Latest / Becker’s Payer Issues Podcast / The Evolving Role of Provider Data in Healthcare

Transcript

The Evolving Role of Provider Data in Healthcare · Becker’s Payer Issues Podcast

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  Hi, everyone. This is Rosie Talaga with Becker's
• 0:02
  Healthcare. Thank you so much for tuning into
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  today's Becker's Healthcare podcast series. Today, we're going
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  to talk about the evolving role of provider
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  data in healthcare
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  from compliance requirement to strategic asset and how
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  it impacts AI readiness, network performance, and member
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  trust.
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  Joining me for today's discussion
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  is Robert Holzer, strategy and innovation leader, NextRise
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  and Innovations,
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  Martin Luti,
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  chief technology officer at Quest Analytics, and Bob
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  Tavernier,
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  solution executives at Quest Analytics.
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  Robert, Martin, and Bob, thank you so much
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  for being here today. To get us started,
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  can you all please share a little bit
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  about yourself and your work in health care?
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  And we'll start with Martin.
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  Yeah. Good morning, everybody.
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  My name is Martin Lutte, CTO at Quest
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  Analytics
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  and where we work with health plans and
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  regulators
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  to,
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  provide our network compliance and performance to help
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  them with that. I spent
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  twenty five years in health care technologies and
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  health care technology
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  at a variety of different companies
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  like Optum and Strata
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  and, worked on population health management systems
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  and financial platforms.
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  So I worked
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  a lot with data and
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  have lots of visibility in data problems that
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  we're gonna talk about today.
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  Thank you. Bob, can you please introduce yourself?
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  Absolutely. I'm Bob Tavonier, a solution executive at
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  Quest Analytics.
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  I've been working with Quest for about seven
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  years,
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  five years on the payer side, two years
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  at Quest Analytics directly.
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  Prior to Quest, I worked with, Healthcare Service
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  Corporation
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  for twenty five years,
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  both within internal and external operations,
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  focusing in, not only network management,
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  but also working within our technology space, working
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  with clinical operations, claims customer service, as well
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  as product development. Super excited for the discussion
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  today.
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  Thank you. And last but not least, Robert.
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  Hi. This is Robert Ulzer.
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  I spent the last couple decades,
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  working in health care at a large pair
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  with with Bob and Health Care Service Corporation,
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  leading strategy,
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  innovation.
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  I have a background in application development and
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  enterprise architecture,
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  focusing in data space.
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  And more recently, I've started my own company,
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  Next Verizon Innovations,
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  where I'm applying that knowledge into solving and
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  and building health care applications,
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  and maybe dabbling in the senior living community
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  space as well and building application for them.
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  But, excited to be here and talk about
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  the data challenges.
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  Thank you. We're excited to have you all.
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  And now that we know a little bit
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  of more about the perspectives that are bringing
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  to the table today, let's dive into the
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  conversation.
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  So first, provider directories aren't just a compliance
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  checkbox anymore. They're increasingly
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  visible to members and regulators alike. How has
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  that shift changed the way that your organization
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  thinks about provider data, and where is it
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  created the most urgency internally?
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  And, Bob, I'd like to ask you this
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  question.
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  Absolutely.
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  When you really think about the member's experience,
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  it starts with the directory.
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  That's their first glimpse when they're shopping for
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  insurance, whether they have insurance
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  and looking for primary care or specialist, it
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  really does start with that directory.
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  Directory is truly foundational.
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  When you think about the directory, the member
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  is expecting that directory to be accurate.
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  So when you think about areas such as
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  trust,
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  that's where trust is either
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  won or lost,
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  with the directory. But when you think about
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  the shift internally
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  around building that trust,
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  the speed and expediency around focusing around the
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  accuracy of provider data, keeping up with the
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  changes, knowing directories churn at the rate of
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  60 to 70%
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  annually.
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  And how do you continue to work with
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  different and disparate data sources
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  to truly drive
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  transparency
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  with regards to the data,
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  and ensuring that the members have the highest
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  level of experience possible?
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  So that's a great point for such a
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  foundational
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  factor to be transparent, clear, and accurate to
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  build that trust.
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  There's a lot of conversation right now about
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  AI readiness.
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  How does the quality of your foundational data,
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  provider data in particular,
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  determine what AI can and can't do for
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  your organization today? Are there gaps or blind
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  spots that you've had to address before AI
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  could be reliably
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  deployed in any given area?
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  Martin, I'd like to hear your perspective.
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  Yeah. Obviously, it all starts with data. So
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  if your data is bad and you have
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  inconsistencies
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  there and have duplicates,
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  then AI will not do much for you.
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  It will just kind of inherit all these
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  problems.
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  It will these problems will propagate through all
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  your systems,
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  and you actually make the problem worse. And
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  once that bad data
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  hits even members,
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  the damage is already done.
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  So
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  that's where it starts. Have a really solid
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  data foundation
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  with deduplicated data, have a one identity across
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  disparate systems,
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  and make sure the data is really up
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  to date. Once that happens,
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  really good things can actually come out of
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  AI. So looking at hot spots
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  across your data where the team needs to
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  base dive in, looking at anomalies of the
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  data,
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  very powerful
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  where AI really comes comes into play. But,
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  again, if you're looking at sort of your
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  infrastructure,
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  I think the best place to start is
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  really
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  not asking,
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  am I ready for AI? But sort of
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  how trustworthy is my data to really be
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  able to put AI to work. And once
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  that's in place, it can be very powerful
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  and
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  help lots
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  saving lots of time for analysts.
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  Absolutely. And making sure that base and foundation
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  that the AI would be built upon is
