Latest / Becker’s Payer Issues Podcast / From Siloed Systems to Seamless Platforms: Transforming Health Plans with Technology

Transcript

From Siloed Systems to Seamless Platforms: Transforming Health Plans with Technology · Becker’s Payer Issues Podcast

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  Hello, everyone. This is Jacob Emerson with the
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  Becker's Health Care podcast.
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  Thanks so much for tuning in today where
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  we're excited to talk about navigating market dynamics,
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  innovation, and the future of member care.
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  Joining me today for our discussion is Rob
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  Duffy, who is the chief technology officer at
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  HealthEdge.
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  Rob, thanks so much for taking the time
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  to be with me on the podcast today.
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  Hey. Thank you for the invite. I really
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  appreciate it. Thank you for listening to the
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  conversation.
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  Absolutely. Likewise. And before we dive into everything
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  we wanna talk with you about, can you
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  tell us a little bit more about yourself
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  and your career background?
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  Yeah. My name's as you've introduced already, my
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  name's Rob Duffy.
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  I come from a background,
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  at, large tech companies like Amazon
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  and, Uber and Expedia and Salesforce, you know,
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  really
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  developing large scale platforms and and creating
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  these incredible pieces of technology that can be
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  leveraged to unlock huge amounts of innovation and
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  and velocity
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  with the with their consumers. And,
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  I joined HealthEdge
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  nine months ago, ten months ago. And when
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  I joined HealthEdge, it was,
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  undergoing a little bit of a platform transformation.
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  And, I brought with me,
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  the the sort of non health care,
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  technical
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  expertise that you would find at these large
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  companies, and the the job has been really
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  transforming
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  and bringing the the products that we have
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  together and creating, creating this platform
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  of converge technology.
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  Absolutely. So it sounds like a unique career
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  journey that brought you to HealthEdge, Rob.
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  Let let's get started today by talking about,
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  as you know, interoperability
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  and integration
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  becoming increasingly crucial in health care operations today.
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  Yeah. In this environment, what do you think
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  is the role of platform based technology, and
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  what are some of the key advantages
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  for health plans in particular?
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  So if you think about a a, you
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  know, a health plan,
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  they have thousands, if not tens of thousands
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  of different integrations and and pieces of data
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  flying around and different data models and ways
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  that they get,
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  data from one place to another.
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  And what we're looking at now is some,
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  regulation
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  that, is saying, well, we should we should
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  try and talk in a standard format. We
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  should try and talk in a in a
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  single way. And when you have lots of
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  in integrations and you have lots of pieces
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  of technology,
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  what you essentially have is is a large
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  piece of technical debt that you have to
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  deal with when you have to try and
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  get all of those things to speak the
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  same standard.
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  And I think
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  many people in the industry
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  have seen in the last, you know, five
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  years, maybe even ten years,
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  that an approach of sort of stringing
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  lots of different point solutions together
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  means that anytime you wanna change something, you
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  have to change it in many different places.
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  And now that we're seeing this broad, generalized
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  drive towards a standard data format and a
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  standard data model, it means that this string
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  of pearls approach is becoming increasingly difficult and
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  complex complex to manage. So I I think
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  when I think about platforms, I think about
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  taking it away from a large number of
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  point solutions and point tools that you have
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  to constantly change to keep up with changing
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  regulations and and changing standards and changing formats
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  and really moving that across to, you know,
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  a platform level approach.
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  That means that companies like HealthEdge can do
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  that work once we can do it in
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  in the right places, and then you don't
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  have to worry about trying to keep up
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  with all of these
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  changes in standards and formats and regulations.
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  As a health plan, you can really lean
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  more on these platform based technologies or or
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  technology platforms to do that work once.
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  Let me follow-up with you there, Rob. How
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  would you say that regulations
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  are driving the push for a more connected
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  health care ecosystem?
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  I mean, we obviously have, you know,
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  this buyer standard is coming on, coming on.
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  We have the, you know, the the auth
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  requirements,
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  and and those are really driving this
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  consolidation
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  around a a data model
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  and a way of communicating
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  across different health health care applications.
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  And it it's become not optional. You know?
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  It's become a thing that the the regulation
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  is driving.
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  People have to keep up with that regulation
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  and have to be compliant with it. And
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  what that means is that, you you know,
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  the CIOs and CTOs that I speak to
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  are really looking at a a large project
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  ahead of them to get all of their
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  different systems and tools compliant. And and that
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  means
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  that the the work to do that is
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  can sometimes feel overwhelming.
