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

Transcript

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

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400 payer and health plan executives
• 0:12
  and more than 100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George W.
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:34
  Hello, everyone, and welcome to the Becker's Healthcare
• 0:36
  Podcast. I'm Scott King. Thrilled today to be
• 0:38
  joined by Jay Nakashima, president of eHealth Exchange.
• 0:42
  Jay, how are you doing today? Thanks so
• 0:43
  much for joining us.
• 0:44
  Yeah. Hey. Thank you for having me. I'm
• 0:46
  doing great.
• 0:48
  Excellent. Yeah. It's a new year, but, some
• 0:50
  of the same kind of trends and topics
• 0:52
  in health care and with health plans and
• 0:54
  and so maybe some new ones to address.
• 0:55
  So we'll dive into all that. But, Jay,
• 0:57
  before we get started on the topics, I
• 0:59
  was just wondering if you could please share
• 1:00
  a little bit about your background and career
• 1:03
  journey, please.
• 1:04
  Yeah. You bet. So,
• 1:07
  so I've been working in the health IT
• 1:10
  space
• 1:11
  for over thirty years.
• 1:13
  I spent about ten years,
• 1:17
  my first ten years with health plans
• 1:20
  as they were merging and
• 1:22
  acquiring others every other day,
• 1:25
  and, was ultimately
• 1:27
  the CIO
• 1:28
  of an HMO
• 1:30
  PPO.
• 1:31
  I then moved over to the
• 1:34
  clinical
• 1:35
  IT space. So I worked for
• 1:38
  a couple of large,
• 1:41
  EHR vendors
• 1:43
  that helped out,
• 1:44
  hospitals and health systems.
• 1:47
  I then went to work for a large
• 1:49
  national
• 1:50
  provider,
• 1:52
  again, on the clinical IT strategy
• 1:56
  side. And then I've been,
• 1:58
  running
• 1:59
  eHealth Exchange,
• 2:01
  which is a nonprofit,
• 2:04
  data exchange network, and I've been doing that
• 2:07
  for the past
• 2:09
  eight years.
• 2:10
  Wow. Thanks for sharing your career journey, Jay.
• 2:12
  So much great experience in there. The first
• 2:15
  topic I wanted to get to,
• 2:17
  how are your relationships with providers changing
• 2:20
  as both sides face cost pressure and workforce
• 2:23
  shortages?
• 2:24
  Yeah. Great question.
• 2:26
  So eHealth Exchange was created about twenty years
• 2:30
  ago by the federal government,
• 2:32
  as strange as that sounds,
• 2:34
  as,
• 2:35
  as a nonprofit
• 2:37
  health tech company,
• 2:39
  another strange concept.
• 2:41
  But at any rate,
• 2:42
  the Health Exchange was originally founded,
• 2:46
  to help
• 2:47
  health care providers
• 2:50
  exchange,
• 2:51
  rich clinical information, so patients'
• 2:54
  electronic medical records,
• 2:56
  and, to exchange those among healthcare providers
• 3:01
  and with federal agencies.
• 3:04
  So, when I mentioned federal
• 3:06
  agencies, you might think of like the
• 3:09
  Veterans Administration,
• 3:10
  the largest,
• 3:12
  healthcare provider in the country,
• 3:14
  and the Department of Defense, who has army
• 3:17
  hospitals, navy hospitals, etcetera. But at any rate,
• 3:19
  hospitals,
• 3:19
  etcetera.
• 3:21
  But at any rate,
• 3:23
  it really took us it really took us
• 3:26
  a good ten years,
• 3:28
  to get health care providers
• 3:30
  to exchange
• 3:31
  data
• 3:32
  at scale and with trust.
• 3:35
  And that was for the HIPAA treatment purposes.
• 3:39
  And, you know, got to the point where
• 3:41
  we were exchanging,
• 3:43
  you know, over 20,000,000,000
• 3:46
  healthcare
• 3:47
  transactions
• 3:48
  annually,
• 3:49
  and of course, in all 50 states.
• 3:52
  And, and now we're up to 25,000,000,000.
• 3:56
  But the vast majority of those,
• 3:59
  electronic medical records being exchanged
• 4:02
  are still being exchanged for the HIPAA treatment
• 4:06
  purpose.
• 4:07
  So, think of
• 4:08
  a clinician at the chair side, bedside,
• 4:11
  tableside, whatever,
• 4:13
  about to prescribe a medication or order a
• 4:16
  surgery.
