Latest / Becker’s Payer Issues Podcast / Rethinking Prior Authorization Through Technology and Alignment with Chris Gay of Evry Health

Transcript

Rethinking Prior Authorization Through Technology and Alignment with Chris Gay of Evry Health · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Amerson with the
• 0:02
  Becker's Payer Issues podcast.
• 0:04
  Thrilled today to be joined by Chris Gay,
• 0:06
  who is the CEO of EveryHealth.
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  Chris, thanks you so much for taking the
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  time to be here with me once again
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  on the podcast.
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  Well, thank you, Jacob, for having me on
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  on the podcast.
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  Absolutely. And before we dive into everything we
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  wanna talk with you about today, Chris, for
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  our audience that might not be familiar, can
• 0:23
  you tell them a little bit about yourself
• 0:25
  and what it is that you do at
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  EveryHealth?
• 0:28
  Sure.
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  Chris Gay. I'm the CEO and one of
• 0:31
  the cofounders of EveryHealth. So I was a
• 0:33
  software developer by training, and that's turned serial
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  entrepreneur.
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  And, inside of EveryHealth,
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  I mostly set the strategy
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  and, make sure that we have the resources
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  to fulfill that strategy. And, and that includes
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  a lot of talent and recruitment.
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  And in terms of our company,
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  we started eight years ago as a start
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  up
• 0:56
  trying to address issues that we felt were
• 0:58
  inequities in US health care around access and
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  quality and engagement and total cost.
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  And,
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  we started out in Silicon Valley with a
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  $120,000.
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  Now what you can best think of us
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  as a software company that owns a full
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  health insurer.
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  And,
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  we focus on the mid market commercial mid
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  market fully insured.
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  Most of our membership is in the state
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  of Texas.
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  Fantastic. So a bit of a unique structure
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  there,
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  in terms of the wider industry landscape, Chris.
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  And I wanted to start us off by
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  going back to the conversation that you and
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  I had had here on the podcast about
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  six months ago this summer.
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  You had mentioned that EveryHealth has achieved a
• 1:42
  7%
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  prior authorization denial rate with 100% of those
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  denials upheld on appeal,
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  which as you know, far out outperforms
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  the industry average.
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  And and then you also offered to license
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  your technology that, has led you to achieve
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  that to competitors.
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  So I wonder, you know, broadly, if we're
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  looking out across the industry, this is a
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  topic that gets a lot of negative headlines,
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  a lot of bad press for a lot
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  of insurers.
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  So,
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  you know and this is all, of course
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  the the context here is, you know, this
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  summer, nearly 50 insurers committed to,
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  standardizing
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  electronic prior auth processes, including EveryHealth,
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  in collaboration
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  with the government. And so
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  broadly, across the industry, what what's the biggest
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  obstacle here, do you think,
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  that's preventing
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  larger insurers especially from
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  replicating what you've built at EveryHealth?
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  Is it fundamentally
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  a technology problem, like we heard doctor Oz
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  suggest this summer,
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  or is this a business model problem at
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  its core, or is it something else? What
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  do you think?
• 2:47
  Oh,
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  I think it's
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  three things.
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  So I'll I'll, I'll answer the first one
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  as the technology, and you can come back
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  with the other two as follow-up questions.
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  It is a technology issue,
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  and it's a technology issue. And, again, I
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  I think it's the other two things as
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  well.
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  But it's a technology issue because of the
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  scale.
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  Prior authorizations are a shared frustration
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  by both the medical provider community
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  and health systems and physicians
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  and the health plan and
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  payer side of the industry.
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  But we have a job in population health
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  to look across health systems, look across employers
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  and state lines.
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  When we do that at at a at
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  a large data level,
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  you see a lot of variation in clinical
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  care.
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  And that impacts medical quality. That impacts patient
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  experience.
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  It also impacts the broader community.
