Latest / Becker’s Payer Issues Podcast / How Accurate Provider Data Drives Better Care Access and AI Innovation

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How Accurate Provider Data Drives Better Care Access and AI Innovation · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:03
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you. Excited for a conversation on the
• 0:08
  foundational role of accurate provider data in modern
• 0:13
  healthcare.
• 0:14
  Care. And I'm very excited to be joined
• 0:16
  by Joey Soliske, director of digital health operations,
• 0:19
  Alghedi Health Network, and Preeti Subramani,
• 0:22
  vice president product management at Highmark Health for
• 0:25
  our conversation today. Joanne Preeti, thank you so
• 0:28
  much for being here today. It's great to
• 0:30
  have you.
• 0:31
  Yes. Thanks so much for having us.
• 0:33
  Yeah. Absolutely.
• 0:34
  I wanna kick us right off. We have
• 0:36
  a lot to talk about. There's a lot
• 0:37
  of elements to this conversation.
• 0:39
  I wanna talk about with something very start
• 0:41
  with something very important.
• 0:44
  What is the single most important area where
• 0:46
  Accurid provided data
• 0:48
  makes a difference
• 0:50
  within your organization?
• 0:52
  Joey, why don't we start with you? Sure.
• 0:54
  Yeah. So, just quick background on Allegheny Health
• 0:56
  Networks. We're a 14 hospital system in Western
• 0:58
  PA,
• 0:59
  with over 3,000 physicians and clinicians, and we
• 1:01
  have a great partner in Highmark Health. So
• 1:03
  I know Preeti will talk about that collaboration
• 1:05
  we have from a a payer and provider
• 1:07
  perspective across the network.
• 1:09
  But for us in the in the health
• 1:10
  system lens, you know, I think the single
• 1:12
  most important area where it matters
• 1:14
  is in relation to the clinician
• 1:17
  information being consistent.
• 1:19
  And what I mean by that is it's
• 1:21
  consistent across the various channels for how our
• 1:23
  patients
• 1:24
  could access our system. So whether that be
• 1:26
  through Google, whether that be through our website
• 1:28
  and find care, that same information about our
• 1:31
  clinician or location should be the same. Mhmm.
• 1:33
  And if we have if it's the same,
• 1:35
  then it builds that trust, and consistency so
• 1:37
  they keep wanting to come back.
• 1:40
  Yeah. Pratib?
• 1:41
  I think
• 1:42
  Joey hit on a key point here, which
• 1:44
  is trust in the information that we're providing.
• 1:47
  And the single most important area from, our
• 1:50
  Highmark Health insurance
• 1:52
  perspective is that member experience and their ability
• 1:55
  to find
• 1:56
  compatible care options.
• 1:58
  And one of the first things that people
• 1:59
  do when they get their insurance
• 2:01
  is look for which doctor is in network,
• 2:04
  and they want to understand exactly what network
• 2:07
  they're in, how much things are gonna cost
• 2:09
  when they go to that doctor, how to
• 2:10
  schedule an appointment with that doctor. So there
• 2:13
  are a lot of information that we need
• 2:14
  to kinda collect and bring together,
• 2:17
  for those individuals so they can understand how
• 2:19
  to go get the health care that they
• 2:20
  need and use the health insurance plan that
• 2:22
  they've just purchased.
• 2:24
  Yeah. And I think what's very interesting about
• 2:26
  this conversation, and and you both touched on
• 2:27
  it a little bit, it's sort of this
• 2:29
  this ecosystem approach. Right? There's so many connecting
• 2:31
  pieces to this, so many dots that need
• 2:34
  to be connected for this to be able
• 2:35
  to be successful,
• 2:37
  and and to be a successful approach, which
• 2:40
  is really important. And I wanna talk a
• 2:41
  little bit about some of the disconnects that
• 2:43
  you're observing in this, process in itself
• 2:47
  or then in turn also the opportunities that
• 2:49
  it
• 3:02
  Sure. Yeah. So Sure. Yeah. So for for
• 3:04
  us,
• 3:05
  it's also, you know, providers and the locations
• 3:07
  data. Again, because I think something we
• 3:09
  find is that there is inconsistency
• 3:12
  even in, like, you know, some of our
• 3:13
  branding name in downstream systems or, again, I'll
• 3:15
  use the Google example displaying this. The patient
• 3:18
  may go to their MyChart patient portal and
• 3:20
  see there have an upcoming appointment at a
• 3:22
  different facility name than what they saw on
• 3:24
  our website and Google. So if we get
• 3:25
  all that connected
• 3:27
  across a different, pillars within an enterprise,
• 3:30
  it makes that be consistent and feel easy
• 3:32
  for our patient and members again. And so
• 3:34
  for us, that is, really making sure
• 3:37
  that
• 3:38
  facilities,
• 3:40
  departments like our credentialing department, you know, for
• 3:42
  medical staff services
• 3:44
  is sending their information for to us. Also
• 3:47
  that our real estate department, they'll have the
• 3:49
  updated facility info is sent into this, like
• 3:51
  a platform,
• 3:52
  that you have the reviews about your clinicians
• 3:54
  coming in. And so when you connect all
• 3:56
  those different areas together into one, it allows
• 3:58
  for you to have that, I'll call it,
• 4:00
  cohesive experience downstream then, by doing that.