• 4:17
  And we've shifted over the past five years
• 4:21
  to also
• 4:23
  focus on payer provider exchange,
• 4:26
  and
• 4:28
  provider
• 4:29
  to public health exchange.
• 4:31
  So, we're really excited about reducing
• 4:34
  the burden that both payers
• 4:37
  and providers have
• 4:39
  when exchanging
• 4:41
  patients' electronic
• 4:43
  medical records.
• 4:45
  I appreciate you shedding a light on all
• 4:47
  that wonderful work there, Jay. A lot of
• 4:49
  progress has been made, and certainly a lot
• 4:51
  of growth there. Next question I want to
• 4:53
  ask you, where do you see the biggest
• 4:55
  gap today between payer strategy and
• 4:58
  operational execution? I think it's, you know, in
• 5:01
  my mind, it's really in the it's really
• 5:04
  in the,
• 5:06
  lack of understanding
• 5:07
  of of how inefficient
• 5:09
  the current processes are.
• 5:12
  So, you know, when I speak with providers,
• 5:14
  you know, from large sophisticated
• 5:17
  health systems,
• 5:18
  you know, they often tell me, oh, you
• 5:20
  know, we don't share patient records with payers.
• 5:24
  And just as nicely and tactfully as I
• 5:26
  can, I say,
• 5:28
  well, of course you do? You know, you've
• 5:30
  been doing this for thirty, forty years.
• 5:34
  It's just been a behind the scenes operation
• 5:37
  that number one is required in your payer
• 5:40
  provider
• 5:41
  contract,
• 5:42
  but it might be also happening in an
• 5:45
  unscalable,
• 5:47
  unscalable
• 5:48
  fashion.
• 5:49
  So, it might be happening
• 5:51
  via,
• 5:52
  and sorry for the non techies,
• 5:54
  it might be using an old school HL7
• 5:58
  version two interface,
• 6:00
  or it might be someone swapping
• 6:03
  Excel CSV
• 6:05
  files,
• 6:05
  or it might even be the dreaded fax
• 6:08
  machine.
• 6:09
  But regardless, that data is being exchanged today,
• 6:13
  but it's
• 6:15
  expensive
• 6:15
  and clumsy,
• 6:17
  and, and so that's what eHealth Exchange is
• 6:20
  trying to
• 6:21
  tackle.
• 6:22
  We're trying to,
• 6:24
  number one, demystify
• 6:26
  the process,
• 6:28
  use national standards,
• 6:31
  and apply modern technology
• 6:34
  so that it's easier and less expensive to
• 6:37
  exchange
• 6:38
  the medical records.
• 6:40
  Are you surprised that there has to be
• 6:41
  efforts to kinda get people to adapt to
• 6:44
  pretty basic modern tech at this point?
• 6:47
  Yeah.
• 6:48
  You know, it's,
• 6:49
  yeah, it's it's really surprising,
• 6:52
  you know, that, that fax machines are are
• 6:55
  not only alive and well, but they're used
• 6:59
  at such tremendous volume currently.
• 7:02
  And so, you know, when we speak to
• 7:04
  payers and providers about this and we explain
• 7:06
  the possibilities,
• 7:08
  they really do get excited.
• 7:11
  In terms of possibilities, what's one investment or
• 7:14
  initiative you believe will most reshape how health
• 7:16
  plans operate over the next two to three
• 7:18
  years?
• 7:20
  Yeah. Great question.
• 7:21
  So, you know, so we we use the
• 7:24
  national standards, which have been, you know, government
• 7:27
  endorsed, and it's called HL seven.
• 7:30
  And we're using,
• 7:32
  modern
• 7:33
  APIs. So think about
• 7:35
  think about the the the programming
• 7:38
  framework, you know, used in your mobile phones,
• 7:42
  you know, for social media,
• 7:44
  to deal with your bank,
• 7:46
  to order coffee at Starbucks,
• 7:48
  whatever.
• 7:49
  And so, you know, we're leveraging that same
• 7:52
  technology.
• 7:53
  We're actually using the healthcare
• 7:57
  FHIR, FHIR,
• 7:59
  technical specifications,
• 8:02
  to
• 8:03
  facilitate
• 8:04
  the movement of electronic
• 8:06
  medical records.
• 8:08
  And of course, we're not using mobile phones
• 8:10
  to do this,
• 8:11
  but we're installing
• 8:13
  these apps,
• 8:16
  on health plan and providers'
• 8:19
  large
• 8:19
  institutional
• 8:21
  computer servers,
• 8:23
  to facilitate the exchange
• 8:25
  in a scalable,
• 8:26
  standardized,
• 8:28
  trusted
• 8:29
  fashion.