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  When we waste resources, it means there's less
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  to be used for everyone else. It's not
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  a limitless ceiling. We can't continually
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  spend more,
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  and more and more as a society
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  without driving higher quality medical outcomes.
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  Happy to spend more
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  when
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  it's,
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  corresponds with higher outcomes.
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  But because it's a big data problem and
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  because it spans a lot of complexity, it's
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  perfect for technology. Let computers do
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  the boring,
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  challenging work of matching records,
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  doing eligibilities for patients, doing eligibilities for facilities,
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  doing eligibilities for providers,
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  doing the code checks.
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  Computers are great at that.
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  And that's why software is superb for the
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  solution and why we're happy to license what
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  we do for other peep.
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  It works. It works really well, and it
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  lets our staff work at the top of
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  their license, allows you to turn things around
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  in minutes instead of days back to the
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  patient.
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  It's the benefit of that, and it results
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  in higher medical quality.
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  So tech can really solve a lot of
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  problems here.
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  So, ultimately, this is a scale issue in
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  in your mind. And I I wonder you
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  know, I remember
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  like I I said in that original conversation
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  that we had this summer, you had offered
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  your your to license your technology to competitors.
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  Have any taken you up on that since
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  since our conversation?
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  Yes. I will tell you it's in pilot
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  with other companies.
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  It's pretty straightforward to do,
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  but, you know, large companies need time to
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  make decisions and evaluate things, and that's perfectly
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  understandable.
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  But we're pretty pleased that others want to
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  change what they're doing and
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  make it more patient focused
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  with faster turnaround times and lower cost and
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  higher quality. So that's what the software allows.
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  Certainly. So you mentioned this is also a
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  technology problem, Chris. And and like I said,
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  my original
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  question, you know, I posed to you that
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  this is a potentially a business model problem
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  too for the industry.
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  Do do you think that that's an accurate
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  assessment?
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  Absolutely.
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  I think you have
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  you've got organizations
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  on the payer provider side
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  on both sides
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  that,
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  to put it politely,
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  are trying to maximize margin.
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  And there are times to have margin. As
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  the Sisters of Charity used to say, if
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  you have no margin, you have no mission.
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  Right? So having margin isn't a crime. None
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  of us can
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  build even nonprofits without margin.
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  The challenge you have is you have very
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  sophisticated large organizations
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  and,
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  on both sides, and
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  there is a lot of optimization
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  going on.
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  And I would argue,
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  my opinion, there's a lot of artificial friction
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  created.
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  And and
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  there are parties on both sides that
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  really push the extremes.
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  And
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  the way the business models work,
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  you know,
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  either side can outdo it outdo the other.
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  And there's so for instance, on the the
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  payers payer side, you have,
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  organizations
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  that in response to a bunch of garbage
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  being submitted,
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  expanded the number of codes
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  that they put on the for qualification.
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  And, hey, said, look. Let's pump the brakes
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  a little bit. Let's take a little more
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  time to evaluate this because too many things
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  were getting pushed through
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  that didn't meet medical quality or standards.
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  And they erred on the side of too
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  many codes and too slow.
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  If you wanna be you know? And then
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  on the on the provider side, you've got
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  organizations that have contracted out their what they
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  call revenue cycle management.
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  They're not even directly talk talking to the
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  health plan. They put it to a third
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  party, and that third party is oftentimes
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  submitting
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  for anything they can think of,
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  and often resubmitting.
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  So they'll fire off the same claim nine
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  times
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  inside of forty five days.
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  And the payer has to respond to all
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  nine of those even though eight of them
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  are dupes duplicates.
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  This is just a couple of examples of
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  how both sides kinda weaponized against each other.
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  And,
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  it's fundamentally because the business models aren't aligned
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  around patient care. And that's why AHIP has
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  stepped forward and said enough of this nonsense.
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  50 of us has health plans, including EveryHealth.
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  We're gonna lead the industry. We're gonna say,
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  let's reduce the codes.
