Latest / Becker’s Payer Issues Podcast / Transforming Payment Integrity with AI: A Conversation with Raj Ronanki, CEO of Lyric

Transcript

Transforming Payment Integrity with AI: A Conversation with Raj Ronanki, CEO of Lyric · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Elizabeth Gregersen with Becker's
• 0:03
  HealthCare. I'm excited to be joined today by
• 0:05
  Raj Rananki,
• 0:06
  CEO of Lyric.ai.
• 0:09
  Thank you so much for joining us.
• 0:11
  Yeah. Lots of changes, Elizabeth. So, as you
• 0:13
  know, Lyric was previously called Claims Extend, and
• 0:16
  it's been a a storied utility in in
• 0:20
  the health insurance and the health plan industry.
• 0:22
  It's been around for, you know, thirty plus
• 0:24
  years. And over the course of those thirty
• 0:27
  years, it's, changed ownership
• 0:29
  structures and various entities,
• 0:31
  from, you know, from time to time.
• 0:34
  Most recently,
• 0:35
  it was part of Change Healthcare, and as
• 0:37
  a part of the UnitedHealth
• 0:38
  acquisition, it was divested into a independent company.
• 0:42
  TPG acquired the company about, you know, a
• 0:45
  little over two and a half years ago.
• 0:46
  And, at that the point that I joined
• 0:49
  the company.
• 0:50
  And and, really, the goal was to to
• 0:52
  really understand what made the company tick. And,
• 0:56
  I think one of the first things that
• 0:57
  I learned was that the culture of the
• 0:58
  company
• 0:59
  and and the customer obsession and orientation
• 1:03
  were really just remarkable. There was not a
• 1:06
  single customer that was dissatisfied with with the
• 1:08
  state of the software or had any issues.
• 1:10
  So
• 1:11
  that was something that was very important for
• 1:12
  us to preserve and build on. You know?
• 1:14
  So what we did was then
• 1:16
  combine sort of
• 1:17
  that ethos of of a customer obsession that
• 1:20
  sort of served customers with distinction
• 1:22
  and really bought in some world class technology
• 1:25
  to to kinda power that. So the last
• 1:27
  couple years, that's what we've been doing. It's
• 1:29
  just to
• 1:30
  transform
• 1:31
  Lyric and our flagship application, which was a
• 1:34
  great point solution,
• 1:35
  from that into a platform
• 1:37
  that could then create multiple offerings and solutions
• 1:40
  for our customers and deliver that as a
• 1:42
  one stop shop for
• 1:44
  end to end, you know, payment integrity.
• 1:47
  Perfect.
• 1:48
  Did you wanna talk a little bit about
• 1:50
  what you're most looking forward to in the
• 1:52
  future? Yeah. As as I as I look
• 1:54
  ahead,
• 1:55
  I think, there have been a few times
• 1:57
  sort of in our in our history in
• 1:59
  in the recent past.
• 2:00
  I I think back to the Internet era,
• 2:02
  the mobile era, where
• 2:05
  the the tectonic shifts in technology
• 2:07
  really propelled, you know, businesses forward.
• 2:10
  And there was lots of disruption that happened,
• 2:13
  but there was a lot of opportunities created.
• 2:15
  So when I look at all that's happening
• 2:18
  in the world of AI, Gen AI, and
• 2:20
  how that's gonna disrupt pretty much every industry,
• 2:23
  you know, health care included, you know, I
• 2:25
  see tremendous opportunity for Lyric
• 2:27
  to leverage those technologies, which we already are
• 2:29
  to some extent,
• 2:30
  and reshape how health care can happen in
• 2:32
  our country, which is it could be more
• 2:34
  real time.
• 2:35
  I think we could be much more transparent.
• 2:37
  I think we could drive a lot of
• 2:38
  waste out of the system, create more value
• 2:40
  and impact. And the tech is our friend,
• 2:42
  you know, to be able to do all
• 2:44
  of that. So most looking forward to the
• 2:46
  next, you know, two to three years, you
• 2:48
  know, Lyric sort of driving a greater degree
• 2:50
  of impact with a greater amount of transparency
• 2:52
  and ultimately
• 2:54
  powering the transformation of the system to be
• 2:56
  much more real time, much more transparent, much
• 2:58
  more consumer friendly
• 2:59
  with more access and equity to in health
• 3:01
  care that, you know, has largely been missing
• 3:03
  for the last couple of decades.
• 3:05
  Perfect.
• 3:06
  So I'd love to talk about ClaimShark.
