Latest / Becker’s Healthcare Digital Health + Health IT / Richard Clarke, PhD, Senior Vice President and Chief Analytics Officer at Highmark Health

Transcript

Richard Clarke, PhD, Senior Vice President and Chief Analytics Officer at Highmark Health · Becker’s Healthcare Digital Health + Health IT

• 0:01
  The Becker's team is excited to announce the
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  launch of our new CFO and Revenue Cycle
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  Tune in for conversations with finance experts from
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• 0:25
  This is Laura Dierdahl with the Becker's Healthcare
• 0:27
  podcast.
• 0:28
  I'm thrilled today to be joined by Richard
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  Clark, senior vice president and chief analytics officer
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  at Highmark Health. Richard, it's a pleasure to
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  have you on the podcast today.
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  Yeah, Laurel. Thanks so much for having me.
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  Now I'm excited to hear more about some
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  of the cool things you're doing at Highmark
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  Health. I know, you're in such a a
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  unique position and unique market as well there
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  at Pittsburgh. But before we dive in, I'm
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  wondering, can you tell us just a little
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  bit more about Highmark Health and what makes
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  it unique?
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  Yeah. I'd be, more than happy to. You
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  know, Highmark Health is a integrated,
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  health services company, and, you know, I think
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  one of the things that makes us unique
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  is with, the the different assets that we
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  have. Right? So we have Allian Health Network,
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  which is a network of 14 hospitals, ambulatory
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  surgery centers, health and wellness pavilions, and employed
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  physician organization,
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  many other assets. We have, of course, our
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  blue branded health plan,
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  with over 5,000,000 members, and we have a
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  number of diversified businesses. Our, national dental business
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  stop loss, our,
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  technology company engine, and, really, that just leads
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  to so many,
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  opportunities
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  to,
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  serve members, to improve health, to investigate and
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  understand,
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  how different interventions lead to positive outcomes, to
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  experiment,
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  and, really, overall to, you know, achieve the
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  goals of living health, our strategy, which is
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  really creating more health and creating more affordable
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  care.
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  Well, that's amazing to hear. I know there's
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  so much, to be done in in that
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  space and finding the best quality as well
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  as being cost efficient. Now in looking in
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  the last year or so, what accomplishment are
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  you most proud of?
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  Well, I'm gonna I'm gonna cheat a little
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  bit and give you, give you two. So,
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  you know, one really gets at that intersection
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  of payer and provider and, you know, Allegheny
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  Health Network in kind of the context of
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  Highmark Health is really our living laboratory for
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  our strategy. And, you know, we're doing a
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  ton of work to just investigate how payer
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  and providers can collaborate together to kind of
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  do exactly like you just said. Right? Really
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  meet that quintuple aim,
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  aim, and deliver,
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  you know, care that is high quality, more
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  affordable, equitable,
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  etcetera. And, you know, one of the things
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  in that vein that we're really proud of
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  is we implemented a,
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  quality and shared risk program between our health
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  plan and LA health network.
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  Last year, it's, you know, one of the
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  larger ones that we're aware of. It's, you
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  know, serves over 350,000,
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  members across every segment,
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  a commercial ASO, fully insured Medicare,
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  ACA, etcetera. We've just been learning so much
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  around the integrated economics, how to use that
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  blended data,
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  across payer and provider to lead to more
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  actual information,
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  earlier interventions, and ultimately,
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  achieve just a better outcome for our patients.