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  We're gonna say,
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  let's enforce more digital submissions so we
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  can clearly identify dupes faster.
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  We want patients to get an answer quickly,
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  and we're gonna do this all based upon
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  improving medical quality and patient experience.
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  And so I think it's a great example
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  of how a political organization can step in
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  and say,
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  everyone put the knives and forks down.
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  Let's have a real conversation, and we'll we'll
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  we'll be the first to start. Yeah. Absolutely.
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  So AHIP has stepped in. A lot of
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  this, I think, behind the scenes has been
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  very much pushed by CMS, of course.
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  And you say that it's a lot of
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  the this issue that it's artificial,
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  that it maybe could have been been fixed
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  sooner.
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  And on and on top of that that
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  context of what's going on federally
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  and and with AHIP and and all the
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  groups that they represent,
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  We we're seeing around the country. It's been
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  happening for years, but it's really ramped up,
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  I would say, the last year or two
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  where we've seen a lot of the states
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  take on this issue themselves.
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  California, pretty notably
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  this year, passed and and then, enacted two
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  prior authorization reform bills,
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  one mandating,
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  quicker response times for these requests,
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  another allowing the states or regulators to to
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  waive,
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  these requirements entirely for for certain services or
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  certain approval rates that are achieved.
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  And so
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  I wonder, you know, from where you said,
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  I know you're you're operating solely within Texas,
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  but how effective do you think state level
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  reforms are at actually reducing friction,
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  you know, this this patchwork of state mandates
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  versus what we're seeing now with with this
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  pledge at the federal level with the private
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  sector?
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  I yeah. And I'll I'll be clear. I'm
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  speaking personally here for myself.
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  I'm not a fan of Patrick state regulation.
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  Again, because as as health plans on the
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  population population health side, we're spanning states, and
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  it just creates system complexity.
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  I'm more a fan of the voluntary,
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  initiatives that we we're part of at AHIP
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  that are looking nationally.
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  Let's talk about some of the things in
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  there. Effectively, what they're looking for is faster
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  turnaround times and gold parting.
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  And,
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  I I don't
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  I don't think you need more legislation to
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  get there.
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  Like, we we've proven you can
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  you can do this at every help with,
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  you know, 100%
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  upheld upon appeal and only a 7% medical
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  denial rate. And, oh, by the way, this
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  year, we're driving even lower. I think we're
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  on track this year to be somewhere around
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  four to 5%.
• 10:58
  Again, always upheld on appeal. So you can
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  use technology,
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  and you can use voluntary commitments
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  to improve the patient experience
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  and to work with providers,
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  and to improve medical quality and lower costs.
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  It's it's all doable.
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  Now having said that,
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  I would say, you know, my goal and
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  my organization's goal is, hey. Let's go further.
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  What if we could eliminate PAs?
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  What if we could gold card everything?
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  And, Jacob, that requires partnership with providers.
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  That requires partnership with the American Medical Association
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  and the American Hospital Association.
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  But we could get there as an industry,
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  but I would put some backstory on it.
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  Right?
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  There has to be accountability. Hey. If you
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  want us to gold card everything, that's like
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  saying there's gonna be a blank check.
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  We'll prove to us that you've got the
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  clinical
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  you you follow the your own clinical guidelines.
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  Just follow your own guidelines. And the trouble
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  is still a lot of large organizations
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  and and provider groups don't follow their own
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  care guidelines.
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  And yet, we as a society gave $30,000,000,000
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  of taxpayer money for EHR upgrades
• 12:11
  and systems upgrades across the industry.
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  And yet we're still getting
• 12:16
  45%
• 12:17
  of our submissions that we receive are fax
• 12:19
  and paper.
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  And and even then, we gotta dig through
• 12:22
  it all. So, like,
• 12:24
  my organization, I'd be willing to gold card
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  everything if providers came to us and said,
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  hey.
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  We're following our own Garrett guidelines. It's all
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  here in the EHR.
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  We'll have a digital connection.