• 3:08
  Why was it the target of your first
• 3:11
  major organization acquisition?
• 3:14
  Great question. Very excited about that acquisition. And,
• 3:17
  you know, in fact, last week, we had,
• 3:19
  you know, some of our strategic customers in
• 3:21
  for an advisory board meeting here in Chicago.
• 3:24
  And we reviewed, you know, more, more of
• 3:26
  the detailed product road map and the rationale
• 3:29
  for the acquisition with them, and they'll be
• 3:30
  very excited about,
• 3:32
  you know, what we could bring in
• 3:34
  together with Lyric, you know, what what we
• 3:36
  can actually do in terms of impact for
• 3:38
  them. The main reason we acquired them was
• 3:40
  that, you know, it's twofold. One was we
• 3:43
  wanted to strengthen our platform capabilities. So think
• 3:45
  of that as the technical foundation, the plumbing,
• 3:48
  and making things easier for us to develop
• 3:50
  content,
• 3:51
  not only us, but also other partners that
• 3:53
  could develop content on our platform.
• 3:55
  And they have capabilities that enable us to
• 3:57
  do that. So our Lyric 42 platform, which
• 3:59
  we announced several months ago, I think would
• 4:02
  stand to to sort of have greater impact
• 4:04
  and greater potential with the ClaimShark edition.
• 4:08
  So together with them, we're setting out to
• 4:10
  create a ERP, sort of an enterprise resource
• 4:13
  planning system for payment integrity
• 4:16
  that would combine real time analytics insights with
• 4:19
  workflow
• 4:20
  so that all the the, you know, sort
• 4:23
  of the mess that our clients sometimes have
• 4:25
  to deal with in terms of silos, in
• 4:26
  terms
• 4:27
  of fragmented sort of data and fragmented teams,
• 4:31
  unify all that under one platform so that
• 4:33
  all things payment integrity, all thing medical trend
• 4:36
  could be in one place where you can
• 4:37
  look at it globally and action it. So
• 4:39
  ClaimShark allows us to do that. In addition,
• 4:42
  we can also
• 4:43
  leverage some of their post pay capabilities. So,
• 4:45
  for example, they have a coordination of benefits
• 4:47
  offering that's in post pay.
• 4:49
  They have a claims audit, you know, function
• 4:51
  that's in post pay and start to integrate
• 4:54
  that into prepay so that we can drive
• 4:57
  more yield and more impact, you know, for
• 4:58
  our customers.
• 4:59
  But also with that data,
• 5:01
  ultimately, we'd be able to create more real
• 5:03
  time intelligence on medical trend,
• 5:06
  so that we won't have to just react
• 5:08
  to the things that have happened in the
• 5:09
  past, but proactively predict what could happen with
• 5:11
  medical trend and mitigate it. And that was,
• 5:13
  I think, a super exciting development for us
• 5:15
  in terms of what we could do for
• 5:17
  our customers
• 5:18
  and I think the
• 5:19
  transformative impact could have on the whole industry.
• 5:22
  Absolutely. I had a panel that was actually
• 5:24
  talking about how to get all your different
• 5:26
  silos of data and merge them together. So
• 5:29
  it sounds really important. Yeah. How does Lyric
• 5:32
  balance the need to deliver high value services
• 5:35
  with the goal of achieving scalability
• 5:37
  and higher margins through technology and automation?
• 5:41
  Yeah. For no. For us, in our case,
• 5:42
  I think those things are not,
• 5:45
  at odds with with each other. In other
• 5:48
  words, driving more impact, driving more scale. You
• 5:50
  know? You know? Since Lyric is already at
• 5:52
  a hundred plus helpline customers, you know, we
• 5:54
  already have,
• 5:55
  you know, sort of achieved escape velocity in
• 5:57
  terms of scale.
• 5:59
  So now what we're doing is is looking
• 6:01
  at all the things that we do internally
• 6:03
  that require, you know, human horsepower to go
• 6:05
  drive. And we're saying, well, let's give AI
• 6:08
  the right of first refusal in doing anything.
• 6:10
  So before we add any single person, we'd
• 6:12
  say, well, can AI solve this problem? Or
• 6:14
  even if, let's just say, we wanna drive
• 6:16
  a little bit more productivity across the the
• 6:18
  company, we're asking everyone to use AI in
• 6:21
  their in their day to day life so
• 6:22
  that we can get that five, ten, fifteen,
• 6:25
  twenty percent, you know, productivity list. Right? So
• 6:27
  that's
• 6:28
  pretty much most companies are doing that. What's
• 6:30
  unique about but but Lyric is that where
• 6:34
  are we going next with that is this
• 6:35
  notion of creating autonomous operations.