• 4:04
  And I think that the biggest opportunity, which
• 4:05
  I know Preeti will talk about, is for
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  us being a pay biter or a payer
• 4:09
  and a provider health system here is we
• 4:10
  can really connect and have
• 4:12
  that clinician information be as up to date
• 4:14
  as possible for our members as well, which
• 4:16
  we're really excited about.
• 4:18
  Yeah. Priti, talk a little bit about that.
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  How important is that piece?
• 4:22
  I think
• 4:23
  Joey hit on it, you know, pretty well.
• 4:25
  We know that providers are struggling with managing
• 4:28
  their own data and the accuracy they have
• 4:31
  with that data. Mhmm. And then from a
• 4:33
  health insurance perspective,
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  we have
• 4:35
  a multitude of providers that are in that
• 4:38
  same boat, and we are receiving a lot
• 4:39
  of inaccurate data from all of those providers.
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  And then trying to determine
• 4:45
  what,
• 4:46
  data is accurate, what's inaccurate, and how do
• 4:48
  we showcase this to,
• 4:51
  our members in the right way. And so
• 4:53
  that that's one of the biggest disconnects upfront
• 4:55
  in the journey
• 4:57
  as we think about this. And we're starting
• 4:58
  to deploy different capabilities in that space
• 5:01
  to validate and ensure that data accuracy is
• 5:04
  there. Then the other disconnect comes more downstream
• 5:08
  in the customer journey when they're actually looking
• 5:10
  for care and then trying to schedule an
• 5:13
  appointment with that clinician or provider office
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  when they don't have enough information on how
• 5:19
  to actually go get an appointment.
• 5:21
  So they might get only, that far in
• 5:23
  the journey, and then they can't figure out
• 5:24
  how to schedule an appointment. Sometimes they just
• 5:26
  give up
• 5:27
  or if they get frustrated through that process.
• 5:30
  And so those are both upstream and downstream.
• 5:32
  We're trying to figure out how do we
• 5:34
  solve that for people that
• 5:36
  we give them the right information and we
• 5:37
  tell them how to finish that full customer
• 5:40
  journey so they can actually go get the
• 5:41
  health care with that clinician that they need.
• 5:44
  Yeah. Actually, managing that relationship is so key,
• 5:47
  and that happens through that collaboration and and
• 5:49
  identifying those opportunities for improvement, which I think
• 5:52
  is is so important.
• 5:53
  Joey, let's talk about some of the the
• 5:55
  strategy
• 5:56
  pieces to this and how you're achieving this.
• 5:59
  Right? Can you share, an example of something
• 6:02
  that's worked in terms of a strategy that
• 6:04
  you've implemented,
• 6:06
  that's really improved this process? And and what
• 6:08
  are some of the things that you've learned
• 6:09
  throughout this?
• 6:11
  Yeah. I think there's a couple different things
• 6:13
  that, you know, from a process perspective,
• 6:16
  that we need to think about. Because, you
• 6:17
  know, if you have a technology or the
• 6:19
  connection points in place, that's great. But if
• 6:20
  you don't have the upstream
• 6:22
  data or information or the right operational leaders
• 6:24
  that know where and how they request a
• 6:26
  change and what needs to happen, then it's
• 6:28
  not gonna be accurate downstream. So you need
• 6:30
  to fix as well at the very start,
• 6:32
  core process item. And for us, one of
• 6:35
  the big buckets is, you know, annual review
• 6:38
  of the information with operations. So how do
• 6:40
  you do, you know, like, a yearly help
• 6:41
  check up, you know, on your information for
• 6:43
  your data with your clinicians, with your operators,
• 6:45
  for locations? And is that phone number still
• 6:48
  accurate, you know, for that primary care clinic
• 6:50
  in Pittsburgh?