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  So that's been one that has been a
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  real journey,
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  in terms of learning and,
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  you know,
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  really excited about what that,
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  means, not only for the,
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  payer and provider,
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  Highmark and Alligator Health Network, but how we
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  can also then take that out to other,
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  provider partners,
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  of ours. And then the second is really
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  all about generative AI and the work that
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  we've,
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  been doing there, particularly around
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  the broad adoption,
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  of AI across our enterprise. You know, we,
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  we have
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  a AI center of excellence here that we're
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  really focused on making kind of, AI the
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  easy button,
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  within our our company. And, there's lots of
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  exciting things going on from large scale solutions,
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  like the ambient listening technology that we've been
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  rolling out across Allegheny Health Network to improve,
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  you know, the clinicians,
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  day to day work and kind of bring
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  a lot of joy back to practice,
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  but also,
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  the rollout of our at scale,
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  secure generative AI solution we call Sidekick,
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  for every single one of our 50,000 employees,
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  and that's just been amazing. We have,
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  over 10,000
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  active users on our internal platform. We just
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  surpassed
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  the 1,000,000,
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  prompt,
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  submitted,
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  threshold. And, you know, we've been out training
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  thousands of our employees
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  on prompt engineering,
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  how to use these tools,
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  every single director and up, we spent time
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  with. And just as as my time at
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  the company, I've I've never had so many
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  people stop me in the elevator or stop
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  me in the hall and tell me some
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  new cool way, that they're using this technology
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  to to create efficiencies to better serve our
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  patients and members, and it's just been
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  just such an exciting time.
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  That's amazing to hear. You know? And what
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  a a really cool way that you are
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  able to, weave generative AI into the things
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  you're doing every day to make life easier
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  for the clinicians.
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  And it it seems like as well, the
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  patient journey is more efficient. And I'm curious,
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  when you look at, you know, that,
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  unique position you have as you were talking
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  about that intersection of being a payer and
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  provider,
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  in in going more towards that,
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  quality based shared risk programs.
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  Is there something that you can share with
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  us that you've really learned over the last
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  few years,
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  that could, you know, really,
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  has helped you find that the right note
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  or or strike the right path, in terms
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  of, you know, how you're thinking about care
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  delivery and the type of data that you're
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  collecting and
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  ways that,
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  you are bridging that into the patient care
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  that our clinicians are delivering on a daily
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  basis?
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  Yeah. Yeah. I mean, well, we could have
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  a really long conversation on that because I'll
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  tell you there's a lot there. But I
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  I would just offer two things. Right? You
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  know,
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  first is,
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  you know, payers and providers, frankly, they just
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  speak different languages. Right? And so we've been
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  spending a lot of time just educating
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  kind of both sides of that, but also
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  making sure that the data can sync. And,
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  you know, conceptually, it sounds easy,
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  but really understanding
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  how some of that faster moving clinical data
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  inside of the EMR
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  then relates to what ultimately,
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  we see in terms of the cost of
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  care inside of these value based programs is
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  not as easy as you think. It's actually
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  really hard,
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  but it's also really worthwhile because ultimately
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  what we want to get to,
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  as, you know, our kind of head of,
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  Alligator Health Network tells me all the time,
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  which I totally understand is, you know, we
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  want the fast moving clinical data to inform
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  the actions that we want to take, and
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  then we want the
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  claims data to ultimately confirm
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  that those actions are leading to that goal
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  of more, higher quality, lower,
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  you know, cost care. And, you know, that's
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  been a journey. We've learned a lot, you
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  know, for sure. And then the second thing
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  is, you know, it at the end of
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  day, it's all about workflow.
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  Right? And it's like, how do you get
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  into that workflow in the most seamless and
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  easiest way possible
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  so that we can drive adoption frontline. And,
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  and we're just not in a position nor
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  should we be to add any
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  administrative burden. In fact, we have to take
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  it off of the providers, but we have
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  to do so in a way that also
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  allows us to give them the insights they
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  need inside of these, quality,
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  you know, and risk programs so that they
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  can achieve those better outcomes.
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  That's amazing to hear. You know? And it
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  really, really fascinating to think about,
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  you know, aligning the different elements and size
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  of the provider, the payer, bringing them together,
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  and then, coming to that kind of,
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  space where you're able to work together to
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  align in a a meaningful way. Now looking
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  ahead, where do you see some of the
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  big growth opportunities
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  for your team in the next twelve months
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  or so?
