Latest / Becker’s Payer Issues Podcast / Dr. Aisha Rahim, Medical Director and Co-Lead, AI Governance Council, Johns Hopkins Health Plans (JHHP)

Transcript

Dr. Aisha Rahim, Medical Director and Co-Lead, AI Governance Council, Johns Hopkins Health Plans (JHHP) · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy, care, and
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  benefit solutions.
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  and prevention of health care's most complex conditions
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  easier and more accessible as we drive organizations
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  and people forward.
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  Hello. And welcome to the Becker's Payers Issues
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  podcast recorded live at the Becker's
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  I'm joined today by doctor Ayesha Raheem.
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  Ayesha, can you take a moment to introduce
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  yourself and tell us a little bit about
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  your organization?
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  Sure. Yeah. Thank you for having me today.
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  Really appreciate.
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  My name is Ayesha Rahim. I'm a medical
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  director at Johns Hopkins health plan.
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  I'm also a co lead at AI governance
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  council at Johns Hopkins health plans. And,
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  Johns Hopkins health plan serves, close to 350
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  to 400 member
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  lives in state of Maryland, Virginia, DC. We
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  have portfolio of health plans, including Medicaid,
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  Medicare,
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  uniform services, family health plan, as well as
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  employer health program.
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  And so what we are trying to do
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  is trying to
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  build enterprise wide artificial intelligence strategy that can
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  serve our members,
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  our employees, and our organization as a whole.
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  Balancing affordability and quality is a constant challenge
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  for health plans. So how is your organization
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  innovating to manage the cost of care while
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  maintaining or improving member outcomes?
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  That's a great question, actually. And
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  as you know, all or most of the
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  health plans are trying to balance that. I
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  mean, affordability,
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  has changed over a period of time, and
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  a lot of health care has been less
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  affordable.
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  And so plans have to become more innovative
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  in terms of how they can offer their
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  services
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  in a lesser cost, but at the same
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  time offer a higher quality of care. And
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  at any given point in time, we are
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  trying to see where we can
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  streamline our services.
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  We can,
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  focus on members
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  that are just only high risk but at
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  risk, but also we can make some impact
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  in their lives. And so we use artificial
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  intelligence. We use a lot of data analytics
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  to identify those members so that we can,
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  interact with them, impact them, and,
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  make changes so that they we can improve
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  their lives as well as their health
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  and, so that we can,
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  leverage technology
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  to,
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  to improve member outcome. And when we do
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  that, we are using lesser resources to,
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  produce more gain and improve the lives of
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  our members. So there's a constant struggle, and
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  a lot of times, you know, the health
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  plans are on a receiving end. But at
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  the same time, the struggle, we keep on
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  doing that so that we know that at
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  the end of the day, we are serving
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  our members, and we're trying to do best
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  for our members.
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  And so you mentioned your organization has a
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  very large, geographic footprint. Mhmm.
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  So within that geographic footprint, there must be
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  a lot of diversity
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  and different demographics. So addressing health equity has
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  become a critical focus for many health plans.
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  Can you share an overview of a key
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  initiative
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  here that you're involved in, and you're particularly
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  excited about? And what are you hoping to
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  achieve?
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  That's a great question. And,
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  HealthEquity has been at the forefront of our
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  health plan strategy for a long time. Johns
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  Hopkins health system
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  as well as Johns Hopkins,
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  health plan has been focusing,
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  on it,
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  because we serve diverse population in state of
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  Maryland with a very different demographics. And so
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  some of our portfolio health plans are actually
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  pursuing health equity accreditation,
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  which means that we're gonna
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  we are doing organization
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  wide transformation
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  and collecting data based on race, ethnicity, and
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  then building up strategy to,
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  improve the lives of our member based on
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  that data.
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  For example, we have a class program, which
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  is a culturally linguistically
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  appropriate services.
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  And what we do is we when we
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  collect the data, we analyze the data and
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  find out if there any disparity,
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  in terms of health outcome regarding particular disease
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  process in one
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  member demographic versus another. And when we find
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  that demographic disparity, what we do is we
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  institute programs, services, care management to address those
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  disparities, and, hence,
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  we sort of try to reduce or close
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  the gaps in terms of the race.