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  ready to go and stable.
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  Robert, what would you like to add for
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  this question? Yeah. I think, Mark did a
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  great job of hitting on the technology side.
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  I'd like to hit more on the the
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  human side,
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  and that you really need to have organizational
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  change and structure to be able to leverage
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  AI effectively. So thinking about the ownership of
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  the data, the standard definitions, is everyone aligned
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  on what it means to to be an
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  active provider or, you know, in the network.
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  And once you have that sort of consistent
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  understanding of viewpoint and the knowledge and education
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  about how to apply AI, then those individuals
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  in the organization
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  can take advantage of the better, cleaner
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  data. Absolutely. Not enough to just buy AI,
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  but to really get that buy in from
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  everyone in your culture and your team.
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  Margin pressure,
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  regulatory
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  risk, member trust, health plans are managing a
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  lot of competing priorities.
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  As you look at the next six to
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  twelve months,
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  where are you seeing health plan organizations
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  rethinking their strategy?
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  And where does network performance come into play?
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  Martin, I'd like to ask you how you
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  feel about this question.
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  Yeah. So what we've been seeing is that
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  sort of a decision is being accelerated
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  with payers.
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  Sort of previously, it was about, okay, let's
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  make sure our networks are compliant.
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  Now it's more about how can we make
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  networks compliant and also perform.
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  So what is actually going on in the
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  the real world is very important.
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  Obviously, also with the regulator coming in and
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  wanted to have better data,
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  out out there.
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  What usually the instinct is when pot budgets
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  are tight and there's margin pressure
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  to actually cut the cut the cost. And
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  what frequently happen is, okay,
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  that actually networks
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  are being cut.
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  And that can be a problem if we
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  are looking at an area that,
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  where
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  your providers are really thin and you're basing
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  decisions on bad data.
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  Because what actually can happen is that you
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  may think you're
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  eliminating, like, low value providers, but then actually
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  don't have any providers in that area, which
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  will lead to member aberration right away or
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  then also, issues with actually the regulator.
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  So I think there's been a shift to
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  kind of, like, compose better networks in general,
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  which we saw sort of,
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  been seeing and then also focus on this
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  is actually a really strategic,
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  component, your your network data.
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  So and then there's an internal component as
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  well, obviously,
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  kind of like cutting down some processes,
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  making things faster and better. That's what, we
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  have been seeing so far. Thank you for
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  breaking that down. And then for leaders who
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  may be earlier in this journey, what's one
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  move you'd tell them to make first? And,
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  Bob, I'd like to hear your perspective.
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  Absolutely.
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  I'll go I'm gonna go back to one
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  of the keywords, trust.
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  Starting small and really focusing in on trust,
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  thinking about data, right, as as a foundation.
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  Many of the health plan organizations out there
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  are diversified. They have multiple lines of business.
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  So starting small, thinking about really working with
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  a single line of business,
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  working with your data to ensure that you
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  have mechanisms in place that can be trusted,
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  that you can create a governance model from
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  that,
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  thinking about the people, the process, and the
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  technology
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  side of that, and taking incremental steps
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  to improve that data.
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  One area that they may want to consider
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  is utilizing claims.
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  So utilizing claims as the backbone
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  of that single line of business
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  that can be that support that governance model
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  to further help to iterate and improve the
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  accuracy
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  and transparency
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  of that data ultimately for members.
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  Definitely. I think there's a common trend in
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  the conversation today that starting with data and
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  making sure that's as clean as possible really
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  buys buy in and trust and just making
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  sure that that accuracy is really there.
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  Is there anything that we haven't covered today
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  that you think deserves more attention in this
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  conversation, Bob?
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  Absolutely. So the the world of health care
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  changes,
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  exponentially every year, and the regulators are a
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  very big part of that. Whether you're thinking
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  about the federal level through CMS, or you're
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  thinking about the state level,
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  CMS is actually they're they have a major
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  focus around provider data.
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  That journey, took off several years ago. It
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  gathered steam, the fall of last year,
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  and the Real Providers Act actually was signed
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  into the law,
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  the very beginning of this year. But it's
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  really about transparency
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  and having payer organizations
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  truly help to put their provider data out
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  there and make it transparent for members in
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  a way that's consumable,
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  but also that, again, back to it being
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  accurate and the members can trust it. But
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  it is signed into law, real providers act,
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  and it's going to continue to iterate
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  around, health plan organizations
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  really being able to
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  represent their health plans through the directories. Right?
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  And that's really who they stand for, and
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  that's where members can ultimately help to trust
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  them to, make a decision going forward.
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  Really great point. Robert, anything you'd like to
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  add? Yeah. I think scalability is gonna be
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  a bigger deal. A lot of companies are,
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  you know, doing pilots. They're proving it out
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  in maybe a one line of business or
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  a small market,
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  but they have to think through what are
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  the organizational effects, what do they learn from
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  those pilots, how do they structure the organization
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  so they can support it ongoing,
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  are they putting the right governance as we've
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  talked about in place for both AI and
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  for data,
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  are they, you know, looking at the outcomes
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  and measuring the right things?
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  And then finally, organizations that scale successfully are
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  the ones who are gonna put the plumbing
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  in first,
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  before they look to kinda grow and add
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  on the features beyond that.
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  Absolutely.
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  Regulatory changes, scalability, two great things to keep
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  in mind as we close this conversation.
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  Thank you, Robert, Martin, and Bob, for your
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  time and great insights today. We also wanna
• 12:04
  thank our podcast sponsor, Quest Analytics.
• 12:06
  You can tune in to more podcasts from
• 12:08
  Becker's Health Care by visiting our podcast page
• 12:10
  at beckershospitalreview.com.