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  Yeah. You know, there there there's a lot.
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  I'll I'll just highlight a couple that I'm
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  really excited about. You know, first is,
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  you know, I I'm
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  excited to see just really the huge value
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  realization from the scaled use of generative AI.
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  You know, we've seen it in a lot
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  of early areas of adoption. We've seen it
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  in a lot of the pilots,
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  and we're seeing it in,
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  starting to to be at scale. And it's
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  gonna happen. It's gonna happen for our clinicians,
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  certainly in the area of software developers and
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  certainly in the area of our contact centers,
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  really that kind of, you know, scaled impact.
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  You know, I think the second is,
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  you know, really how it kinda continues to
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  streamline our hospital operations leading to more efficient
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  care and really allowing clinicians to work at
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  the top of their license. We're liberating,
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  you know, many hours,
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  for our clinical staff by taking away some
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  of that,
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  administrative burden, and I'm excited
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  to see that,
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  you know, continue. And then I think the
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  next wave of innovation is, of course, what
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  everyone is talking about, agentic workflow.
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  And, you know, we're excited about that. We've
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  launched our first kinda single use agent.
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  We're really exploring,
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  you know, not only the technical aspects of
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  what has to be true to have a
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  broader ecosystem agents that are orchestrated against tasks,
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  but also the people aspects of that.
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  Not only, you know, building them within
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  the AI center of excellence, but really enabling
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  a broad swath of our, enterprise
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  to be reimagining
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  processes,
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  and workflows,
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  using AI as, you know, another piece of
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  the workforce. And that's gonna be the next,
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  you know, big step forward,
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  that, again, is gonna be a a real
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  source of growth and impact for us.
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  Fascinating
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  to hear. I think it's just,
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  seems so critical to find that right technology.
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  And interesting that you mentioned the agentic workforce
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  is something,
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  honestly, I've just been starting to write about
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  on the,
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  the the digital side as well, and it
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  it seems like so many opportunities, some really,
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  really cool things that you're able to do
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  once you have the technology and learn how
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  to harness it in the right way.
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  How do you make sure you're making the
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  right investments,
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  especially with so many different technologies and companies
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  coming out with applications,
• 10:28
  that,
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  you know, promise big things? How do you
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  know that it's gonna have the right return
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  for the type of investment that you need?
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  Investment that you need?
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  Yeah. You know, it's a great question. I
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  think ROI is becoming an increasing,
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  you know, topic of conversation, you know, for
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  sure.
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  In some ways, I feel like, you know,
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  we've been lucky. We we,
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  invested in our secure Google Cloud platform in
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  late twenty twenty with a strategic partnership with
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  them. So that enabled us to really move
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  quickly
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  in terms of feeling confident
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  that we could turn on,
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  you know, some of these, you know, generative
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  AI solutions and connect them
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  safely and securely to our data. So we've
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  been doing a lot of that. And in
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  those spaces, I guess, I'm in some ways
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  less worried about whether or not this particular
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  use is the absolute highest ROI
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  use case. You know? We we see huge
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  strategic value in, you know, a broad swath
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  of our workforce, learning how to talk to
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  machines, getting very used to prompting, getting very
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  used to incorporating an AI assistant into their
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  work. I think when when it comes to,
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  you know, selecting additional,
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  you know, fit for purpose,
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  partners for some of those solutions, we're being
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  very intentional. You know, I mentioned the ambient
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  listening
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  component for our, you know, clinicians. We have
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  a we've been running a pilot with, you
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  know, nearly 500 clinicians with several different,
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  potential
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  Ambient partners in all sorts of different settings,
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  right, inpatient and ambulatory, etcetera, to make sure
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  that we are
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  selecting. But then I would also say at
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  the end of the day, making sure that
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  we are
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  working hard on our ecosystem to allow for,
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  onboarding of new options, integration of new solutions,
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  building, making sure the build by decision isn't
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  like a binary one that can never be
• 12:13
  revisited because everything is changing so quickly
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  that to think that you can, like, pick
• 12:18
  today and be perfect is is a fool's
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  errand. Right? I think you just have to
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  acknowledge that, you know, innovation is moving so
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  quickly. And so being able to have a
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  eco innovation ecosystem that allows for experimentation, rapidly
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  moving, you know, solutions in
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  you know, solutions in and out of the,
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  of the ecosystem, not only technologically, but also
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  in terms of the contracting that has to
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  come with that, etcetera, is is just really
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  important.