• 6:38
  So
• 6:39
  automation is, you know, taking a task, a
• 6:41
  process, you know, or an end to end
• 6:43
  sort of workflow and saying, how could we
• 6:44
  automate that?
• 6:46
  Autonomous would mean that not only are we
• 6:48
  automating a process with a set of agents,
• 6:51
  but those agents could talk to other workflow
• 6:53
  and other processes. And then
• 6:55
  through that discussion
• 6:56
  that could happen, you know, a settlement or
• 6:59
  a outcome could be reached. So it's autonomous
• 7:01
  automation.
• 7:02
  So where could that be applied? So we
• 7:04
  look at things like coordination of benefits or
• 7:06
  itemized bill reviews or or
• 7:08
  reviewing a medical chart, all of which require
• 7:11
  human sort of judgment and understanding.
• 7:14
  But what if we could train agents to
• 7:16
  go do all of those tasks
• 7:18
  and then ultimately
• 7:19
  deliver
• 7:20
  normally the functions that require people,
• 7:23
  but deliver that, through software? So
• 7:26
  call that delivering,
• 7:27
  services software.
• 7:29
  That was something we're very excited about. But,
• 7:32
  over the course of the next two or
• 7:33
  three years, I think you could go from
• 7:35
  automation to autonomy to complete autonomy, which means,
• 7:39
  we're probably gonna require very few people to
• 7:42
  to do the things that are routine administrative
• 7:44
  tasks, and then focus instead the human attention
• 7:47
  to the things that matter around clinical decisions,
• 7:49
  clinical care,
• 7:50
  things that always should be you know, we
• 7:52
  should have a human in the loop.
• 7:54
  Absolutely.
• 7:55
  How does Lyric prioritize
• 7:57
  product development and road map decisions to ensure
• 8:00
  alignment with the shift left approach? And what
• 8:04
  are the key criteria for determining which products
• 8:06
  and content areas to invest in?
• 8:10
  Yeah. For us, it's it starts and ends
• 8:12
  with, you know, what what our customers are
• 8:14
  asking us to do. And because we're so
• 8:16
  intimately involved in in and integrated in real
• 8:19
  time with with a lot of the claims
• 8:21
  operations and claims systems of our our customers
• 8:23
  sort of, you know, operational architectures,
• 8:26
  the needs kinda surface themselves and as to
• 8:29
  what we need to what we need to
• 8:31
  build. So that sort of serves as kinda
• 8:33
  one source of input,
• 8:35
  in in shaping our road map. The second
• 8:36
  is we are proactively researching what's out there.
• 8:36
  Obviously, the data that we have access
• 8:37
  to,
• 8:40
  Obviously, the data that we have access to
• 8:42
  informs new features and functions that we need
• 8:44
  to build, you know, in our product. You
• 8:46
  know? So I think of that as a,
• 8:47
  you know, another source of of innovation.
• 8:50
  And then there's what can tech do, and
• 8:52
  how is that gonna disrupt and that gonna
• 8:54
  disrupt and reshape what's happening,
• 8:56
  in our industry.
• 8:58
  And and that's a little bit of combination
• 8:59
  of of experimentation.
• 9:01
  You know? It could be r and d
• 9:02
  in several areas to figure out, you know,
• 9:04
  what could be feasible to go productize for
• 9:06
  us,
• 9:07
  as well as, you know, continuous customer feedback.
• 9:10
  You know, as we are doing small pilots,
• 9:12
  you know, beta and alpha programs,
• 9:15
  getting early and and frequent feedback from our
• 9:17
  customers so that we're all all very tightly
• 9:19
  linked with what customer needs are,
• 9:21
  And then innovate within that sort of sphere
• 9:24
  of customer need driving innovation.
• 9:27
  Also, us pushing some outside in ideas to
• 9:29
  make sure that, we're challenging our customers to
• 9:31
  think ahead, you know, rather than just kind
• 9:32
  of,
• 9:34
  you know, building everything exactly to their specs.
• 9:36
  You know? So that's sort of the process
• 9:38
  by which we prioritize. And then,
• 9:40
  the the number one thing that drives it
• 9:42
  at Lyric and the single metric that matters
• 9:45
  for us is the value that we're creating
• 9:46
  for customers. So of all the things that
• 9:48
  we do, we rank order things that by
• 9:50
  the things that create the most most impact,
• 9:52
  and that's how we we get after it.
