Latest / Becker’s Healthcare Podcast / Jay Nakashima, President of eHealth Exchange

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Jay Nakashima, President of eHealth Exchange · Becker’s Healthcare Podcast

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  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400 payer and health plan executives
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  and more than 100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George W.
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone, and welcome to the Becker's Healthcare
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  Podcast. I'm Scott King. Thrilled today to be
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  joined by Jay Nakashima, president of eHealth Exchange.
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  Jay, how are you doing today? Thanks so
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  much for joining us.
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  Yeah. Hey. Thank you for having me. I'm
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  doing great.
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  Excellent. Yeah. It's a new year, but, some
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  of the same kind of trends and topics
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  in health care and with health plans and
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  and so maybe some new ones to address.
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  So we'll dive into all that. But, Jay,
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  before we get started on the topics, I
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  was just wondering if you could please share
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  a little bit about your background and career
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  journey, please.
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  Yeah. You bet. So,
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  so I've been working in the health IT
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  space
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  for over thirty years.
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  I spent about ten years,
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  my first ten years with health plans
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  as they were merging and
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  acquiring others every other day,
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  and, was ultimately
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  the CIO
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  of an HMO
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  PPO.
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  I then moved over to the
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  clinical
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  IT space. So I worked for
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  a couple of large,
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  EHR vendors
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  that helped out,
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  hospitals and health systems.
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  I then went to work for a large
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  national
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  provider,
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  again, on the clinical IT strategy
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  side. And then I've been,
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  running
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  eHealth Exchange,
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  which is a nonprofit,
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  data exchange network, and I've been doing that
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  for the past
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  eight years.
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  Wow. Thanks for sharing your career journey, Jay.
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  So much great experience in there. The first
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  topic I wanted to get to,
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  how are your relationships with providers changing
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  as both sides face cost pressure and workforce
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  shortages?
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  Yeah. Great question.
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  So eHealth Exchange was created about twenty years
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  ago by the federal government,
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  as strange as that sounds,
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  as,
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  as a nonprofit
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  health tech company,
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  another strange concept.
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  But at any rate,
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  the Health Exchange was originally founded,
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  to help
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  health care providers
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  exchange,
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  rich clinical information, so patients'
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  electronic medical records,
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  and, to exchange those among healthcare providers
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  and with federal agencies.
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  So, when I mentioned federal
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  agencies, you might think of like the
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  Veterans Administration,
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  the largest,
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  healthcare provider in the country,
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  and the Department of Defense, who has army
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  hospitals, navy hospitals, etcetera. But at any rate,
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  hospitals,
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  etcetera.
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  But at any rate,
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  it really took us it really took us
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  a good ten years,
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  to get health care providers
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  to exchange
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  data
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  at scale and with trust.
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  And that was for the HIPAA treatment purposes.
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  And, you know, got to the point where
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  we were exchanging,
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  you know, over 20,000,000,000
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  healthcare
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  transactions
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  annually,
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  and of course, in all 50 states.
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  And, and now we're up to 25,000,000,000.
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  But the vast majority of those,
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  electronic medical records being exchanged
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  are still being exchanged for the HIPAA treatment
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  purpose.
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  So, think of
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  a clinician at the chair side, bedside,
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  tableside, whatever,
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  about to prescribe a medication or order a
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  surgery.
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  And we've shifted over the past five years
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  to also
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  focus on payer provider exchange,
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  and
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  provider
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  to public health exchange.
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  So, we're really excited about reducing
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  the burden that both payers
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  and providers have
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  when exchanging
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  patients' electronic
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  medical records.
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  I appreciate you shedding a light on all
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  that wonderful work there, Jay. A lot of
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  progress has been made, and certainly a lot
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  of growth there. Next question I want to
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  ask you, where do you see the biggest
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  gap today between payer strategy and
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  operational execution? I think it's, you know, in
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  my mind, it's really in the it's really
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  in the,
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  lack of understanding
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  of of how inefficient
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  the current processes are.
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  So, you know, when I speak with providers,
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  you know, from large sophisticated
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  health systems,
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  you know, they often tell me, oh, you
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  know, we don't share patient records with payers.
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  And just as nicely and tactfully as I
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  can, I say,
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  well, of course you do? You know, you've
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  been doing this for thirty, forty years.
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  It's just been a behind the scenes operation
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  that number one is required in your payer
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  provider
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  contract,
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  but it might be also happening in an
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  unscalable,
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  unscalable
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  fashion.
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  So, it might be happening
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  via,
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  and sorry for the non techies,
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  it might be using an old school HL7
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  version two interface,
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  or it might be someone swapping
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  Excel CSV
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  files,
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  or it might even be the dreaded fax
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  machine.
