Latest / Becker’s Payer Issues Podcast / Innovating Payer-Provider Collaboration with Veradigm’s Courtney Yeakel & Michael Moore

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Innovating Payer-Provider Collaboration with Veradigm’s Courtney Yeakel & Michael Moore · Becker’s Payer Issues Podcast

0:00
Hi, everyone. This is Erica Spicer Mason with
0:02
Becker's Healthcare. Thank you all so much for
0:04
tuning into the Becker's Healthcare podcast series. So
0:07
today we're going to talk about how innovative
0:09
tech can connect payers, providers, and patients to
0:12
improve outcomes and quality.
0:14
And joining me for this conversation are two
0:16
leaders from Veradigm.
0:17
We have with us Courtney Yackel, Chief Product
0:20
Officer, and Michael Moore, Chief Revenue Officer. Courtney
0:23
and Michael, welcome to the podcast.
0:25
Thank you. Thank you. We're so glad to
0:28
have you both with us. But before we
0:30
get into the questions, I wanted to see
0:31
if you'd like to share just a little
0:32
bit more about yourselves, your organization, whatever feels
0:35
top of mind. Absolutely. Thank you so much,
0:37
Erica.
0:38
So I'm Courtney Yackel, chief product officer with
0:41
Veradigm, and I started out my healthcare journey
0:44
on the payer health plan side of the
0:46
house,
0:47
for about ten years. So everything from risk
0:50
adjustment, quality analytics, strategic business unit,
0:53
primarily focused on government programs. So whether that
0:56
be Medicare advantage,
0:58
Affordable Care Act, or the state specific Medicaid
1:01
lines of business. So again, everything from analytics
1:04
and financial reporting,
1:06
to the lovely data submissions, and then of
1:08
course, keeping up with the multiple CMS regulatory,
1:12
guidance that, we all know and love. Yeah.
1:14
You know payers inside and out. Absolutely. And
1:17
then jumped over, to start up mode and
1:19
have been, a part of the Veradigm family
1:22
for about ten years now. So very much
1:24
looking forward to the payer issues roundtable this
1:27
week along my esteemed colleague here, Michael.
1:31
So hi, everyone. This is Michael Moore. I
1:33
am, the chief revenue officer for Veradigm Payer.
1:37
And we were talking last night and getting
1:39
ready for this that I can't believe it's
1:41
been thirty five years since,
1:43
I got into the,
1:46
technology space and and health plans and,
1:49
providers. So I've spent a career
1:53
working in health care technology, helping
1:56
get to that triple aim
1:58
and connecting
1:59
providers
2:00
and
2:01
payers so that we have the outcomes that
2:03
we all seek, and that's healthier patients. So
2:06
we're really glad to be here. This has
2:07
been a great conference so far. See a
2:09
lot of old colleagues and,
2:12
new people getting into the industry, and we're
2:14
just really excited to be a part of
2:15
this podcast.
2:16
Oh, I'm thrilled to have you both on
2:18
the podcast with us today, and I love
2:20
that we're addressing
2:21
what's going to benefit both payers and providers.
2:23
You know, so often the conversation is kind
2:25
of siloed, who's doing what, but I appreciate
2:28
that this we have this perspective on the
2:29
line of, alright, how are these groups working
2:32
together to get the patient outcomes and quality
2:33
outcomes that they wanna see.
2:35
So as payer and provider partnerships evolve and
2:38
we are seeing a more kind of conscious
2:41
effort among these entities to collaborate and work
2:43
together,
2:44
what strategies have you both seen successfully reduce
2:47
administrative complexity,
2:49
especially
2:50
doing so while being able to improve patient
2:52
outcomes. Can you share us through any examples
2:54
of that?
2:55
Certainly. Thank you. It's
2:57
it's really interesting when you look at,
3:00
how these organizations, provider organizations and payer organizations,
3:05
addressing the market and creating their strategies. Number
3:09
one, you should keep in mind that
3:11
all the government sponsored programs, these are the
3:14
Affordable Care Act or Edge,
3:16
Medicaid, and Medicare Advantage,
3:18
are all becoming more and more complex.