• 8:31
  Yeah. You know, I I know we just
• 8:32
  kinda touched on being surprised that
• 8:34
  people are are still using, you know, fax
• 8:37
  machines for a lot of these records. But
• 8:39
  I've also heard, you know, particularly at our
• 8:42
  conferences
• 8:43
  from payer leaders that they're surprised how many
• 8:45
  seniors
• 8:46
  are utilizing these apps correctly and efficiently. Have
• 8:49
  you seen that?
• 8:51
  I you know, I I haven't seen it
• 8:53
  personally, but, but it's something that eHealth Exchange,
• 8:57
  definitely
• 8:58
  supports.
• 8:59
  You know, I think I think I I
• 9:01
  really haven't seen it just because our scale
• 9:03
  is so big. Again, 25,000,000,000
• 9:05
  records
• 9:07
  annually.
• 9:08
  And,
• 9:09
  the number, the percentage of that that's facilitated
• 9:13
  by individuals
• 9:15
  is still relatively
• 9:16
  small.
• 9:17
  But, you know, to your point,
• 9:21
  as consumers and individuals,
• 9:23
  become more and more tech savvy,
• 9:26
  and unfortunately,
• 9:28
  as healthcare costs increase,
• 9:31
  and and as patients become more vested
• 9:35
  in their
• 9:36
  clinical healthcare outcomes,
• 9:39
  yeah, I see them absolutely
• 9:41
  using
• 9:42
  technology,
• 9:44
  to,
• 9:45
  for electronic medical records.
• 9:48
  I, you know, personally
• 9:50
  use it myself.
• 9:52
  And, it's really helpful because, you know, like
• 9:54
  most people, I see more than one health
• 9:57
  care provider
• 9:59
  in more than one setting,
• 10:01
  and I like to have all of my
• 10:02
  data consolidated,
• 10:05
  in one place that I can access
• 10:07
  via my phone or via my,
• 10:11
  my laptop.
• 10:13
  Absolutely.
• 10:14
  If you could change one regulatory or industry
• 10:17
  practice tomorrow
• 10:18
  to improve affordability and access, what would it
• 10:21
  be and why?
• 10:23
  You know, there's something in HIPAA called the
• 10:25
  minimum
• 10:26
  necessary rule.
• 10:27
  And, you know, this was written back, you
• 10:29
  know, in the previous century,
• 10:33
  before before computer systems and the Internet
• 10:37
  were really deployed widespread.
• 10:39
  And so what this rule is is currently
• 10:43
  interpreted to say
• 10:45
  is that,
• 10:47
  is that,
• 10:48
  HIPAA covered entities, so including payers and providers,
• 10:53
  can only exchange
• 10:55
  the minimum
• 10:56
  necessary
• 10:58
  for quality
• 10:59
  purposes.
• 11:00
  And so the million dollar question is, what's
• 11:03
  the minimum necessary?
• 11:06
  And, you know, computer systems,
• 11:08
  be it at two in the morning or
• 11:10
  two in the afternoon,
• 11:12
  have a hard time interpreting that.
• 11:15
  So I'd love,
• 11:16
  the policy side,
• 11:19
  to have the government
• 11:20
  publish
• 11:21
  an interpretation
• 11:23
  of what is the HIPAA minimum necessary.
• 11:26
  Yeah. I think that'd be fantastic.
• 11:29
  I I certainly think you'll have some support
• 11:30
  there. Yeah. The last the last thing I
• 11:32
  want to ask you, Jay,
• 11:34
  what issue is putting the most pressure on
• 11:36
  health plan margins right now,
• 11:39
  and how will you respond differently in in
• 11:41
  2026?
• 11:43
  Yeah. So the biggest pressure for health plan
• 11:45
  margins right now I I mean, it's gotta
• 11:47
  be,
• 11:48
  you know, of course, there's,
• 11:49
  of course, there's the medical loss ratio,
• 11:52
  but the administrative
• 11:54
  costs are really getting a focus in the
• 11:57
  in,
• 11:58
  in the media,
• 12:00
  as well as from investors.
• 12:02
  And, and so we're really excited to help
• 12:06
  reduce the administrative
• 12:08
  cost,
• 12:10
  via electronic medical exchange.
• 12:13
  Jay, thanks so much for joining the podcast
• 12:15
  and for a great conversation. Look forward to
• 12:16
  working with you again soon. Alright. Thank you,
• 12:19
  Scott.