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  But regardless, that data is being exchanged today,
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  but it's
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  expensive
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  and clumsy,
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  and, and so that's what eHealth Exchange is
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  trying to
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  tackle.
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  We're trying to,
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  number one, demystify
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  the process,
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  use national standards,
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  and apply modern technology
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  so that it's easier and less expensive to
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  exchange
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  the medical records.
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  Are you surprised that there has to be
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  efforts to kinda get people to adapt to
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  pretty basic modern tech at this point?
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  Yeah.
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  You know, it's,
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  yeah, it's it's really surprising,
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  you know, that, that fax machines are are
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  not only alive and well, but they're used
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  at such tremendous volume currently.
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  And so, you know, when we speak to
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  payers and providers about this and we explain
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  the possibilities,
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  they really do get excited.
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  In terms of possibilities, what's one investment or
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  initiative you believe will most reshape how health
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  plans operate over the next two to three
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  years?
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  Yeah. Great question.
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  So, you know, so we we use the
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  national standards, which have been, you know, government
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  endorsed, and it's called HL seven.
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  And we're using,
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  modern
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  APIs. So think about
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  think about the the the programming
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  framework, you know, used in your mobile phones,
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  you know, for social media,
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  to deal with your bank,
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  to order coffee at Starbucks,
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  whatever.
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  And so, you know, we're leveraging that same
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  technology.
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  We're actually using the healthcare
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  FHIR, FHIR,
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  technical specifications,
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  to
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  facilitate
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  the movement of electronic
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  medical records.
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  And of course, we're not using mobile phones
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  to do this,
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  but we're installing
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  these apps,
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  on health plan and providers'
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  large
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  institutional
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  computer servers,
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  to facilitate the exchange
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  in a scalable,
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  standardized,
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  trusted
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  fashion.
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  Yeah. You know, I I know we just
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  kinda touched on being surprised that
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  people are are still using, you know, fax
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  machines for a lot of these records. But
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  I've also heard, you know, particularly at our
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  conferences
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  from payer leaders that they're surprised how many
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  seniors
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  are utilizing these apps correctly and efficiently. Have
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  you seen that?
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  I you know, I I haven't seen it
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  personally, but, but it's something that eHealth Exchange,
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  definitely
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  supports.
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  You know, I think I think I I
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  really haven't seen it just because our scale
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  is so big. Again, 25,000,000,000
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  records
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  annually.
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  And,
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  the number, the percentage of that that's facilitated
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  by individuals
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  is still relatively
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  small.
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  But, you know, to your point,
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  as consumers and individuals,
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  become more and more tech savvy,
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  and unfortunately,
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  as healthcare costs increase,
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  and and as patients become more vested
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  in their
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  clinical healthcare outcomes,
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  yeah, I see them absolutely
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  using
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  technology,
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  to,
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  for electronic medical records.
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  I, you know, personally
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  use it myself.
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  And, it's really helpful because, you know, like
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  most people, I see more than one health
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  care provider
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  in more than one setting,
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  and I like to have all of my
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  data consolidated,
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  in one place that I can access
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  via my phone or via my,
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  my laptop.
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  Absolutely.
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  If you could change one regulatory or industry
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  practice tomorrow
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  to improve affordability and access, what would it
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  be and why?
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  You know, there's something in HIPAA called the
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  minimum
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  necessary rule.
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  And, you know, this was written back, you
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  know, in the previous century,
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  before before computer systems and the Internet
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  were really deployed widespread.
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  And so what this rule is is currently
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  interpreted to say
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  is that,
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  is that,
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  HIPAA covered entities, so including payers and providers,
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  can only exchange
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  the minimum
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  necessary
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  for quality
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  purposes.
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  And so the million dollar question is, what's
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  the minimum necessary?
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  And, you know, computer systems,
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  be it at two in the morning or
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  two in the afternoon,
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  have a hard time interpreting that.
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  So I'd love,
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  the policy side,
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  to have the government
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  publish
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  an interpretation
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  of what is the HIPAA minimum necessary.
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  Yeah. I think that'd be fantastic.
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  I I certainly think you'll have some support
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  there. Yeah. The last the last thing I
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  want to ask you, Jay,
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  what issue is putting the most pressure on
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  health plan margins right now,
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  and how will you respond differently in in
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  2026?
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  Yeah. So the biggest pressure for health plan
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  margins right now I I mean, it's gotta
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  be,
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  you know, of course, there's,
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  of course, there's the medical loss ratio,
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  but the administrative
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  costs are really getting a focus in the
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  in,
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  in the media,
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  as well as from investors.
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  And, and so we're really excited to help
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  reduce the administrative
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  cost,
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  via electronic medical exchange.
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  Jay, thanks so much for joining the podcast
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  and for a great conversation. Look forward to
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  working with you again soon. Alright. Thank you,
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  Scott.