Allen Karp

Because now, by moving the value base, we're passing some of the financial risk to those providers, along with the tools necessary to manage that risk.

And therefore, we can eliminate some of those processes, which will lower costs and provide a much more efficient flow for the patients and for our members.

The other area would be on our side, being a payer, using the AI machine learning technology to be able to identify those pre-authorizations, for example, that are overturned a significant portion of the time.

So we could teach the machine how to look for those.

And then when a provider calls in for a pre-authorization,

they would be able to get that pre-authorization on an automated basis.

Now that allows our nurses to focus on those clinical conditions that are either in a gray area or not yet supported by the evidence and makes the whole process much more efficient.

Faster, less paperwork for physicians and hospitals.

Sure.

We have built relationships with our hospital systems and providers in New Jersey.

We have about 4,500 primary care physicians that are under a

value-based reimbursement system.

So we pay them for their ability to provide more affordable costs for our members and also hit certain quality screens.

It always starts with quality.

We then give them the data

and analytics capability by providing insights to our providers so that they can take action for those areas that are creating higher cost for those services that are provided in the market, like radiology, for example, where there may be too much testing.

Or another example would be where a patient can go to a freestanding outpatient center for care

and not only get a much more efficient and better experience, but also be able to reduce cost because of the cost structure and the processes that are in place in those outpatient centers.

It's a journey, and it's a marathon, not a sprint, because what we're asking the providers to do is think about how they manage their patients in a different way.

We have a significant number of primary care physicians under value-based,