time
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  before they even have left their provider's office
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  whether or not everything has been taken care
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  of.
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  That's wonderful.
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  And there is a constant tension between keeping
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  costs down and actually delivering a good member
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  experience,
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  especially as it comes to care coordination.
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  So how is your organization balancing cost containment
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  with improving member experience and quality outcomes, and
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  what are you seeing the greatest opportunity for
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  impact?
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  Yeah. So, you know, we see across the
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  country and hear from all stakeholders. That's
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  patients,
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  providers,
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  health systems, the federal government, the challenges
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  of affordability,
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  particularly in an environment where health care is
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  evolving rapidly.
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  I'd wanna step back for a second and
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  actually say that we should be very optimistic
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  about health care.
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  Outcomes are better than they've ever been.
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  There's tremendous innovation. We wanna be able to
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  support that. But in order to do so,
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  we really have to be fiduciaries
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  for our members
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  and make sure that they get the access
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  to the highest quality,
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  most cost effective care possible.
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  So there's a couple of things that we're
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  doing that we really think are,
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  very impact. One is we're really partnering,
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  with providers. I think, historically, this has been
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  a very transactional
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  relationship.
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  So, you know, we have a breadth of
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  value based care relationships
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  covering
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  primary care,
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  specialty care, and this gives us an opportunity
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  to really align on the outcomes that matter.
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  And if you think about it, when I
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  was training as a as a physician, someone
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  said, hey. Go take a look at the
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  patients. How many of them
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  do you think wanna be in the hospital?
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  The answer was none. Right. How many of
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  them, you know, actually need to be here?
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  Maybe half.
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  And so our ability to be preventive, get
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  upstream in care delivery
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  to make sure that people are getting the
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  appropriate screening tests, they're on the medications that
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  we know work.
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  That gives opportunity to really change those outcomes
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  for those members and do it in a
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  way that gets higher quality
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  and lowers the cost of care.
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  So those are initiatives that we're particularly,
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  excited about.
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  And digital engagement and transformation continues to accelerate
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  across health care. So what technologies and AI
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  are you prioritizing right now, and where are
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  you seeing meaningful ROI as well as better
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  engagement with members?
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  Yeah. So, you know, we are in an
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  exciting moment right now, and, you know, I'll,
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  you know, share with you. I was very
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  deliberate in joining Aetna and CVS Health because
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  I felt that with technology
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  innovation,
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  with the dawn of sort of this new
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  AI world,
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  there was gonna be advantage to scale.
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  As a part of the larger CVS ecosystem,
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  which includes our retail stores, includes,
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  Caremark,
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  as well as Aetna,
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  We've got the ability to engage with Americans
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  in many different ways and use that
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  capability
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  to accelerate transformation. And so, you know, you
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  may be familiar, but CVS Health made a
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  $20,000,000,000
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  commitment,
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  to advance technology
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  with a large focus on interoperability and making
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  it easier and simpler
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  for members to navigate their health care.
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  I I think how easy it is for
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  me to go on my iPhone and, you
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  know,
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  order chocolates on Valentine's day or flowers for
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  my mother
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  on,
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  mother's day or even things like to my
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  kids at their school supply when school starts
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  next week.
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  Health care should be that easy to navigate.
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  So we've got an opportunity to engage with
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  people in a very, very different way.
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  Some of the things that we're doing at
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  Aetna that I think are particularly,
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  exciting is we've launched something called care paths.
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  So that's the ability to go into our
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  Aetna Health app. And depending on the condition,
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  actually embedded within that app, be able to
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  look up everything. What are your benefits? Who
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  are the in network providers?
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  What do we know is the highest value
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  care?
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  If you do have a claim submission or
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  a prior authorization,
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  where is it in the journey? Just like
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  if I order Domino's pizza,
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  I can go look at a tracker and
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  see where that pizza actually is.
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  You should be able to do the same
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  when you wanna understand where things are. And
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  over time build other things that we know
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  are really critical. People wanna see cost transparency.
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  They wanna see quality information.
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  We're also using AI to streamline the process.