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  And, hey, if we ever want a variance
• 12:38
  on something, like, hey, there's a good reason
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  we're varying from the clinical guidelines. Here's all
• 12:42
  of our documentation.
• 12:43
  Great. Let's go. Let's do this.
• 12:46
  And we have the technology to do this
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  at a national level, Jacob. There's no reason
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  we couldn't take the best care guidelines of
• 12:51
  the whole world
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  and
• 12:53
  every major system in The United States and
• 12:55
  put it in a single system of record
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  or open source it and say hook that
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  up to your EHR. And every point in
• 13:01
  time, for any given patient, you would know
• 13:03
  the next step in their journey of care
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  based upon the evidence.
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  And so I I think there's a way
• 13:09
  we could all do this nationally,
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  but the patchwork approach of state by state
• 13:13
  legislations misses the forest for the trees.
• 13:16
  Sure. No. I I totally get that. And
• 13:18
  I think it's you know, when you look
• 13:20
  into some of these state bills even more
• 13:22
  into detail, you realize they don't necessarily,
• 13:25
  they don't affect or they don't,
• 13:27
  yeah, they don't affect
• 13:29
  the plans that most people are on. A
• 13:31
  lot of self insured plans,
• 13:33
  they really only affect the plans that states
• 13:35
  themselves can can regulate.
• 13:37
  And then, of course, you got the issue
• 13:38
  where a lot of health plans most health
• 13:39
  plans are operating
• 13:41
  in different states with, you know, employees that
• 13:43
  recover all over the country. You bring up
• 13:45
  a great point about what they actually regulate.
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  A lot of states are regulating less than
• 13:49
  20% of the market. Yeah.
• 13:51
  Yeah. Because the rest of it's federally regulated,
• 13:53
  Medicare or
• 13:55
  ACA or self insured to your point under
• 13:57
  ERISA. Yeah. And,
• 14:00
  it's stopped making fully insured health plans,
• 14:04
  carry all the water for everyone else like
• 14:06
  Gangadine.
• 14:07
  Mhmm. If you're gonna regulate the market, regulate
• 14:09
  the entire market,
• 14:11
  not just 20% of it because that creates
• 14:13
  adverse selection.
• 14:14
  Yeah. And it's fascinating when you see the
• 14:16
  headlines as if it is affecting the whole
• 14:18
  market,
• 14:19
  because I think there is just not an
• 14:20
  understanding
• 14:21
  in the media of of the complexities of
• 14:23
  that.
• 14:25
  But before
• 14:26
  before we run out of time today, I
• 14:28
  do wanna make sure to ask you about,
• 14:30
  the the traditional Medicare prior auth pilot, which
• 14:33
  is set to go into effect in just
• 14:35
  a few weeks.
• 14:36
  We know who, the vendors are gonna be
• 14:38
  that are gonna administer this.
• 14:41
  A a good chunk of them are connected
• 14:42
  to insurers in some way. Either they they
• 14:44
  work with them already on prior auth or
• 14:47
  they've been funded
• 14:48
  by them.
• 14:50
  And and then if this for our listeners
• 14:52
  who might not be familiar, this is the
• 14:53
  wasteful and inappropriate service reduction pilot, w I
• 14:56
  s e r, initiative,
• 14:58
  starting in January, introducing prior auth requirements for
• 15:01
  17 services to traditional
• 15:03
  Medicare for the first time.
• 15:05
  There's been a lot of criticism this year.
• 15:08
  There's been legislation introduced in the house by
• 15:10
  Democrats to stop this entirely. The hospital association
• 15:13
  has been,
• 15:14
  critical of the legislation,
• 15:17
  specifically around the AI use that this is
• 15:19
  gonna introduce to the program,
• 15:21
  in terms of decision making, it sounds like.
• 15:23
  So,
• 15:25
  you know, what do you think about this,
• 15:26
  Chris, in terms of
• 15:28
  is adding prior auth requirements to traditional Medicare
• 15:31
  a step forward or backwards?