• 6:51
  Is that clinician specialty still up to date?
• 6:54
  Then do they, you know, do they get
• 6:56
  additional information they want in their biography now
• 6:58
  to display on Google in MyChart again in
• 7:00
  member portal for our Highmark members? So the
• 7:03
  annual review and expectation setting, having a team
• 7:05
  who does that is important. The second point
• 7:07
  then is how do you make sure to
• 7:09
  make a request for a change in one
• 7:11
  location? So as a clinician, you know, if
• 7:13
  something doesn't look right, downstream, you know exactly
• 7:16
  where we need to go to to make
• 7:17
  a request for a change and that there's
• 7:19
  service level arrangements on that change being, you
• 7:22
  know, done by the next day by appropriate
• 7:23
  teams in your enterprise. So, those are a
• 7:25
  couple of the process related items we're really
• 7:28
  trying to think through to make sure the
• 7:29
  data can be clean.
• 7:31
  Yeah. Absolutely. Pretty same for you. What what
• 7:32
  have you observed? What what's working for you?
• 7:36
  So we we're doing a couple of different
• 7:38
  things, and I talked about one of them.
• 7:40
  So we're really taking all of the information
• 7:42
  that we're getting from providers and using a
• 7:44
  third party company,
• 7:46
  that looks externally at different, sources of information
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  when using AI and ML
• 7:52
  to really validate all the information we're getting.
• 7:54
  So they look at credentialing systems and other,
• 7:57
  CMS and other, areas to say, hey. This
• 8:00
  information is accurate or not accurate, making sure
• 8:02
  that flow is going,
• 8:04
  through. We also took a look at our
• 8:06
  provider directory and how it was structured on
• 8:08
  the back end over the last couple of
• 8:10
  years and
• 8:12
  have completely untangled or unraveled it and then
• 8:16
  reorganized
• 8:16
  it into a cloud infrastructure,
• 8:19
  which actually just went live today.
• 8:22
  So we're super excited about that. And what
• 8:24
  that helps us do is, one, it drives
• 8:27
  better quality of how all of those all
• 8:29
  of that provider data is connected to our
• 8:31
  plan and network data, but it also drives
• 8:34
  accessibility
• 8:35
  of that information across a lot of different
• 8:37
  channels.
• 8:38
  So customers can engage with it through a
• 8:41
  chat,
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  through an agent, through a voice channel, or
• 8:44
  through the search tool that we have today.
• 8:47
  Yeah. It's it's constantly advancing, it sounds like.
• 8:49
  It's you're evaluating
• 8:50
  constantly, which is which is awesome.
• 8:53
  Yes. Exactly. That's right.
• 8:55
  Yeah.
• 8:56
  You both talked about the importance of sort
• 8:59
  of this accuracy piece. Right, Joey? You talked
• 9:01
  about the fact that, hey. We need to
• 9:03
  know if that provider's address in Pittsburgh is
• 9:05
  still correct. That needs to line up. So
• 9:06
  that's a simple
• 9:08
  that's the simple accuracy piece. Obviously, that's what
• 9:11
  provided data does in itself.
• 9:13
  Can you talk a little bit about why
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  it's also so important
• 9:17
  to leverage when it comes to sort of
• 9:19
  the more overarching
• 9:21
  theme of improving
• 9:23
  care coordination
• 9:24
  and then in turn really improving
• 9:27
  the patient and member experiences.
• 9:29
  We talk about trust, etcetera. Why is it
• 9:32
  so important from an overarching perspective
• 9:35
  as well, not just the accuracy piece that
• 9:37
  we already touched on?
• 9:39
  Yeah. Sure. I mean, I think for, like,
• 9:41
  Preeti sort of talked about it earlier too,
• 9:43
  but, a big strategy of ours as an
• 9:45
  organization is called the living health strategy and
• 9:48
  something we're working towards in the payer and
• 9:51
  the provider systems. And, ultimately, a big part
• 9:53
  of that is how do we
• 9:54
  reduce, you know, stress or frustration or fragmented
• 9:57
  approaches for our members and patients and make
• 9:59
  it feel seamless. And I think this is
• 10:01
  a huge part to it. You know, when
• 10:02
  we can have this
• 10:04
  accurate info that's integrated seamlessly
• 10:07
  into the member portal that Preeti talked about
• 10:09
  to
• 10:10
  know what's up to date and they can
• 10:12
  make their appointment more easier, that that really
• 10:14
  reduce that fragmentation. And it strategically helps
• 10:18
  our patients trust us and then continue to
• 10:20
  want to come back and, and to come
• 10:21
  to our facilities.