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  I mentioned getting, you know, authorizations done much
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  more quickly. So almost all authorizations now have
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  an opportunity to have an automated or an
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  AI feature where we can rapidly approve,
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  that. And so patients are getting information in
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  real time.
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  We're using the information to help our nurses.
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  So imagine thousands of pages of medical information
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  they're trying to digest that's almost impossible for
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  a single human to do. But to use
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  AI to take a look through all those
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  clinical documents and help them see what the
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  correct information is so we can be proactive
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  and help our members. That's pretty differentiating. We're
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  actually finding our nurses are saving 90 top
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  ninety minutes a day of computer time, and
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  that's time they can now reinvest in engaging
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  directly
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  with our members, which we know is is
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  so valuable.
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  And then finally, at an investor day,
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  we demonstrate technology, what we think the future
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  could look like with asynchronous
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  capabilities,
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  where we actually don't just become a payer
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  of health care, but a solutions company. So
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  if someone has a question about their child's
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  earache at two in the morning
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  or they had a tick bite recently and
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  they're wondering if they should be concerned about
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  the rash that they've developed or they wanna
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  know who's the highest quality gastroenterologist.
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  We're able to provide all of that to
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  them in the palm of their hands. So,
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  yeah, this is an exciting time in health
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  care. I think there are certainly a number
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  of challenges,
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  but we're optimistic that we can play a
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  major role in changing how people experience health
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  care and helping them get better outcomes.
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  Absolutely.
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  And how do you see AI supporting member
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  facing interactions while maintaining that trust and quality?
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  So I think you brought up a great
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  point. I'm just gonna anchor on the word
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  trust.
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  Trust is probably the most valuable asset in
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  health care. If you think about all the
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  tools a physician has, people also, like, what's
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  the most powerful tool? Is it a proton
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  beam? Is it a linear accelerator? Like, what
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  is it? It's trust.
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  Right? And so there's a couple things that
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  I would anchor on. We have to absolutely
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  be guardians of our members' information. They have
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  to feel that that information
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  is safe.
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  I'm very proud of the fact that CVS
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  is one of the founding members of the
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  Coalition for Health AI.
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  Right? We think that people are gonna be
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  transformed by their ability to access care and
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  do it directly,
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  but they have to be able to trust.
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  And you think about other technologies where over
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  time people have begun to trust those technologies
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  more and more. So financial transactions. I mean,
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  the fact that you can go online
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  into your bank and look at, you know,
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  what you have in your account electronically,
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  thirty years ago, that would have been mind
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  blowing. No one would have absolutely trusted that
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  you could take a look at something
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  online and that that was real and reflection
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  of your assets and they were safe.
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  And so we really have to work to
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  earn that trust.
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  One of the other ways that you do
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  this is by creating really valuable
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  experiences. So
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  we've got a series of capabilities where we
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  can directly engage our members. We're using
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  rich communication, so RCS technology. So imagine a
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  chat that doesn't feel, you know,
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  rigid, but actually feels like you're communicating directly
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  with an empathic human being.
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  So we can proactively outreach the people whether
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  they have
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  diabetes issues, hypertension,
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  cardiovascular,
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  their pregnant mothers, their their,
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  new parents, and be able to have communications
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  with them that are meaningful and specific and
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  personalized.
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  I think those opportunities really change how people
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  interact.
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  And imagine how you would feel if you
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  got a text message that actually lowered your
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  out of pocket spend. Right? Right now, you're
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  spending this amount of money on a medication.
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  Actually, we can get you that same amount
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  of medication,
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  but for significantly
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  lower cost. Or we see that you have
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  an appointment
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  in three months. We found availability
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  within two weeks. So our ability to create
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  delightful experiences and change how people really view
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  the industry from being payers to solution oriented
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  organizations
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  and partners, I think is really exciting.
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  Well, doctor Kornitzer, thank you so much for
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  taking the time to sit down and have
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  this conversation today.
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  Again, we are recording live at the fourth
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  annual Payer Issues Spring Roundtable.
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  Thank you so much for being here. Thank
• 11:50
  you for having me.