Payer executives anticipate building their equity and population management teams and leaning on AI and new technology in the coming years.
The 11 leaders featured in this article, part of an ongoing series, are all speaking at Becker's fall Payer Issues Roundtable, which is set for Nov. 4-6, 2024, at the Hyatt Regency in Chicago.
If you work at a health plan and would like to join as a speaker in November, contact Randi Haseman at rhaseman@beckershealthcare.com.
Question: How do you anticipate your teams will change in the next two to three years?
Abdou Bah. Senior Vice President of Medical Management and Chief Health Equity Officer of EmblemHealth (New York City): At EmblemHealth, we expect the mix of our clinical and non-clinical roles to shift. We anticipate increased utilization of licensed clinical social workers to address behavioral health needs, community health workers, and community-based Care Navigators to assess and support our members with social determinants of health. The use of new technologies will accelerate the delivery of quality healthcare, allowing staff to increase focus on the highest impact actions and value-added services. We believe that long-term health is impacted by the things people do every day, the places where they live, and the resources available to them. We have 15 Neighborhood Care centers throughout New York City, and each features Customer Care Navigators who live in the communities they serve, providing in-person and virtual customer support, connections to community resources, and programming to help the entire community learn healthy behaviors.
Stacy Edgar. Chief Executive Officer and Founder of Venteur (Berkeley, Calif.): As businesses quickly adopt individual coverage health reimbursement arrangement plans, recognizing they are a win-win for employers and employees, we anticipate growing our customer success and account management teams to ensure we can continue to provide concierge service to employers and employees. We're also heavily investing in the AI technology that powers our plan selection tools, and so we'll see continued growth on our product and engineering teams in the next few years.
Jack Hooper. CEO and Co-founder of Take Command Health (Richardson, Texas): A key mission of ours at Take Command is to cascade change in the health insurance market. This starts internally with a focus to empower our leaders and teams so that they can empower our client administrators who can empower their employees and so on. This means intentionally equipping our teams with new tools (developed by us, AI-based, etc.), training, and maybe most importantly decision rights in the coming years. This intentional "pushing down" is hard for managers and requires a lot of trust but is crucial for us to take steps forward internally so that we can push the market forward externally.
Joanne Mizell. Chief Operating Officer of Banner | Aetna (Phoenix): Banner|Aetna is making investments in population health and care management to support our members. We continue to grow our team to help support additional capacity in key areas like care advocacy for complex conditions and lifestyle modification programming. Based on our initial success serving members via these high-touch programs, we expect to see growth in this area over the next few years.
Jaja Okigwe. CEO of First Choice Health (Seattle): There is so much unpredictability in the world and in our industry right now that it is hard to predict the next 12 months, let alone the next two to three years. My sense is that our teams will roughly be the same but will continue to have to be more adaptable.The workforce will remain hybrid and that will force leaders to be better at creating connections and coaching. New technologies will change how we work and that will favor people who are curious and adaptable. And, finally, employees will expect organizations to weigh in on issues beyond basic business, forcing companies to take stands on social issues.
Ted Regalia. Vice President of Pharmacy Benefits at Network Health (Menasha, Wis.): When considering staff changes over the next two to three years, three changes come to mind. First, healthcare regulations continue to increase and evolve. Compliance with these changes is becoming more challenging. We have added compliance and regulation monitoring staff and we will likely add more staff to audit, monitor and assist with compliance. Second, the medication therapy management program qualification changes will likely generate a significant increase in the number of members qualifying for this program. We have had great success with our in-house clinical pharmacists performing most of the comprehensive medication reviews, and it differentiates us from other health plans. The clinical interventions performed by these pharmacists also generate savings for both the member and the health plan. We are considering adding more clinical pharmacists to our staff to continue this good work. Finally, I must mention technology and AI. We have been working with automation, however, it has been a slow start. Most of our efforts involve the automation of reporting and improving efficiency of our auditing. The goal has been to free up our staff to do bigger and better, as well as improve job satisfaction and employee retention. We will continue to get better and AI will continue to augment our efficiency.