• 10:23
  I think the other thing we're really thinking
• 10:24
  about is, you know, once this
• 10:26
  info now if you have all this
• 10:29
  centralized about your locations and your clinicians, how
• 10:31
  do we
• 10:32
  redesign the way that a patient could come
• 10:34
  to our facility? Not traditionally, I was find
• 10:36
  a doctor. Now let's say,
• 10:38
  make it find care truly. You know, you
• 10:40
  should you now have all your locations info
• 10:43
  and your provider info. You know, a patient
• 10:45
  or member could search for my right knee
• 10:47
  pain hurts.
• 10:48
  What do I need to do? And we
• 10:49
  should know that that means, you know, orthopedic.
• 10:51
  You live here as your ZIP code, here's
• 10:53
  the nearest facility with an open appointment. It
• 10:54
  allows for us to get to that true
• 10:56
  fine care experience faster. So that's something, you
• 10:59
  know, in the future, we're really excited about
• 11:01
  designing and building. We have all this, you
• 11:03
  know, data accuracy upfront, in there.
• 11:06
  Yeah. Priti, you you touched on the the
• 11:08
  strategic lever that this can be, right, and
• 11:10
  sort of the the initiatives too that that
• 11:12
  you're working on to improve this. What does
• 11:14
  this look like for you, and and how
• 11:16
  is it streamlining that care coordination piece too?
• 11:19
  Yeah. And I think, you know, we've been
• 11:22
  using the word trust a lot, and we
• 11:23
  know that all of the provider data being
• 11:26
  accurate,
• 11:27
  that's bad data is just gonna erode people's
• 11:29
  trust. And when there's good data, it builds
• 11:31
  that trust. So that's obviously core to everything
• 11:33
  we're doing. And then on top of that,
• 11:36
  we're layering in additional information to make sure
• 11:39
  that when in the moment that they're actually
• 11:41
  looking for a provider,
• 11:43
  how do we give them information that they
• 11:45
  need to complete that task or journey? So
• 11:48
  how do we provide information about appointment availability?
• 11:51
  How do we make that more personalized
• 11:53
  with care gap information as well and make
• 11:56
  sure that they get the right information in
• 11:59
  those moments?
• 12:00
  We could suggest preventative screenings.
• 12:02
  We can also provide information
• 12:05
  if they don't have a, let's say, physical
• 12:07
  therapist within a 30 mile radius, how do
• 12:09
  we connect them to our virtual physical therapy
• 12:11
  services
• 12:13
  and make sure that they get access to
• 12:14
  the care that they need regardless of where
• 12:17
  they're located or their ability to kind of
• 12:19
  physically go into a location?
• 12:21
  And then the other piece of that is
• 12:22
  also to make sure that we're connecting them
• 12:25
  with information that they want to know about
• 12:26
  these clinicians.
• 12:27
  In some cases, they wanna have more personal
• 12:30
  connections if it's a primary care doctor. And
• 12:32
  we learned this a lot through our research
• 12:34
  that people are interested in understanding, you know,
• 12:37
  they speak their language, can they relate to
• 12:39
  this person? Do they offer virtual care options?
• 12:42
  And so we wanna make sure we provide
• 12:44
  that enhanced
• 12:45
  provider information beyond just location,
• 12:49
  and how to contact them so that they
• 12:51
  can make that decision in that moment and
• 12:52
  don't have to do additional research on third
• 12:55
  party sites to,
• 12:57
  get the full picture that they need to
• 12:59
  make a decision and move forward with their
• 13:00
  health care. That extra Googling takes a lot
• 13:03
  of time. So I agree that this does
• 13:05
  really improve the patient experience.
• 13:08
  Exactly. And I'll say they've we've in our
• 13:10
  research, we saw they were using Google, Yelp,
• 13:12
  Nextdoor,
• 13:13
  everything they could to kind of find that
• 13:15
  information.
• 13:16
  Yeah. Absolutely. I wanna close this out with
• 13:19
  sort of a a little bit of a
• 13:20
  forward looking view on this. Right? So we've
• 13:23
  touched on what you all are doing, how
• 13:25
  it's working, and sort of the initiatives that
• 13:27
  you're you're trying to move forward in the
• 13:29
  next couple of years or even immediately right
• 13:32
  now.
• 13:33
  When we are doing this correctly
• 13:35
  and everything that we've mentioned so far,
• 13:38
  how does that accurate provided data then also
• 13:41
  set sort of the foundation
• 13:43
  for
• 13:44
  AI initiatives and other initiatives in your organization,
• 13:48
  and what should we consider as the prerequisites
• 13:51
  for success there? Joey, we'll start with you.
