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Our connected health services make the treatment, prediction, and prevention of health care's most complex conditions easier and more accessible as we drive organizations and people forward. This is Haley Recker with the Becker's Payer Podcast. And today, we're recording live at the Becker's third annual spring payer issues roundtable. I am thrilled today to be joined by Brad Riley, vice president of analytics and reporting at Longevity Health. Brad, thank you so much
for joining me today. Hey. Happy to be here. So before we get started, can I just have you go ahead and introduce yourself and a little bit about your background? Sure. Absolutely. So, appreciate the opportunity to be here. I think this is the second time doing it. So, happy happy to be here and to take part. So, like Haley said, I'm Brad Riley. I'm the VP of analytics and reporting at
Longevity Health Plan. Longevity is the fastest growing national I SNP plan, so we're a clinical services organization and an I SNP plan. We just crossed the 10,000 member threshold this year, so we're really excited about that. And we currently partner with, over 300 SNPs in roughly 13 different markets, and we're hoping to expand that a little this year. So excited to be here. Excited to talk about tech, AI, and and ways that, you know, I'm from my perspective, I'm getting to see that impact
the industry and and longevity health. Well, that's awesome. Thank you so much for sharing. Now to begin our conversation today, I wanna talk about balancing affordability and quality. So how is your organization innovating to manage cost of care while maintaining or improving member outcomes? That's a good question. I mean, especially with the rates the way the way they are now and everything else. You know, '25 is a tough year. '26 is ramping up to
be look a little better. But, with the Medicaid stuff coming in, you know, nobody's ever quite sure how that's gonna look. It's it's you know, changes month by month. So I think a couple things. One, obviously, at the forefront of everything else right now is is both quality based care agreements and quality based payment agreements. I I think that's absolutely where the industry is going. That's how longevity is structured, and how we, you know,
partner with with our partners. I think the other piece, obviously, is leveraging technology, specifically, the buzzwords AI, especially, you know, this past at at Becker's, but, you know, everywhere else too. And I think understanding how to how to do that is important. You know? With with Longevity Health, we treat our members in the facilities, and so we we only partner well, our members are only in skilled
nursing facilities. And so we have nurse practitioners and registered nurses and LPNs, that dependent upon the market will go in and and they they have a specific facility with a specific panel. And, you know, we found that, that really impacts avoidable admissions, readmissions. It lifts the residents' experience so they're not constantly going back and forth. And so from a model perspective, that absolutely avoids inpatient costs.
But at the same time, from an administrative perspective, corporate perspective, understanding how we could leverage different technology tools like AI, to do things. I think it's definitely a little early still on the clinical end of
using AI. There's a lot of proof of concepts out there that are really cool, but having the ability to kind of leverage different tools, whether it's, machine learning tools to better stratify your population or to augment or identify fraud waste and abuse, anything like that that we could use to kind of optimize the existing workflows that aren't, particularly clinical in nature, I think, is is
a low hanging fruit. And then I think also just administrative tasking, equipping employees with the proper tools that are available in today's market, to help them be more efficient. And and, frankly, you know, everyone's tired of hearing this, but do more with less. I I think, give them a really cool tool. Let them let them use these tools to help them optimize their work. You still have a person involved there, so we're not talking pure Agentics
at this point. Right? But, you have human level oversight with a tool that can help them, improve their day to day tasking and keep them more efficient. Absolutely. Well, I'd like to keep that conversation going about that quality of care. Mhmm. So what best practices or tools does your organization rely on to keep quality of care at the forefront? So, I mean, a couple things. I think one, quality of care is
there's different couple different angles. Right? You've got, like, the HEDIS angle, but you also have the the actual quality of the care. I already touched on, the quality based agreements. I think that's vital. Right? Moving away from fee for service and and incentivizing people purely based off of the quality of of care that they're delivering to patients, I think, is is key. That's with PCP groups. That's with with skilled nursing facility. You know, every everything across
the board. I think, at the same time, understanding broader provider behavior is important. Right? So when we look at and we leverage machine learning or predictive analytics to, create these more network driven oversight tools that allow you to see, you know, of your inpatient stays, which inpatient stay is really you know, what's the readmission rate based off of different inpatient providers? What what type of costs are we seeing coming from them? Is the is it qualitative
in nature? And I and I think there's a lot of opportunity there in, optimizing network, understanding and this is across the industry, right, not just at longevity health, but understanding what providers are delivering quality care versus just delivering care. And I think when you optimize your network to focus specifically on the quality care, I think that's a big big next step because you can only control what you can control.