• 15:33
  And what should what does CMS need to
• 15:35
  get right here to avoid some of these
• 15:36
  problems that, we just lightly touched on in
• 15:39
  terms of the commercial market?
• 15:42
  Boom.
• 15:43
  There's a lot in there, Jacob.
• 15:46
  You know, first, it's a clever bill acronym
• 15:48
  there, WISER.
• 15:50
  And,
• 15:51
  you know, the challenge being,
• 15:53
  Medicare wasn't supposed to stay. I think what
• 15:56
  people forget is that Medicare wasn't supposed to
• 15:58
  stay the way it currently is. That originally
• 16:00
  Medicare Advantage
• 16:02
  was launched a long time ago
• 16:04
  and was meant to be kind of rolled
• 16:06
  back into.
• 16:08
  And so we wouldn't have Part a and
• 16:09
  Part b anymore in their current forms,
• 16:12
  that we're supposed to learn from Medicare Advantage.
• 16:15
  But the people that launched that and the
• 16:18
  leadership and the policies have now changed, and
• 16:20
  we have independent programs in the country of,
• 16:22
  in effect, Medicare and Medicare Advantage, two very
• 16:25
  different programs.
• 16:26
  And what I what I think the administration
• 16:28
  because I don't speak for the industry. What
• 16:29
  I think they're trying to do is trying
• 16:30
  to take some of the lessons learned from
• 16:32
  Medicare Advantage and pull it over.
• 16:34
  And one of those is that sometimes, again,
• 16:37
  you've got a lot of clinical variation.
• 16:39
  And it's
• 16:40
  too much
• 16:41
  too much clinical variation, and it has a
• 16:44
  big impact, particularly for a large federal program.
• 16:48
  And they're trying to reel that in a
• 16:49
  bit.
• 16:50
  The trick is it's very early. It's too
• 16:52
  soon to tell. We can't grade them on
• 16:55
  their performance. All they did was issue a
• 16:57
  request for
• 16:58
  proposals,
• 16:59
  and they've chosen some vendors. But they haven't
• 17:02
  done any work yet, so we have no
• 17:03
  way to judge their performance.
• 17:05
  I think it can be done very well,
• 17:06
  though, Jacob.
• 17:08
  I personally don't have a problem with using
• 17:11
  AI to do all the
• 17:13
  the boring work that no nurse and doctor
• 17:15
  wants to do. No nurse or doctor wants
• 17:17
  to scan through
• 17:18
  faxes and emails and go through 50 pages
• 17:22
  of notes to find the one thing that's
• 17:24
  the indication necessary to support
• 17:27
  the clinical guideline.
• 17:29
  But software
• 17:30
  and AI is just
• 17:32
  software, software does all that really well.
• 17:35
  So it can be a decision support tool
• 17:37
  presented to the nurses and doctors. Say, hey.
• 17:39
  Look. We found three indications of breast cancer.
• 17:43
  This supports,
• 17:45
  you know, further treatment. Let's go. And let
• 17:47
  the nurse or doctor go straight to the
• 17:49
  point in the notes that have the indications.
• 17:52
  They got directed straight to the the guidelines.
• 17:54
  And so
• 17:56
  they're able to work at the top of
• 17:57
  the license and do more patient care, and
• 17:59
  they get a turnaround time back to the
• 18:01
  patient. It's quick.
• 18:02
  Everybody wins.
• 18:04
  So as much as people are frustrated by
• 18:06
  Medicare all of a sudden having a potential
• 18:09
  new process to it, it may not be
• 18:11
  a bad thing.
• 18:13
  That's just my opinion.