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  Makes a lot of sense. I I appreciate
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  the insights there and, you know, a lot
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  of opportunities ahead. Really fascinating to see some
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  of the cool things that are coming down
• 12:52
  the pipe, but I know there are headwinds
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  as well. Some what are some of the
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  big challenges that you're anticipating and starting to
• 12:58
  navigate through?
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  Yeah. You know, with any large scale transformation,
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  and that's exactly what this is. Right? This
• 13:04
  is kind of digital
• 13:06
  kind of AI transformation at scale. There's always
• 13:08
  a bunch of,
• 13:10
  you know, of challenges.
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  Obviously, a lot of opportunity too, but but
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  I would highlight two here. Right? One one
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  is, you know, the kind
• 13:18
  of the challenge that is always present. And
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  just because it's, generative AI now, it's really
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  no different, and and that's behavior change.
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  You know, at the end of the day,
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  we're talking about people and at
• 13:30
  scale creating behavior change, both of our, staff
• 13:33
  internally that are working on this, but also
• 13:35
  then our members and patients to, to get
• 13:38
  to kind of more health. Right? And so
• 13:39
  that's hard, and that requires a lot of
• 13:41
  thought around incentives,
• 13:44
  around structures,
• 13:46
  you know, around,
• 13:48
  you know, how we frame and deliver information.
• 13:50
  So there's a huge change management comport component
• 13:54
  of this,
• 13:55
  that we think a lot about. In fact,
• 13:57
  you know, the
• 13:58
  my lead of our AI program, that's that's
• 14:00
  her background is really around change and around
• 14:03
  change management.
• 14:04
  And then the second, of course, is the
• 14:06
  just the business environment. Right? It is, there's
• 14:08
  a lot of,
• 14:10
  near terms pressures. There's a lot of headwinds.
• 14:12
  There are a lot of challenges in the
• 14:13
  environment right now. And so how we serve
• 14:16
  that dual mission of,
• 14:18
  you know, creating,
• 14:20
  near term business impact while still investing kinda,
• 14:23
  quote, unquote, through the cycle, if you will,
• 14:24
  to make sure that we can kinda get
• 14:26
  to those longer term, you know, strategies and
• 14:28
  successes is really important.
• 14:31
  And that comes down to just,
• 14:33
  you know, really good prioritization,
• 14:35
  really good thoughts around,
• 14:37
  again, balancing strategy
• 14:38
  and some of the near term execution,
• 14:41
  but certainly does make this a little harder
• 14:43
  than maybe trying to do it when there
• 14:45
  were fewer pressures.
• 14:47
  Absolutely. I think that makes a lot of
• 14:49
  sense, and and really helpful to think through
• 14:51
  that near versus long term strategies.
• 14:55
  How do you balance both of those with
• 14:56
  yourself as well as your teams in keeping,
• 14:58
  you know, the main thing the main thing,
• 14:59
  but not losing sight of where you're going
• 15:01
  as well?
• 15:03
  Yeah. You know, it it it's like communication,
• 15:05
  communication, communication.