• 9:55
  Could you discuss Lyric's partner strategy and its
• 9:58
  importance in your overall strategy?
• 10:02
  Yeah. So so think of partners
• 10:05
  and developers and our own teams
• 10:08
  all sort of being participants on our on
• 10:10
  our platform.
• 10:11
  So Lyric forty
• 10:13
  two, technical plumbing and the thing that maps
• 10:16
  data and does all of the the hard
• 10:18
  work of of being integrated in in real
• 10:20
  time environment with with our clients.
• 10:22
  Based on that position
• 10:25
  in a processing architecture of claims,
• 10:28
  we can do a lot more in terms
• 10:30
  of, real time prepay, you know, sort of
• 10:30
  solutions. Clearly, you
• 10:32
  know,
• 10:36
  flagship prepay applications that we're we're rolling out
• 10:38
  and continuing to enhance.
• 10:40
  But we know that innovations happen
• 10:43
  across, you know, the industry. There's lot of
• 10:45
  money going into new AI startups, new
• 10:48
  partners that have unique capabilities that may be
• 10:50
  somewhat niche.
• 10:52
  But perhaps, you know, some of those companies
• 10:54
  have found it hard to scale and get
• 10:56
  into break into the helpline ecosystem.
• 11:00
  So by working with us, we we're able
• 11:02
  to, a, verify that what they're saying they
• 11:05
  do actually happens.
• 11:06
  And then if if that's the case,
• 11:09
  then we can start to kinda match them
• 11:11
  up against customer needs and take them to
• 11:13
  our our customers to sort of integrate them
• 11:16
  into our our ecosystem and deliver
• 11:18
  value through a set of a one stop
• 11:20
  shop, one integration, make it easy for our
• 11:21
  customers to do business with us. So that's
• 11:23
  the partner strategy. And there's a new one
• 11:25
  that we're we're gonna launch this year, which
• 11:27
  is around developers.
• 11:29
  So much like, you know, Apple has a,
• 11:31
  you know, developer program for iOS and Microsoft,
• 11:34
  you know, obviously been a leader in partner
• 11:36
  developer programs for the last fifty years.
• 11:39
  We're gonna use Lyric's platform to make it
• 11:41
  available to third party developers that could create
• 11:43
  applications on our platform, and then we'd integrate
• 11:45
  that and make it available to our customers.
• 11:47
  So those would be the three sources. One,
• 11:49
  our own developers creating content,
• 11:51
  part established partners that have an existing go
• 11:54
  to market that
• 11:55
  perhaps are looking, you know, to shift left
• 11:58
  and and do more in prepay. So we'd
• 11:59
  be a conduit for that. And then lastly,
• 12:01
  it'd be things that don't exist that developers
• 12:03
  wanna create. We become platform for that as
• 12:05
  well.
• 12:06
  So what are the key differentiators of a
• 12:08
  Lyric solution and the payment integrity market,
• 12:12
  and how does the company ensure its offerings
• 12:14
  provide a unique value?
• 12:17
  Is the is the last thing you said.
• 12:19
  And it's a unique value is the scale
• 12:21
  of of the savings that we create and,
• 12:24
  for our customers through,
• 12:26
  essentially what we call payment accuracy,
• 12:28
  payment accuracy solutions. You know? So which is
• 12:31
  our interest is in not, you know, either
• 12:34
  upcoding or downcoding or detecting that as much
• 12:37
  as
• 12:38
  making sure whatever is built, you know, by
• 12:40
  the provider community is accurate.
• 12:42
  And without judgment as to whether they should
• 12:44
  get paid more or the same or less
• 12:46
  than, you know, what what what they're describing
• 12:48
  in in in their bill.
• 12:50
  So if you've if you kinda start with
• 12:53
  that premise and then say our unique sort
• 12:55
  of position in the in the health care
• 12:58
  ecosystem is the amount of value that we
• 13:00
  create, which is,
• 13:02
  last year, I think when we benchmarked, it
• 13:04
  was nearly $20,000,000,000.
• 13:06
  So it's it's really building on that and
• 13:08
  then saying, what else could we do? So
• 13:10
  given that we serve over a hundred customers
• 13:12
  and we have visibility into, you know, claims,
• 13:15
  representing over a 80,000,000
• 13:17
  lives, we have a very longitudinal sort of
• 13:19
  view as to what's happening in with with
• 13:21
  with claims across the country.