Krystal Revai Sodaitis, MD. Associate Chief Medical Officer of Health Alliance Medical Plans (Champaign, Ill.): In the coming years, I anticipate that teams in the medical field will need to broaden their scope to effectively navigate the increasingly detailed landscape of medicine. As medical knowledge continues to expand and specialize, it becomes impractical for teams to possess clinical expertise in every area. Interdisciplinary collaboration and an innovative approach to problem-solving will become essential.
Pankhuri Sharma. Strategy and Operations Leader at Humana (Louisville, Ky.): Looking ahead over the next two to three years, I foresee changes within our teams driven by the ongoing evolution of AI and technology. With the continued advancement and regulation of predictive analytics, coupled with seamless data sharing, we can anticipate increased analytical decision-making capabilities. Moreover, the increasingly specialized solutions can help us further streamline administrative tasks, enhancing overall team efficiency.
Additionally, I expect to witness a heightened level of interconnectedness among teams throughout the organization, to facilitate the sharing of vision, strategies and insights, ultimately driving us toward improved health outcomes and reduced cost of care. Lastly, considering the increasingly remote or hybrid nature of work, I anticipate a greater emphasis on talent identification and mentoring, along with more opportunities for connection beyond work and optimal communication tools to ensure everyone remains informed and engaged.
Barry Streit, Senior Vice President of Growth at Essence Healthcare (Maryland Heights, Mo.): Teams at Essence Healthcare will continue to evolve over the next two to three years, driven by a new generation of Medicare consumers, particularly the late-stage boomers entering the Medicare space. Our workforce will be shaped by the high-growth mentality, deep commitment to our members, and desire to embrace new technology that define our culture. Generative technology will enable rapid innovation, giving our teams both the opportunity and responsibility to challenge past practices and exceed the high expectations of our five-star plan. As we support a new generation of Medicare consumers, we will partner with technology in new ways, questioning existing practices and generating innovative ideas. Team members who actively seek opportunities to learn, adapt to technological advancements, and explore emerging trends in the industry will thrive. By fostering an environment that encourages curiosity, flexibility, and the willingness to ask questions and propose innovative ideas, we'll nurture and grow an agile workforce that will remain at the forefront of delivering exceptional care and meeting the ever-changing demands of our Medicare consumers.
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): Our company is incredibly innovative and forward-thinking. Our teams are already having great conversations about how to do the work differently with new technologies, automation and capabilities, as well as the smart, responsible, thoughtful, potential use of AI where it is appropriate and makes sense. For example only, AI and automation could potentially be helpful in "reading" physician contracts and identifying clauses. Rather than having a human manually look for the clause, perhaps AI and automation can help us to find the clause more quickly, and then we can validate the clause with human eyes. This is just one possibility, but I see our teams becoming able to do work more efficiently across the organization over the next two to three years, which helps everyone: our employees, our members, our employer groups, our government programs, and all of our stakeholders in the healthcare ecosystem. It's an exciting time to innovate. There are so many possibilities to get better at what we do for our members.
Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): I anticipate that our teams will transform quite a bit in the next two to three years. We will need fewer persons to perform utilization management and more team members focused on health equity and social determinants of health. The proportion of team members addressing medical care needs will fall, balanced by a rise in persons addressing behavioral health concerns. New tools that incorporate artificial intelligence capability will allow us to refocus from large volume, manual review work to small volume, detailed reviews that address the subtlety of complex care issues.
Troy Williams. Vice President of Hospital Partnerships at First Choice Health Network (Seattle): We've been growing outside of our current geography for the last five years. That means our workforce is becoming more distributed. It also means we are expanding our services into new parts of the country. As we become a blended workforce and more remote, we will examine automation toolsets and processes to accommodate changing needs. We'll have more tech interface, data transfer and analytics and also explore how AI can improve repetitive but appropriate tasks.