• 15:08
  Right? You know, we really, you know, value,
• 15:11
  you know, the interactions and the ability to
• 15:13
  have that and, you know, doing our absolute
• 15:15
  best to create a flat organization,
• 15:17
  where we're bringing,
• 15:19
  you know, cross functional teams together. You know,
• 15:21
  there there is nothing that I've done in
• 15:23
  my career
• 15:24
  that is more cross functional than, you know,
• 15:26
  this AI work recently. It truly requires
• 15:29
  all aspects of the organization,
• 15:32
  operations,
• 15:33
  IT,
• 15:34
  the, you know, advanced analytics teams, legal, compliance,
• 15:38
  you know, you name it to come together
• 15:41
  to figure out how to make this work.
• 15:43
  And,
• 15:43
  you know, the good news on that is
• 15:45
  we're building all sorts of new,
• 15:47
  strong relationships because the best way to do
• 15:49
  that is, you know, do hard things together.
• 15:51
  You know? But it's also everyone learning,
• 15:54
  you know, different components of the organization that
• 15:56
  maybe they didn't see as much before. So
• 15:58
  I think that's a big,
• 16:00
  piece of it. And then it is just,
• 16:02
  you know, a lot of grit and frankly
• 16:04
  continued focus because it's also hard and you
• 16:07
  can't get distracted
• 16:08
  just because maybe it didn't work in the
• 16:11
  second or in this moment. Right. And just
• 16:13
  the determination to say no, but we do
• 16:15
  think the future direction is clear. And, you
• 16:15
  know, as the
• 16:18
  And, you know, as, David Holmberg, our CEO,
• 16:20
  says all the time, the strategy is a
• 16:21
  series of s curves, and we're certainly
• 16:23
  navigating one of those s curves, you know,
• 16:26
  right now, but we have to keep our
• 16:27
  eyes towards that, you know, that end goal
• 16:29
  of delivering,
• 16:30
  you know, more health and more affordability for
• 16:33
  the communities we serve.
• 16:35
  Really, really helpful advice. Thank you again so
• 16:37
  much,
• 16:38
  Richard. This has been amazing. Before we wrap
• 16:40
  up here, I'm wondering, what is the number
• 16:42
  one thing that you're doing right now to
• 16:44
  set yourself up for success in the long
• 16:46
  term?
• 16:48
  Yeah. It's a great question. I mean, I'm
• 16:49
  sure everyone has many of the things I've
• 16:51
  talked about on their strategic plans. Right? So
• 16:54
  I don't think we're,
• 16:56
  you know,
• 16:57
  you know, we're we're not we don't fool
• 16:59
  ourselves and think that we somehow are, you
• 17:01
  know, thinking about things that are necessarily different,
• 17:04
  than everyone else. I think what we really
• 17:06
  just focus on is, you know, how we're
• 17:08
  creating a culture of execution, a culture of
• 17:10
  continuous learning, and really building with people so
• 17:14
  that,
• 17:15
  it is a resilient organization that can can
• 17:18
  continue to react to change, continue to embrace
• 17:21
  change, to create, better outcomes. In the moment,
• 17:23
  we're doing that with a bunch of things
• 17:25
  we talked about here today.
• 17:27
  You know, but really for us, it's all
• 17:29
  about the model
• 17:30
  that we're,
• 17:31
  we're creating that hopefully will allow us to
• 17:34
  continue to
• 17:35
  embrace innovation, embrace change, and and,
• 17:38
  translate that to to more impact. Again,
• 17:42
  keeping the the customer at the center and
• 17:44
  saying, how can we create more more health,
• 17:46
  more affordability, more impact for that member? You
• 17:49
  know, I think that ultimately will will set
• 17:51
  us apart.
• 17:53
  That's amazing to hear. Richard, thank you so
• 17:54
  much for joining us on the podcast today.
• 17:56
  This has been a fun discussion to have,
• 17:58
  and I look forward to connecting with you
• 18:00
  again soon. Yeah. Absolutely. Thank you so much.
• 18:02
  This has been great. Really appreciate it.