• 13:23
  So we take that and we can say,
• 13:24
  well, what does medical trend look like next
• 13:27
  day, next week, next month? Then, you know,
• 13:29
  eventually, we'll start to get to the point
• 13:31
  of predicting medical trend and helping our customers
• 13:33
  ultimately mitigate it more proactively.
• 13:36
  So how does Lyric plan to leverage next
• 13:39
  generation AI applications
• 13:41
  to further enhance its payment integrity solutions,
• 13:44
  drive intelligent value creation, or transparency
• 13:47
  at scale?
• 13:48
  All diddough.
• 13:51
  So, so, I mean, in many ways, we're
• 13:53
  already, you know, have been incorporating AI for
• 13:55
  the last, you know, two plus years.
• 13:58
  We've got a you know, one of the
• 14:00
  leading teams, I think, in the industry when
• 14:02
  it comes to, you know, AI and sort
• 14:04
  of a good combination of AI machine learning
• 14:07
  and and, you know, sort of awareness of
• 14:09
  data and
• 14:10
  a deep sort of expertise in in the
• 14:12
  plumbing and data, which is, you know, about
• 14:14
  80% of the work of any, you know,
• 14:16
  AI initiative. So if you take all that,
• 14:18
  what we're able to do with it is,
• 14:20
  one, increased transparency. So think
• 14:22
  of solutions like, a Lyric Copilot that could
• 14:25
  explain,
• 14:26
  payment accuracy rules
• 14:28
  to providers and eventually to to consumers via
• 14:31
  the health plan channel.
• 14:33
  We could start to create autonomous operations, as
• 14:35
  I mentioned, through,
• 14:36
  automating the work of of humans that typically
• 14:39
  kinda do functions like coordination of benefits or
• 14:41
  itemized bill reviews
• 14:43
  and,
• 14:44
  and deliver that differently and and deliver that
• 14:46
  in real time in prepay.
• 14:48
  But, also, I think,
• 14:49
  the biggest thing I think we could, end
• 14:51
  up doing is that,
• 14:54
  health care is always intended to be kinda
• 14:56
  settled transactions in real time,
• 14:59
  much like fintech, you know, has done about,
• 15:01
  you know, a decade ago.
• 15:02
  But there have been various challenges along the
• 15:04
  way. It's inertia. It's legacy tech on the
• 15:07
  provider side, on the payer side.
• 15:10
  You know, I think leadership lack of sort
• 15:12
  of awareness around kinda what tech can do.
• 15:14
  All that's kinda starting to change slowly but
• 15:16
  surely, and I think it's gonna accelerate in
• 15:18
  the next, few years.
• 15:20
  So Lyric is uniquely positioned to facilitate that.
• 15:23
  In other words, we can take all of
• 15:25
  our AI and all of our algorithms, all
• 15:26
  of our rules, and embed it directly into
• 15:29
  the point of care,
• 15:31
  where as,
• 15:32
  you know, the physician, the provider community is
• 15:35
  delivering care, and then they're recording that care
• 15:38
  in the form
• 15:39
  of in the EMRs in our chronic medical
• 15:42
  records,
• 15:43
  we could essentially be a service
• 15:45
  that then could verify that what's being
• 15:47
  translated in terms of what care was provided
• 15:50
  into stuff that, you know, payers understand is
• 15:52
  accurate. And if we can do that in
• 15:54
  real time at the point of care, then
• 15:56
  once the transaction gets to the payer's footsteps,
• 16:00
  then the rest of the steps could be
• 16:01
  done relatively quickly versus
• 16:04
  it taking
• 16:05
  sometime two hundred plus days, you know, for
• 16:07
  for a claim to get settled, which in
• 16:09
  today's age, in today's tech, there's no reason
• 16:11
  for that. So our view is that that's
• 16:13
  the biggest impact we can have, which is
• 16:15
  that more transparency upfront, more accuracy upfront, and
• 16:18
  then
• 16:19
  straight through processing through the rest of the
• 16:21
  system,
• 16:22
  ultimately getting at that half a trillion in
• 16:24
  waste that happens because of all these issues
• 16:26
  across the system.
• 16:27
  Thank you so much, Raj, for your time
• 16:29
  and insights today. I also wanna thank Lyric
• 16:32
  dot AI for sponsoring today's podcast and invite
• 16:35
  our listeners to tune in to more podcasts
• 16:37
  from Becker's Healthcare by visiting our podcast page
• 16:40
  at beckershospitalreview.com.
• 16:43
  I hope you all have a wonderful rest
• 16:45
  of your day.