• 13:54
  Sure. Yeah. Thanks. I talked about it briefly,
• 13:56
  I think, on the last topic there. But,
• 13:57
  ultimately,
• 13:59
  if you have the information about a provider
• 14:01
  and the location and all this data about
• 14:04
  them, you can feed that information into,
• 14:07
  in the future, your AI agents for call
• 14:09
  center, your chatbot experience, and website or member
• 14:12
  portals. And a patient or a member could
• 14:14
  ask any question or they could say, if
• 14:16
  I may, doctor Joey, where he practices, and
• 14:19
  if we have all that feeding it, they
• 14:20
  can respond quickly and then also surface when
• 14:23
  that appointment's available with them. And so if
• 14:25
  you have a infrastructure or base of all
• 14:27
  that connected from the various parts of the
• 14:29
  enterprise,
• 14:30
  with the phone numbers, fax numbers of a
• 14:32
  facility,
• 14:33
  again, that clinician specialty where they work and
• 14:35
  their schedule availability, you can then truly
• 14:38
  enhance the next layer of engagement for our
• 14:40
  patients and members wherever that may be in
• 14:42
  the future. So you need that base layer,
• 14:45
  though, to enable that experience. I mean, I
• 14:48
  know Preeti is leading a great initiative across
• 14:50
  our enterprise, or our call center that can
• 14:53
  also help feed into that. Yeah. Brutee, feel
• 14:55
  free to elaborate on that. Yeah. And I
• 14:57
  think, you know, what Joe is referring to
• 14:59
  is we're really trying to shift the model
• 15:01
  in our contact centers from assistant service to
• 15:04
  self-service.
• 15:05
  We know that's much more efficient for members,
• 15:07
  and then they can use a twenty four
• 15:09
  seven support model. So if they're laying in
• 15:11
  bed at 11:00 at night and need to
• 15:13
  find a doctor, they don't need our contact
• 15:15
  center to be open if we establish the
• 15:17
  right self-service capabilities.
• 15:19
  And the other place we're trying to start
• 15:21
  thinking about the AI
• 15:23
  utilization outside of just the conversational AI and,
• 15:27
  you know, virtual,
• 15:29
  assistance
• 15:30
  is also personalization.
• 15:32
  So if somebody has a care gap, how
• 15:34
  do we connect them to the right clinician
• 15:37
  and look at, hey. You have five clinicians
• 15:39
  in your area. We see that you're not
• 15:41
  attributed to a PCP, and these five have
• 15:44
  appointments available within the next thirty to sixty
• 15:47
  days, whatever the acceptable threshold is for that
• 15:49
  service type,
• 15:51
  and make those recommendations
• 15:53
  proactively.
• 15:54
  If we have a provider or a clinician
• 15:56
  that leaves our network and they need to
• 15:58
  find a new doctor that's in network, how
• 16:00
  do we proactively
• 16:01
  engage them and let them know that instead
• 16:03
  of saying, hey. Your doctor is no longer
• 16:05
  in network. You need to go find another
• 16:06
  one. How do we actually just use AI
• 16:08
  to make a recommendation
• 16:10
  on some new doctors based on what we
• 16:12
  knew about their previous physician,
• 16:14
  and also, you know, where they live, what
• 16:17
  their preferences are for virtual versus in person,
• 16:21
  and then make recommendations based on that. So
• 16:23
  we really wanna start utilizing,
• 16:25
  AI to drive those intelligent provider recommendations,
• 16:29
  and also driving more self-service capabilities so our
• 16:32
  members can serve,
• 16:34
  through any channel they want and when they
• 16:36
  want.
• 16:37
  Yeah. And I love that at the end
• 16:39
  of the day, this always comes back to
• 16:41
  improving the patient and member experiences
• 16:43
  across the board, whether that be through, again,
• 16:45
  improving trust or just streamlining this whole process,
• 16:48
  which is a fantastic goal to have. Joy
• 16:51
  and Priti, thanks so much for your time
• 16:52
  and insights today. This was a fantastic conversation.
• 16:54
  Thanks for being here.
• 16:56
  Thanks so much for having us. Having us.
• 16:58
  It was great. Yeah. Absolutely. And we also
• 17:00
  want to thank our podcast sponsor, Kairos Health.
• 17:02
  You can tune in to more podcasts from
• 17:04
  Becker's Healthcare by visiting our podcast page at
• 17:06
  beckershospitalreview.com.