3:22
They are all focused on how to document
3:25
your achievements
3:27
as a provider or as a payer. And
3:29
so our our first focus from a strategy
3:32
standpoint is that
3:34
an early adopter
3:36
needs to
3:38
learn
3:39
what their organization needs to be compliant with
3:42
the government as a payer or a provider
3:45
for quality initiatives, etcetera. So they have to
3:47
learn and be educated, educate themselves,
3:50
and, they have to, number two, talk with
3:54
their
3:54
payer organizations. They have to understand
3:57
what that payer organization is trying to accomplish,
4:00
and then they have to
4:02
execute. They have to get involved with that
4:05
payer and collaborate with that payer.
4:08
For a long time, there's always been
4:11
a certain amount of animosity or adversity between
4:14
payers and providers,
4:16
and
4:17
both parties should understand that we are here
4:20
to solve both of their problems. And
4:23
not engaging and not collaborating
4:26
is just going to extend the problems further.
4:30
Well signed, Michael.
4:31
I think in terms of leveraging technology, so
4:34
both Michael and I have been in the
4:36
the health plan payer space for quite a
4:38
long time. And working together at Veradigm, we're
4:41
able to capitalize upon the technology,
4:45
components from the large and growing provider network.
4:49
So when you bring together some of those
4:51
those objectives
4:52
that both payers and providers are diligently working
4:56
to strive to solve for, there's a couple
4:59
of of key themes that you see fragmented
5:01
data, right, in terms of how they interpret
5:04
the data. Michael talks about establishing that dialogue
5:07
together. Well, at first, we need to make
5:09
sure that we're speaking the same language
5:11
in terms of any datasets that we're looking
5:14
at, benchmark reporting, financial reporting. The ways that
5:17
payers are reimbursed is completely different than how
5:21
our physicians are reimbursed. However,
5:23
we are all striving to move towards more
5:25
value based care arrangements, and that's really where
5:28
you bring in the beauty of both risk
5:30
adjustment and quality initiatives,
5:33
leveraging that technology. So if you think about
5:36
analytics,
5:37
making sure that you're able to,
5:39
have that trustworthy
5:40
dataset
5:41
at the point of care so that physicians
5:43
are able to take action upon those.
5:46
We're seeing it through this calendar year 2026
5:49
regulatory guidance that was just released this month
5:52
that is jam packed with some regulatory changes
5:56
that are up and coming for this next
5:57
year, very much focused on capitalizing
6:00
both risk adjustment and quality initiatives
6:03
that are impacting both payers
6:05
and providers.
6:07
At the end of the day, it's all
6:09
in how we establish that trusting relationship
6:12
that will ultimately benefit the health outcomes for
6:14
the member or the patient. Yeah. Such a
6:16
helpful overview. Thank you both for really painting
6:20
the the picture for our listeners.
6:22
And I know you had just mentioned,
6:24
risk adjustment
6:34
home assessments,
6:35
tech driven strategies. So from your perspectives, how
6:38
is that space evolving, and where is technology
6:40
making the biggest difference right now?
6:43
That's a perfect segue.
6:44
We see that,
6:46
risk adjustment and quality are becoming the same.
6:50
Risk adjustment
6:51
from, its
6:53
traditional retrospective view will always be around from
6:56
a a way to get paid properly for
7:01
the risks that are in your patient population,
7:03
getting the proper premium for bearing those risks
7:06
as a health plan or an ACO.
7:09
Likewise, though, shifting
7:11
from a retrospective
7:13
view to a prospective view will be a
7:17
bigger
7:18
ROI
7:19
on the investment in
7:21
the outcomes that you're gonna measure from a
7:24
performance standpoint
7:25
and from a client's health, both the quality
7:29
of the care that they receive through metrics
7:32
for things like HEDIS,
7:33
but also from the outcomes are, do we
7:36
have a healthier and happier patient population?
7:39
Another example of
7:41
quality and risk adjustment
7:43
commingling for the future
7:45
is the use of in home assessments.