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  And then we have other,
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  programs in terms of improving the language services
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  that we offer. Mhmm. You know, improving the
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  data gathering process,
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  improving,
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  network accessibility
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  for our,
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  our diverse population. And so, we are taking
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  these actions and hoping to per, achieve health
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  equity accreditation,
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  at least by August or September
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  2025.
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  And with this big patient population,
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  member satisfaction
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  is really essential to thrive in today's hyper
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  competitive health care market. What experience or engagement
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  strategies have proven effective for your organization,
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  and what are your KPIs? How are you
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  measuring this?
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  Right. Great question. So I think member satisfaction,
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  is one of the key initiatives that we
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  are taking on, especially
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  in last year and this year as well.
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  And that involves,
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  you know, building a brand new member portal,
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  also,
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  leveraging artificial intelligence
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  to,
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  figure out which members are high risk of,
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  the member turnout and so that we can
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  proactively,
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  reach out to them and figure out what's
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  causing that
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  friction and address that. Also, you know, when
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  we meet members where they are, it it
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  gives us the opportunity
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  to
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  to engage them in a way that,
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  which is different from other health plans. For
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  example, like, if the members are going to
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  a certain clinic or a certain market, we
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  would try to see if we can get
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  our services rendered there as well so that
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  we can get their members where they are.
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  In terms of, like, using artificial intelligence, we
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  have,
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  we are looking into chatbots
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  to proactively,
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  remind our members that, you know, these are
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  the health care services and screenings that are
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  due. And, also, when they're trying to reach
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  out to our plan to get information, we
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  can use them, you use the chatbots to
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  engage them. Mhmm. And and in terms of
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  KPI, we are using cap scores. We are
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  doing other metrics, measuring other metric
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  metrics in terms of member satisfaction,
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  that are standard across industries and trying to
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  see how we can using artificial intelligence as
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  well as,
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  trying to see where members are and reach
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  out to them because also sizable population of
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  our members
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  are are working within Hopkins as well. So
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  we can also leverage our own provider,
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  database and providers to engage them as well.
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  So a lot of different tactics,
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  it's a work in progress, and I can
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  tell you it is one of the toughest
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  ones. Especially at high risk members,
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  I would say they are very difficult to
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  engage. Mhmm. And that's where we are having
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  some challenges in trying to figure out how
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  what would be the right engagement strategy
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  other than
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  engaging their providers, engaging where they work or
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  where they reside and play
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  and, you know, the the artificial intelligence. A
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  lot of these populations are not tech savvy
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  too. So it also creates a digital divide,
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  and we have to work on digital literacy
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  and other areas.
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  So So looking ahead, what do you see
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  as the biggest opportunity for payers to really
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  lead the charge in transforming health care delivery
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  and driving better outcomes for all stakeholders?
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  And what can leaders like yourself do to
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  take a step in this direction right now?
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  Right. I mean, that's a that's a very,
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  loaded question, I would say. And I think
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  we can do a lot, but at the
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  same time, our hands are sort of tied
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  because we are not directly,
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  we we we are not providers so that
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  we cannot,
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  directly engage members 100% of the time.
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  But I think we have a lot of
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  areas that we can work on in order
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  to achieve that. And one of the areas
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  I think sort of untapped is that use
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  of artificial intelligence in detection of social determinants
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  of health. Mhmm. I think,
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  that area is not really well
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  studied and how we can use artificial intelligence
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  to address care gaps in minoritized group. I
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  think that's where I think we could possibly
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  invest more and figure out what could be
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  the resources that are already available and how
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  you can use AI to link our members
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  to those resources
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  without heavily,
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  utilizing internal resources so that we can it
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  is more like an organic connection, and we
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  don't have to invest a lot internally for
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  that. So I think that's, SDOH
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  detection as well as,
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  mobilization and providing resources that are outside the
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  organization to our members is one area we
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  can work on.
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  Member engagement is another area we can work
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  on, and I think artificial intelligence has a
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  lot of promise in terms of improving the
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  quality as well as reducing the cost and
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  making sure that we meet the business needs,
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  with the use of artificial intelligence.