• 18:15
  It'll be interesting
• 18:17
  to watch it as as we
• 18:19
  go into next year. I know from our
• 18:21
  from where we sit, you know, we hear
• 18:22
  a variety of opinions on this, from it
• 18:24
  being
• 18:25
  the end of Medicare according to some to
• 18:28
  some saying it's the modernization and, like you've
• 18:30
  said, bringing over some of those lessons learned
• 18:32
  from Medicare Advantage. So definitely something we're gonna
• 18:35
  be keeping our eye on as well.
• 18:37
  And their concern is a federal program is
• 18:39
  also cost.
• 18:41
  Right? Sure. One of the biggest things in
• 18:43
  The United States is just affordability, affordability, affordability
• 18:46
  right now,
• 18:47
  in terms of political messaging.
• 18:49
  And HHS's
• 18:50
  budget
• 18:51
  is huge now. Yeah. Right? And it's growing,
• 18:56
  at a faster rate than the economy.
• 18:59
  At this rate, it's if it continues at
• 19:00
  this rate, it may have already eclipsed it,
• 19:02
  but I think it's probably on track to
• 19:03
  equal the entire budget of DOD.
• 19:06
  Yeah. And, I mean, they wouldn't
• 19:09
  the government has to look at some things
• 19:12
  and say, hey. At what point is this
• 19:15
  too expensive?
• 19:16
  Yeah. Maybe we could manage this better.
• 19:19
  This may not be the correct way to
• 19:21
  manage it, but
• 19:22
  at least they're looking at some pros and
• 19:25
  cons and trade offs, and they're willing to
• 19:27
  try something and experiment. Definitely. To be said,
• 19:30
  I would say look at it in the
• 19:31
  bigger picture of Medicare Advantage
• 19:34
  was
• 19:35
  long term originally meant to become or pull
• 19:38
  all the lessons from MA into Medicare.
• 19:41
  So if you think of it on that
• 19:42
  long arc of fifteen years of policy and
• 19:44
  planning, this is really just coming back to
• 19:46
  where we started.
• 19:48
  It's not so radical.
• 19:50
  Well, Chris, before we go,
• 19:53
  anything that we're missing? Anything you wanna share
• 19:56
  with the wider industry while you have their
• 19:58
  years or or any reflections,
• 20:01
  of of the year that just occurred?
• 20:04
  Well, every time I go into a room
• 20:06
  now,
• 20:07
  and it's not a room of friends and
• 20:09
  family,
• 20:11
  as soon as they learn
• 20:13
  what industry I work in or who I
• 20:16
  work for,
• 20:17
  it's like the tension automatically increases.
• 20:21
  And I think many of my peers in
• 20:22
  the industry have the same issue.
• 20:24
  And so what I would encourage people to
• 20:26
  do is
• 20:27
  engage.
• 20:28
  When they engage with us and they have
• 20:30
  real, honest conversations,
• 20:32
  the temperature drops.
• 20:34
  People went, oh, you've got a reason for
• 20:36
  that. Oh, that makes sense.
• 20:38
  People want a real and honest dialogue in
• 20:40
  this country right now, and I think we
• 20:42
  as leaders in industry have an obligation to
• 20:44
  provide that. And we do that.
• 20:47
  We find commonality.
• 20:49
  And in that commonality,
• 20:51
  we can move
• 20:53
  entire industries forward,
• 20:54
  and we can shift communities
• 20:56
  to better population health. And so I just
• 20:59
  encourage everyone over the holidays here, don't be
• 21:02
  afraid of the hard conversations.
• 21:04
  Have common ones. Have candid ones, and, enjoy
• 21:07
  the holidays.
• 21:08
  That's really great advice. Humanize
• 21:10
  your industry.
• 21:12
  Chris Gay, I really appreciate you taking the
• 21:14
  time to chat with me, before year's end
• 21:16
  and
• 21:17
  really appreciate you sharing your expertise and your
• 21:20
  thoughts with our audience. Thank you. Thank you,
• 21:22
  Jacob.
• 21:23
  And to our audience, if you'd like to
• 21:24
  listen to more podcasts from Becker's, you can
• 21:27
  visit beckershospitalreview.com.