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  And what we're seeing is people are looking
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  for more converged solutions that talk to each
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  other, that work together, and can handle
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  the the changing regulatory environment,
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  because I don't think anyone thinks, you know,
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  this is gonna be a short journey,
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  towards interoperability,
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  but, they're looking for these converged technology platforms
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  that can handle that for them and and
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  allow them to keep up with the pace
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  of change without having to make constant investments
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  in in the technology.
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  And then they can focus their energy more
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  on helping their business users and helping their
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  their their internal customers and their external customers
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  with with more innovative products.
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  Absolutely. And I think the the natural question
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  to that, Rob, is what are some of
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  the biggest challenges you're seeing payer organizations face
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  when transitioning from that siloed technology to a
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  fully integrated platform? And and, ultimately, how can
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  they navigate that effectively?
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  Yeah. I think when you look at any
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  large,
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  ecosystem of tools that has been built up
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  over time,
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  anytime you you pick a tool and you
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  implement something and you model a business process,
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  you make some trade offs, you make some
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  assumptions,
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  and you have to, you know, change the
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  way you work because of something that that
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  tool does or doesn't do,
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  in a way that you'd like it to
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  do. And when you deal with that and
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  you have a we have a large ecosystem
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  of maybe twenty, twenty five, 30, 40 tools,
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  that's, you know,
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  a huge number of places where you have
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  made assumptions and made changes to your business
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  model, and you've made changes to your, internal
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  process and maybe even the staff mix. So
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  the the organization
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  becomes a reflection of the technology that that
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  you have in place.
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  And that is a,
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  hard thing to change because if you want
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  to swap out tools,
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  you can't just swap the tool out, replace
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  it with a new one because that new
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  tool will have,
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  you know, assumptions and things that it does
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  well and things does doesn't do. So you
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  really have to think about this as a
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  a transformation of the business and a transformation
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  of the business models and business processes as
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  well as just, a a technology transformation.
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  And and that is, I would say, one
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  of the biggest challenges, which is making like,
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  figuring out what to keep and and what
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  to throw out and what what is, you
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  know, broken and and needs fixing and should
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  be fixed and can be fixed.
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  And, you know, doing that and doing the
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  technology change is is a big challenge.
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  Understood. So this has to be an enterprise
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  wide approach. And
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  as you see health plans continue to adopt
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  a platform based approach,
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  are there change management principles that they should
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  be keeping in mind to ensure a smooth
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  transition
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  and to maximize their their impact? Any any
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  resources you'd recommend, Rob?
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  You know, change
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  management for me and the the dealing with
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  the people aspects of of technology transformation,
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  I think
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  is 70, if not 80% of the job.
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  I think I've I've been doing platform transformations
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  for
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  two and a half decades, and I think
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  I've come to the conclusion that
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  focusing
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  on the people and focusing on the people's
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  transformation and and helping people have agency and
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  decisions and ensuring that you're not forcing technology
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  on them that they're bought in. They understand
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  the why, and you really dial on dial
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  into the change management,
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  the human elements of change management. I I
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  think that is
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  one of the key things to adopt.
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  And I don't think any platform really is
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  ever successful when it focuses just on the
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  technology,
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  and and sort of underestimates
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  the amount of,
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  people change management and and human change management
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  that's gonna need to to go on. And,
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  you know, in terms of frameworks or resources,
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  I think
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  as you go through
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  this sort of change management process,
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  there's there's a large number of,
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  like a cloud migration is a good example.
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  And there's a large number of resources that
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  are are really applicable to any kind of
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  any kind of large scale
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  change management initiative that is put out by
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  companies like
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  AWS and Azure. And those those kind of
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  cloud hyperscalers that it's their bread and butter
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  to do large scale technology transformation. So they
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  often have playbooks and frameworks that will enable
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  you to do the cloud migration, but I've
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  often found that they're actually just as applicable,
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  if you're changing,
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  what what ticketing system people are using or,
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  you know, if you're changing Office or whatever.
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  It's it's the same principles to,
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  get people aligned, make sure people are bought
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  in, make sure people understand why things are
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  happening, make sure they have agency
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  in the decision making. And and those those
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  frameworks,
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  they're published on these websites. They're they're very
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  easy to consume. And,
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  often, the large scale of cloud migrations means
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  that they have to be very good and
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  very robust. So you can sort of copy
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  that as a template
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  and move it move it across. And I'll
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  say, like,
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  never underestimate the amount of times you have
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  to communicate with people. I think when you
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  are a a leader
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  leading change and leading transformation,
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  it is your
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  day to day
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  job to to constantly be thinking about the
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  transformation and constantly be thinking about the the
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  change management
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  and constantly be thinking about, like, how the
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  communications go out and the why, and you
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  probably are, you know, giving the same presentation
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  to 10 different people every week. But I
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  always think about it in terms of what
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  is that the person that I am talking
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  to or I'm communicating with or presenting to,
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  what is their worldview?