And if you're not being proactive in that space and identifying your network and, trying to encourage proactivity amongst the providers that are that are delivering that that high quality. Whatever KPI is gonna reflect that, I think that's probably that's key. Absolutely. We've talked about the imperative to reduce costs, improve quality, and advance health equity, none of which are small tasks. How do you approach aligning these priorities in your organization's strategic vision?
So I think the theme of the day is gonna be, you know, technology and tools. And I think the biggest thing, one, is allowing the use of technology. I think over the last three years, right, generative AI has blown up, but artificial intelligence is the big buzzword, but it's really existed since the nineteen fifties. So you have machine learning, predictive analytics, different
types of things like that. And I think making sure that we are implementing efficiencies and, by leveraging technology, but at the same time, not reducing the quality and governance of the oversight we have to make sure that we're remaining compliant and to make sure that we're doing it the right way within, you know, CMS standards and whatever other types of standard standards that we operate within. I think that's key. Right?
So, driving forward with technology while ensuring that there's governance and oversight, and I think that that also includes ethical oversight as well. I think some of these really cool models that are coming out with are being shown and found to have, some maybe nonethical steps and and and bias that inherently, was inadvertently added to the model because of of human data that that was ingested and and used
to train it. Right? And I think so taking those resources that we're getting from creating efficiencies and implementing these type of tools and taking a portion of those to be more efficient and and create cost savings, but also leveraging some of those savings, not just pocketing it all and investing a little bit more in the governance and the oversight into the types of tools that you're using is probably a a more robust and long term strategy to make sure that
that through leveraging these new tools, we don't introduce new risk. Well, before we wrap up here, is there anything else that you'd like to share with our listeners today that we haven't already discussed? Yeah. I think my big thing and what I would encourage everybody listening and, especially leaders of teams and executives is if your staff don't become literate with the new tools that are available to them, they're going to get behind and you'll get
behind. And, I think that that means it's important for us to find ways, risk free, while keeping risk and and governance in mind of getting our staff, familiar and used to and exposed to tools, not just in their personal lives. Right? Like, I think everyone's like, oh, I've got Chad GPT on my phone or I've got this. And, you know, when I when I press Google, Gemini pops up at the top. But at the end of the day, if if people aren't thinking of how to use these tools in a professional manner,
they're gonna miss out. Right? We've got a lot of really smart people, and something I believe, in is, you know, I wanna hire people smarter than me. Right? That's that's how you do do well. And and so empowering that staff to do that, is something that I think is is an opportunity. There's a lot of people that are engaged and excited to do it themselves, but at the same time, there's people that might need a little bit of
a push. And so one of the things I actually did for this, I realized on on my team is that I had a lot of really good technical skills, but my staff had an opportunity to learn a little bit more. I like to say how the machine works, but, like, the managed care like, what is managed care? What's a claim? How does a claim process? How does an authorization process? And so I actually created a a customized large language model. And it's just trained. It's
a chatbot. Right? But it's trained on stuff. You can actually it's it's open source, so anybody can can go and look at it and use it. You can go to app.managedcare101.ai. But ask it anything about managed care. Right? Get people used to navigating large language models, NLP, and encourage your staff and empower your staff to operate at the top of of what they're capable of doing.
And I think that's gonna take us a long way over the next few years as continue to see technology, you know, go down the path it's going. Absolutely. Well, thank you so much for joining me today. Again, this is Haley Rutger with the Becker's Payer podcast recording live at the Becker's third annual spring Payer issues roundtable. Brad, thank you so much. Thank you.