7:48
In home assessments are sending a qualified caregiver
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to a person's home.
7:54
And, traditionally, it has been
7:57
very, very expensive
7:59
to, in a rural situation, send
8:02
a nurse practitioner or a doctor to someone's
8:04
home
8:06
for an annual wellness exam or for just
8:09
an encounter. And so virtual care took
8:12
the place of that for a few years.
8:16
What we have seen the best value come
8:18
out of IHAs
8:20
is the gathering of social determinants of health
8:23
data. When you're in a person's home, you
8:26
can see that there are food insecurities
8:29
or there are travel insecurities or there's medication
8:32
rationing that's going on. These are all direct
8:36
drivers
8:36
of people's access to care that directly affects
8:40
the outcomes.
8:42
We've also seen
8:43
that when surveyed,
8:46
close to eighty percent of patients
8:49
don't want
8:50
a caregiver coming into their home. So you've
8:53
got this
8:55
dramatic need
8:57
to address
8:58
patients who aren't getting care due to access
9:01
issues,
9:02
at the same time not wanting
9:04
a caregiver in their home
9:06
out of
9:08
fear or embarrassment
9:10
or whatever the case might be. So
9:13
we see IHAs as valuable,
9:15
but
9:16
the expense of them has to be driven
9:18
toward quality
9:20
and the values that you get out of
9:21
quality results than you do necessarily for care.
9:25
Yeah. And if you don't mind, could I
9:26
just ask you a really quick follow-up question,
9:28
Michael? You mentioned how risk adjustment and quality
9:31
are kind of becoming
9:33
one in the same.
9:35
So how would you encourage organizations to really
9:37
be viewing
9:38
quality and risk adjustment as part of their
9:40
strategic objectives? Do you recommend any shifts there?
9:43
Well, the the biggest shift will be to
9:45
focus on the patient, and and that's
9:48
it shouldn't be a shift, really. Everybody should
9:50
always be focused on the patient.
9:53
But from a documentation
9:55
process, these government programs
9:57
are
9:58
now requiring documentation
10:00
to justify
10:02
and,
10:03
clearly report
10:05
on the production that these programs have. In
10:08
the past, we've seen a number of value
10:11
based care contracts.
10:13
While their their intent was to incent a
10:16
provider organization for a certain performance,
10:19
we've not seen them
10:21
managed
10:22
in the way that they need to to
10:24
clearly document the encounters and the successes that
10:28
you have and also the the the lack
10:30
of success.
10:32
Quality thus then becomes
10:34
an outcome of patient care and measured across
10:38
those, we're we're going to see an extension
10:41
and a broadening of the ways that we
10:43
measure quality
10:45
and,
10:46
not only to include
10:48
patient preferences or the happiness of the patient,
10:51
but the sheer outcomes of the diagnoses
10:53
and,
10:54
service codes that we document in the encounter.
10:57
So interesting. And I I know, Courtney, you've
10:59
been in the payer space a long time
11:01
too. So what would you add? Anything?
11:03
I would add that bringing together both risk
11:06
adjustment and quality really fosters that
11:10
sense of accountability
11:12
for both health plan payers and the physicians
11:15
because, ultimately, they have the same objective,
11:18
having the the member patient right at the
11:20
center of care from a health plan perspective.
11:23
Right? They want to make sure that they
11:24
are able to
11:26
retain the member and offering extremely rich benefits
11:30
that will allow the the member to live
11:32
that healthy independent
11:34
life.
11:35
Same goes for a physician. Right? That is
11:37
their ultimate goal. If you if you take
11:39
out all of the crazy
11:41
acronyms of health care, ultimately,
11:44
the care of the patient is where health
11:46
plan payers and physicians come together, which is
11:49
the beauty of why we all get out
11:50
of bed each day and and do this.