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  And oftentimes, their worldview is
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  thirty or twenty nine days out of the
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  month,
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  they are doing their day job and they
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  have fire drills and customers to deal with
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  and they need to,
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  work on that. And then one day a
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  month for, you know, thirty minutes, they hear
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  a status update on your big change management
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  approach. So while you feel like you're over
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  communicating
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  and you should communicate until you feel like
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  you're over communicating,
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  the people that you're communicating to are oftentimes
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  hearing what you're saying, you know, in in
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  a in a sea of other information that's
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  that's very noisy. So the biggest thing I
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  would say is treat everything,
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  when you're thinking about change management,
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  and you're thinking about adopting a platform approach.
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  Treat everything as a large scale transformation
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  because it is, and
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  communicate, communicate, communicate, communicate almost until you're sick
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  of communicating your message. You know?
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  It's a lot of great advice for for
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  our listeners. So so thank you, Rob.
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  If you were to look ahead into the
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  future, how do you see innovation then continuing
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  to unfold at health plans? What's exciting you
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  right now, and how can our audience listen
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  listening in? How can leaders prepare
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  for this future state?
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  I am incredibly
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  excited
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  about
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  the concept of having data in a consistent
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  data model and stored in in, you know,
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  systems that you can understand
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  the entire enterprise data portfolio.
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  I think once you have that, there are
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  tremendous amounts of things you can do from
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  a business intelligence and and data intelligence perspective.
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  And machine learning and AI are are, you
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  know, two obviously,
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  top of everyone's mind examples of that. But
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  you can also just start thinking about efficiency
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  and and monitoring customer journeys through the system.
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  And for us in this industry where we
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  have this, you know, mess of integrations with
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  thousands of different tools that we and then
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  systems and APIs and batch jobs and messaging.
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  For us to be able to consolidate that
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  data into a single platform where we can
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  start making really, really intelligent
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  decisions
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  about about the businesses that we're running is
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  really exciting. And I think it's not just
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  us making intelligent decisions about the business that
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  we're running, but it's pointing these ML and
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  these AI tools
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  at that data and then training those models
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  and and, you know, asking these agents to
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  to make,
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  decisions about about that data too and and
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  asking them for input and seeing patterns across
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  massive amounts of data. It's just it's incredibly
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  exciting concept given the amount of data that
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  that payers and health plans have. And then
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  I think if I I sort of play
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  that out in my mind,
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  you know, you can take that data and
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  you can take that intelligence
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  and, you know, combine that with cloud,
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  this the infinite scalability of cloud, and you
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  can start doing digital twins of that data
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  and digital twins of the plans and and
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  using that to to do what if modeling
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  and and planning out different scenarios and saying
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  if I change this this contract here or,
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  you know, I change this plan line item
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  here or this this, in our case, the
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  health rules,
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  you know, what impact would that have had
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  over the last twelve months? Where do we
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  think that's gonna go in the future? And
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  you you can have tens
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  of hundreds of or tens and hundreds of
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  these digital twins of your business
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  in the cloud that you're you're able to,
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  to model different scenarios and different tweaks and
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  different pieces of business efficiency and and different,
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  things that are gonna have a real impact
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  to your customer and their customer experience. And
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  that's something that is just
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  a vision that's almost unheard of right now
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  where your data is everywhere.
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  You have to, you know, cut a ticket
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  to a a a business,
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  analyst team or a business intelligence team. You
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  know, they'll put the dashboard together or they'll
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  put the report together. You know, you're looking
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  at two, three week cycle times, sometimes at
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  best.
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  And then you finally get the data, and
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  then you analyze it. You wrote something wrong.
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  You have to go back. You know, there's
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  this really long lead time on business intelligence
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  right now. And I think as we start
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  to consolidate data models and we start to
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  consolidate our data infrastructure,
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  we're gonna be able to, you know, get
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  answers
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  in in almost real time
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  to very, very complex business scenario modeling, and
• 14:08
  that's gonna be incredibly powerful for for customers.
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  Well, clearly, a lot of really exciting things
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  on the horizon. So, Rob, I wanna thank
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  you for taking the time to sit down
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  with us and for sharing your insights with
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  our listeners. We really appreciate it. Thank you.
• 14:23
  It's been a pleasure. I'd also like to
• 14:25
  thank our podcast sponsor, HealthEdge.
• 14:27
  You can tune in to more podcasts from
• 14:29
  Becker's HealthCare by visiting our podcast page at
• 14:31
  beckershospitalreview.com.