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  But in order to be successful,
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  and to successfully employ this technology, we need
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  to have an enterprise wide strategy. We need
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  to have data that backs up that technology,
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  and we cannot just
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  use one off vendors to address that. We
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  have to have a more robust system within
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  organization
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  to drive that change and to make that
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  ROI with the best use case.
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  So,
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  you know, you work very closely with AI.
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  And I'm very curious. As someone who, you
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  know, likely has their ear to the ground
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  more than most,
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  is there a particular
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  use case for AI that maybe people aren't
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  using yet that, you know, maybe two, four,
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  five, ten years from now, there might be
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  they might be using in a way to
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  really
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  transform things in a way that most people
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  don't even see it. Is there anything, like,
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  kinda up and coming that you're particularly excited
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  about?
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  I think a lot of use cases that
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  we are using currently
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  are up and around in the market for
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  a while. Mhmm. And so in terms of
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  artificial intelligence
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  and use cases, I'm thinking out loud.
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  We talked about our use of artificial intelligence
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  and social determinants of health.
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  I mean, I've I speak about artificial intelligence
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  and
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  process improvement.
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  I think where artificial intelligence could be great
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  is,
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  within health plan is, like, if you have
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  a helper like agentic AI Mhmm. Which does
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  the task autonomously
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  Mhmm. Which sort of, like,
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  is is mirroring what you do. Like, for
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  example, I'm,
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  doctor Raheem. I'm logging into system. I'm I'm
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  I have certain checklist that I have to
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  do before I start my work. Agentic AI
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  makes helps me do those tasks autonomously without
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  my intervention so that I have more extra
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  time to do other things. Mhmm. Same stands
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  for other areas in the plan where,
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  we can automate the repetitive
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  tasks
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  and free up that time to do meaningful
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  work, I think that's where I would be
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  more
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  focused on because I feel like
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  it's there, it's on our face, but we
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  we are not utilizing that as much. Right.
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  Right. And we are thinking about it, but
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  we are not operationalizing on it. Right. Right.
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  And,
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  and,
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  like, it it's it's within our organization, and
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  we and it can be specific to
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  different folks, like, let's say, medical directors, human
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  work nurses, claim management,
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  to quality improvement. There are people in the
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  organization that are doing the same work over
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  and on mundane task. And if we can
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  somehow
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  automate those tasks specific to their field Mhmm.
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  The way they do it, it's like sort
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  of creating a digital twin where you have
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  a better version of me doing it faster
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  Right. And,
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  able to achieve things that I'm doing,
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  but at the same time, leaving some time
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  for me so that I can look into
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  more Right. Definitely cognitively diverse tasks so that
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  I can be more productive
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  and more engaged. In fact, it is gonna
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  improve engagement
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  at workplace because if I'm not doing mundane
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  task and repetitive task, I'm probably doing something
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  more meaningful to me. Right. Right. And so
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  that would be improve,
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  my engagement in workplace and
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  reduce the turnaround or attrition within the workplace.
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  Because I feel like within a health plan,
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  nurses and,
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  the
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  workflow has a lot of turnaround and a
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  lot of attrition, and so that can be
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  tackled using, you know, that technology as well
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  as
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  emphasizing and investing in those areas. Well, in
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  a lot of those main mundane tasks that
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  you're talking about automating are probably a lot
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  of what leads to burns and stuff too.
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  Right. Yeah. Just like I log in every
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  day. I have to do check-in into my,
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  you know, let's say, my clock in or
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  whatever it is. I if I'm logged in,
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  I'm probably clocking in. So that could be
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  automatic step. Yep. Yep. I'm opening my email
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  box. That should not be another click. We
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  have to do so many clicks just to
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  do the work that we do. Mhmm. And
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  that could be made quite easy with the
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  use of artificial intelligence and automation, I would
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  say.
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  Right. Well, doctor Raheem, I really appreciate your
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  time today. I can tell you're passionate, and
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  I can tell you're very innovative, and this
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  is a lot of fun. So thank you
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  so much for joining us today. I really
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  appreciate it. Appreciate. Thank you for having me
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  here and giving me an opportunity to talk
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  about our right there at Johns Hopkins Health
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  Plans. It's our pleasure. You have a lovely
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  rest of your day. Alright. Awesome.