11:52
However, it's extremely challenging,
11:55
But bringing together
11:56
high stakes,
11:58
functions across risk adjustment and quality, and Michael
12:01
and I see this every day. And I
12:03
can say this because I've been sitting in
12:05
the health plan shoes. Right? Ensuring that you
12:07
were you're talking and having those conversations in
12:11
terms of your objectives and your strategies,
12:13
not only from a a patient centric mode,
12:16
but in terms of what types of vendor
12:19
partnerships or what types of technology or datasets
12:22
that you're utilizing
12:24
to achieve both the objectives for risk and
12:26
quality. Again,
12:27
with that that total health, care outcome in
12:31
mind. Yeah. Oh, fantastic. And, Courtney, I know
12:33
you mentioned a bit earlier in the discussion
12:35
too that technology is a really big part
12:37
of the trans transformation of getting payers and
12:40
providers to work collaboratively, get the shared outcomes
12:43
and aims that they have.
12:45
And AI is gaining momentum in the payer
12:47
and provider operational space. So
12:49
over the next year or so, what are,
12:51
what are you seeing as realistic use cases
12:53
where
12:54
they will see measurable impact? That's something our
12:57
our listeners are always wanting to know, or
12:59
even an area where you're seeing strong potential.
13:01
Would you mind just elaborating a bit on
13:03
your thoughts there? Sure. Absolutely. Happy to. There's
13:06
so much going on in the AI space
13:09
at this time. I will talk about a
13:11
lot of the exciting things, and then I'll
13:13
pass it over to Michael who will talk
13:14
about the incredibly important pieces around data governance.
13:18
However, what we are seeing right now in
13:20
terms of the immediate impact is we we've
13:23
talked a little bit about bringing those gaps
13:25
in care
13:26
at the point of care, whether they be
13:28
for risk adjustment or quality. But how do
13:30
we ultimately ensure that the documentation
13:33
is complete, accurate, and timely,
13:36
both from a physician education perspective. Right? We
13:40
wanna make sure that we're not overburdening the
13:42
physicians.
13:43
We're not contributing to that fatigue. We wanna
13:46
make it seamless and simple for them in
13:48
terms of presenting those gaps in care. One
13:52
piece of that in terms of leveraging the
13:54
technology is natural language processing, so our NLP,
13:57
and certainly our machine learning. We have access
14:00
to an incredible depth of data,
14:03
And how we use that is extremely important,
14:05
whether we're utilizing
14:07
case and disease registry data for predictive analytics.
14:10
Right? It's establishing
14:12
the the grounds of trust and transparency. Again,
14:16
bridging that conversation between a health plan payer
14:19
and a physician in terms of how did
14:22
you determine these particular gaps in care. Right?
14:25
What datasets did you utilize? And AI is
14:28
a great,
14:29
asset
14:30
for health plans and physicians to leverage in
14:32
that in those means.
14:35
So
14:36
Veradigm,
14:37
has been involved in artificial intelligence and machine
14:40
learning and natural language processing and other
14:44
application of early stage AI,
14:47
for quite some time. Through the process
14:50
of of these technologies,
14:52
we have created
14:54
an artificial intelligence center of excellence at our
14:56
company that brings in
14:59
broad disciplines of people from functional areas of
15:02
a health plan and a provider organization
15:05
to look at applications,
15:07
for leveraging
15:09
AI.
15:10
What we're immediately
15:11
drawn to are the responsibilities
15:14
that go with managing this kind of data
15:18
and these types of tools. And so we
15:20
have established,
15:22
and continue to establish a level of governance
15:24
around usage of this information, distribution of the
15:27
information
15:28
in
15:29
our provider,
15:31
segment, in our life sciences segment, and in
15:33
our payer segment.
15:35
And we will continue to see that evolve,
15:38
and it's a little bit of a a
15:40
an oxymoron of of governance because right now,
15:43
there's just very little governance in the AI
15:46
world. And so,
15:48
we are treading
15:50
cautiously
15:50
but very optimistically
15:52
at using our current capabilities and looking at
15:56
new capabilities for the functional areas we just,
15:59
we just talked about. But
16:01
it it's more than that.
16:03
We are we are applying
16:06
artificial intelligence to the way we do business
16:09
to assist,
16:11
physicians
16:12
and health plans in improving
16:15
their time
16:16
or improving their engagement.
