The last morning of RISE West opened with the question nobody enjoys answering out loud. What are you willing to give up?
Ana Handshuh, principal at CAT5 Strategies, moderated the leadership panel on Sept. 4 in San Diego with Rachel Klein, executive director of Colorado Medicare at Kaiser Permanente, John Willis, Stars program manager at Blue Cross and Blue Shield of Minnesota, and Ally Thomas, Ph.D., vice president of quality improvement at UPMC Health Plan. Margin compression was the assignment, and the panel treated it as an operating reality rather than a forecast.
Quality has to be in the room before the package is set
Thomas described the rule underneath UPMC’s approach. Quality is a required attendee from the first benefit design meeting. Leave the team out until the package is set and the organization inflicts its own member experience problem.
The seat pays for itself in the supplemental benefit debate. The panel described bringing clinical evidence to the actuarial conversation rather than preference, with the falls data behind vision coverage as the clearest case. One in four adults over 65 falls each year. Klein offered the integrated version, walking through the acute care at home benefit Kaiser Permanente Colorado added at the request of its care delivery side.
Benefit cuts also arrive on a delay. Changes take roughly two years to surface in CAHPS results, so plans cutting this fall read about it well after the decision. Size offers no protection either. The panel described benefits used by a handful of members producing organized protest far beyond their utilization.
Cut points still resist the model
Analytics alone will not land the number. The method starts with predictive cut points, then applies a business adjustment for what the industry is doing on the ground. For executives, the panel favors scenarios over precision. Show the range, including the ugly one, and give teams cut points driving action rather than a guess at the landing spot.
Thomas named one governance change worth stealing. Star risk reporting goes to executives monthly with a separate section for business trade-offs, so the C-suite sees the decision and the revenue consequence together.
RISE put its own survey results on the screen
The reveal of the exclusive AI benchmarking survey results followed. RaeAnn Grossman, CEO at HLTHWorks, opened with benchmarking data from industry leaders collected ahead of the conference, then handed it to Jonathan Burow, vice president of customer experience and digital transformation at Independent Health, Krischa Winright, chief executive officer at peregrine3, and Vandna Bhrany, principal at 8BAdvisors.
Forty-four percent of organizations report scaling AI across functions or running it enterprise-wide. Roughly half as many have a documented AI strategy tied to Medicare Advantage performance. Asked which measures have improved because of AI, the most common answer was none yet.
The barriers were not technical
Expertise, missing strategy, and early-stage governance topped the list. Organizations keep deploying tools without setting a baseline, which leaves nobody able to say whether the tool worked. The panel tied the shortfall to sequencing. Establish the repeatable pattern, automate it, then put an agent inside it.
“The best benefit of being able to put a workflow in an AI environment is it shows the agent what staying on rails looks like,” Winright said.
Her adoption story carried the session. A manual chart abstraction team met AI training with open fear about their jobs. A few months in, the same team would not give the tool back. “People don’t change until the pain of staying the same is worse than the pain of change.”
Nobody made it sound easy. Financial pressure is producing workforce reductions before automation is in place, which raises stress rather than lowering it. Burow brought the member-facing side, including a triage agent replacing the phone menu misroutes, and the panel closed on the data question. Winright warned against using AI to build a taller wall around your hospital or your health plan, since the patient journey crosses payer, provider, and vendor boundaries whether the organizations cooperate or not.