Latest / Becker’s Payer Issues Podcast / Building Trust and AI Driven Member Engagement in Health Plans with Howard Weiss

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Building Trust and AI Driven Member Engagement in Health Plans with Howard Weiss · Becker’s Payer Issues Podcast

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  Generative AI is driving the era of infinite
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  60 innovative healthcare organizations
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  to drive patient and member outcomes.
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  Learn more at hippocraticai.com.
• 0:32
  This is Gracelyn Keller with the Becker's Healthcare
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  Podcast, and we are recording live at the
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  fourth annual spring payer issues roundtable.
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  I'm joined now by Howard Weese, who is
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  the vice president of government relations at EmblemHealth.
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  Thanks Thanks for being here, Howard. Let's start
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  our conversation by just having you introduce yourself
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  a little bit further and share more about
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  your role in organization.
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  Sure.
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  I'm Howard Weiss. I work at EmblemHealth.
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  EmblemHealth is a nonprofit,
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  mission based health plan headquartered in New York
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  City.
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  I work in the government relations department, so
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  I'm not operational hands on. I'm not revenue
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  hands on. I really look at legislation regulation
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  and try and keep my colleagues up to
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  date about what's going on.
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  Well, thank you for being here. Yeah. And
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  let's start our conversation.
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  I'd love to hear from your perspective.
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  What is the most pressing operational challenge you're
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  facing payers right now, and how are you
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  addressing it? Yeah. So I'm not gonna answer
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  specifically operational. I think one one of the
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  bigger challenges is the pure lack of trust
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  that,
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  consumers have in the health insurance industry that
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  policymakers
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  have in the health insurance industry. And I
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  think it's truly a difficult thing and truly
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  a
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  factor that threatens the future of the industry
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  as a whole.
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  Fortunate to be work
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  working where I work because we're really focused
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  in on our community based activities.
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  We have
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  15
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  neighborhood care centers,
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  which are located throughout New York City,
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  which provide community services not only to our
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  members, but to people within the community.
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  So that's a huge focus of ours.
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  We,
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  also have recently reduced the number of codes
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  that we require for prior authorization,
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  in an effort to really simplify and make
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  things easier for consumers,
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  hopefully, have them understand that we are in
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  fact on their side.
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  And we're also trying to improve. We've really
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  made it a focus
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  over the past year,
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  of improving our customer service, understanding that it
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  all begins
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  and ends with how consumers feel about EmblemHealth.
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  And and so that's the way we're trying
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  to overcome that lack of trust.
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  And there's 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
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  balancing cost containment with improving member experience and
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  quality outcomes, and where are you seeing the
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  greatest opportunity for impact there? Yeah.
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  So we're
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  trying to grow. And in order to grow,
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  we really feel like we need to make
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  long term relationships with our consumers.
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  So,
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  because of that, you know, we're all on
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  the prevention train. Right? Keeping people healthier longer.
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  It's not necessarily about next year. It's about
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  the year after that and the year after
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  that. It means focusing on star Medicare Advantage
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  and marketplace stars. Right? Because stars
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  aren't only a revenue source. Right? They are
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  absolutely an indicator
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  of the types of services, the quality of
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  services,
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  that you're providing for in all these.
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  The the way we figure it, the more
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  affordable health care is,
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  the lower their out of pocket cost, the
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  best that we can do to help our
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  consumers,
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  navigate those out of pocket cost is going
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  to be in the end a long term
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  plus for an organization.
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  So that's the way we view it. We
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  view it. We're less
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  looking at this as,
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  kind of mutually exclusive
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  and more, hey. This is really in the
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  best interest of our company.
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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
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  right now, and where are you seeing meaningful
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  ROI as well as better engagement with members?
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  Yeah. And,
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  for us, it's
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  we've started new sort of care management programs
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  where we use AI to identify
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  and actually even do the initial outreach to
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  folks that we think might be most effective.
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  For example, there was a big heat wave
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  in New York City over the summer. Right?
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  So we created this bot, which
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  used information from AI,
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  said, hey. Listen. You know, if you,
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  need help doing x y z, here's where
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  to call. And we found it to be
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  very, very effective.
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  Right? So it's,
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  the AI bot is not making any decisions.
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  Right? But they are performing the initial outreach
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  and actually found that people
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  felt like it was personal.
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  So it must have been pretty good buy.
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  But,
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  you know, trying to improve our portals,
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  both from the provider perspective and the number
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  of perspectives and
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  prove their experience,
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  when they're working with us is the one
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  of the ways that we're really looking at
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  best utilizing
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  AI.
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  And as we wrap up our conversation,
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  I'd love to know,
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  your thoughts on health care workforce shortages as
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  they continue to impact payers and providers alike.
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  So how are you thinking about AI as
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  a way to augment, not replace,
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  but augment care teams, especially in areas like
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  call centers, care management, and population health? Yeah.
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  That's exactly it. Right? It's
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  AI is an analytical tool. It helps
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  professionals,
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  health care professionals,
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  consumer,
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  relations professionals, the folks that doing the call
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  centers
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  better focus their activities,
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  spend more time
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  when it comes to care managers, focus,
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  trying to think about what's best for the
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  consumer,
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  distilling information to help them do that from
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  a customer service standpoint,
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  providing them with sort of prompts that seem
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  to,
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  work with certain types of inquiries.
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  So it's a it's a it's a way
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  of supporting those initiatives, and it's not a
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  way of diminishing our need for these extremely
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  valued professions.
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  Wonderful. Well, Howard, thank you so much for
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  joining me today on the Becker's Healthcare podcast
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  and sharing these thoughts and insights. Again, we
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  are recording live at the fourth annual spring
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  payer issues roundtable.
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  Thanks very much.