16:18
To particularly illustrate an example is we have
16:21
the ability for providers
16:24
to speak
16:25
into a microphone and us ambiance scribe their
16:29
information
16:30
into a coding structure that automatically codes a,
16:34
a claim at the point of care,
16:36
vastly
16:37
facilitating
16:38
the documentation time that a provider may have.
16:42
Similarly, we have,
16:44
capabilities that can automate how a patient gets
16:49
scheduled for,
16:50
available appointments in a in a doctor's office.
16:53
If we know a patient is looking for
16:55
a doctor of this type and for this
16:57
type of treatment service, we can scan the
17:00
available providers and availability on their appointments and
17:03
automatically schedule those patients for those encounters,
17:07
dramatically improving the front office operation of a
17:10
physician office.
17:12
So we're using AI to address current functional
17:16
areas. And in the future, we hope to
17:18
be moving to
17:20
where
17:21
AI will provide us decision points.
17:24
And those decision points meaning
17:26
recommended,
17:28
diagnoses or recommending,
17:30
certain services
17:31
or recommending certain
17:33
follow-up visits based on treatment protocols. So
17:37
the world is wide open for AI, but
17:39
we have to proceed very cautiously
17:42
but optimistically
17:43
to address physician and payer problems.
17:46
Yeah. And that that cautious optimism, it really
17:49
comes through. Everything that you just outlined is
17:51
so exciting to think about that future state,
17:53
but having something like the center of excellence
17:55
that Veradigm has sounds essential for this for
17:57
this time when governance is at a minimum.
18:00
So well, thank you both so much. I've
18:02
so enjoyed this conversation.
18:04
Any final thoughts before we close?
18:06
Yes.
18:07
Every time we,
18:09
we get involved with a physician organization
18:13
or
18:14
a a payer organization, whether it's any type
18:16
of risk bearing ACO or,
18:19
subgroup of a payer,
18:21
the one thing we have recognized
18:23
is that,
18:24
our businesses
18:25
are still operating in silos.
18:27
And,
18:28
we still have people within our clients that
18:31
we are introducing to one another, that they
18:34
are
18:35
they are struggling to reach within their own
18:38
organizations
18:39
and collaborate
18:40
among themselves
18:41
and each other. And so one of our
18:44
biggest
18:45
efforts is to make sure that our
18:47
clients are dialoguing
18:49
within their own walls,
18:51
and that are,
18:52
whether they be a a provider or a
18:54
payer, that they are
18:56
educated on the decisions they're trying to make
18:58
and the options that are available to them.
19:00
And they only get that through a proper
19:02
dialogue,
19:03
between payers and providers.
19:05
Yeah. Such an important point. Courtney, any final
19:08
thoughts?
19:09
As you think about
19:10
bringing
19:12
and leveraging technology
19:13
and then, of course, the human component to
19:16
health care, I think now is an incredibly
19:20
exciting and invigorating and certainly an inspiring time,
19:23
especially as we sit here this week,
19:26
to put
19:27
these ideas, thoughts, business cases, the technology into
19:32
action. We have all of the pieces and
19:34
ready to rock and roll. The only thing
19:36
that's keeping us from doing that, right, is
19:39
that relationship between the payer and the provider.
19:42
And, again, because Veradigm is uniquely positioned in
19:45
that aspect and having the expansion
19:48
of provider network and then coupled with the
19:51
payer experience,
19:52
bringing those gaps at the point of care
19:56
to ultimately drive improved health outcomes is incredibly
20:00
meaningful
20:01
to our industry. And I just am so
20:03
thrilled to be a part of it.
20:05
Well, it's been great hearing from you both.
20:07
Such good thought leadership in this short amount
20:09
of time together. So thank you both so
20:11
much for making the time for Becker's. It
20:12
was great having you. Thank you. Thank you.
20:15
And we'd also like to thank our podcast
20:17
sponsor for today, Veradigm.
20:19
Listeners, be sure to tune into more podcasts
20:21
from Becker's by visiting our podcast page at
20:23
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