Latest / Becker’s Payer Issues Podcast / Unlocking the Value of Network Performance Data

Transcript

Unlocking the Value of Network Performance Data · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Laura Dierda with Becker's
• 0:02
  Healthcare. Thank you so much for tuning in
• 0:04
  to the Becker's Healthcare podcast series. Today, we're
• 0:06
  going to talk about network performance.
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  Joining me for today's discussion are Bob Tavernier,
• 0:12
  who is a solution executive for Quest Analytics,
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  and Karen Tashian, who is senior director of
• 0:18
  network regulatory operations at Health Care Service Corporation.
• 0:21
  Bob, Karen, thank you so much for being
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  here today.
• 0:24
  Thank you, Lauren. Thank you very much, Lauren.
• 0:26
  To get us started, can you please introduce
• 0:28
  yourselves and tell us a little bit about
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  your work in health care? And, Karen, we'll
• 0:31
  start with you. Thanks for having us, Laura.
• 0:34
  As you stated, I'm Karen Tashian. I work
• 0:36
  for health care service corporation, which is a
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  Blue Cross Blue Shield franchisee.
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  My job is to make sure that we
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  stay compliant, and so most of my teams
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  work on making sure our networks are adequate
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  and that we're providing enough member access to
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  care. So we manage all of the regulatory
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  filings that are attributed to that. Bob, do
• 0:57
  you wanna go next?
• 0:58
  Thank you, Karen.
• 0:59
  Hi. My name is Bob Tavernier.
• 1:01
  I am a solutions executive here at Quest
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  Analytics.
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  My role is primarily focused on client engagement,
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  focusing on on all solution verticals as it
• 1:12
  relates to network data management,
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  network management,
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  and network monitoring.
• 1:18
  Super happy to be here today. Thank you.
• 1:21
  Well, Bob, Quest Analytics recently partnered with Becker's
• 1:23
  to survey health plan leaders on network performance
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  and related challenges.
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  What were the most striking or validating findings
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  from your perspective, and why are these insights
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  timely and important for payer executives today?
• 1:36
  That's a great question, Lauren.
• 1:38
  Some of the primary
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  focus areas when organizations think about what's most
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  important to them,
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  network performance is hot. It really is.
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  When they think about the top three priorities,
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  lowering administrative costs,
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  improving clinical quality, focusing in on truly member
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  satisfaction,
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  we're those top three.
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  They know that network performance is truly foundational
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  when it comes to ultimately measuring
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  performance of the network and ultimately helping them
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  with their organizational
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  priorities.
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  What's interesting is
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  they really focused on
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  taking a look at deeper dive at competitive
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  intelligence,
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  focusing in on wanting to know more from
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  the data around
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  not only access to care, but understanding more
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  provider costs and quality. Yet the data that
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  they have access to isn't good. From a
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  competitive landscape, they
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  actually stated that they do not have any
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  high quality data. When it came to access
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  to care, they actually had moderate level of
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  quality data. So really understanding how do we
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  collectively help improve overall data to get them
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  to the position of where they want to
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  ultimately go
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  with aligning network data
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  with network design, which ultimately helps with organizational
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  priorities.
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  It's very interesting space. It's super hot space
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  to go in. But, ultimately, when we're focusing
• 3:02
  in on network,
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  it's not only about where the organizations are
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  at today. It's how do we help them
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  to get to the next level. They not
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  only need to be network adequate,
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  but they want to be able to use
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  the network data to ultimately be competitive in
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  the marketplace,
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  have truly marketplace differentiators,
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  and ultimately help to improve the member's experience.
• 3:23
  Well, that's fascinating to hear. And certainly, whatever
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  you can do to get that competitive advantage,
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  in today's health care space makes a big
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  difference. So I appreciate your thoughts there and
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  and is currently what Quastya Analytics is doing,
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  to make a big difference.
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  Karen, in hearing about reviewing
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  the survey findings, which two or three themes
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  resonated most strongly with your experience at HCSC,
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  how is your organization approaching these challenges or
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  opportunities? And can you share any examples of
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  strategies or initiatives that are gaining traction?
• 3:54
  Yep. So that is a really, really good
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  set of questions.
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  We have a saying in the payer industry
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  that I'm sure probably will resonate to some
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  of the listeners where we are, data rich
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  but information poor. And so, especially at HCSC,
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  we have access to all kinds of different
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  types of data, but I think making sure
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  that you are
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  leveraging the right insights in a cohesive manner
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  so that you can have actionable results and
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  strategies,
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  that's really key. You have to know your
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  members, you have to know your provider population,
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  and you have to know what your organization's
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  priorities are. So certainly for us,
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  we are very much prioritizing,
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  making sure that we are lowering medical cost
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  as much as humanly possible,
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  making sure our members are getting the right
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  type of care they need when they need
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  it,
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  and then also making sure that while doing
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  all of this, we're able to grow in
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  a compliant manner,
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  as we're trying to keep up with different
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  regulatory
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  expectations that continue to grow. And managing all
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  of that with, you know, different levels of
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  clinical needs is sometimes a challenge for us.
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  So, certainly, I definitely agree with a lot
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  of the survey results. There's a lot more
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  too that we'll be discussing later today, but
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  I know that HCSC is not necessarily a
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  standout differentiator.
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  We share a lot of the same pain
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  points that Bob just spoke to.
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  That's great to hear and really helpful to
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  have that context
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  in how, you know, you're navigating through today
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  is really a lot of challenges within the
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  health care space and but building and designing
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  the future of health care, what an exciting
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  opportunity that, you know, leaders within the space
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  have today. So as we look toward that
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  future of network strategy,
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  what approaches
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  will best position
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  payers to deliver value and differentiation?
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  How do you both see data and technology
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  evolving to support this? What innovations are you
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  most excited about?
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  So,
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  one of the wonderful things about being in
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  this juncture is technology is on our side.
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  And so with so many advancements in recent
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  technology, just even in the last ten to
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  fifteen years, data is not only more accessible,
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  but there are more solutions and opportunities to
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  do more with them.
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  And so I think there is a world
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  of options and different solutions for payers to
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  take on depending on what their low hanging
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  fruit, solutions are or approaches or opportunities they
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  wanna go after as well as some of
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  those, opportunities that take a longer pathway.
• 6:21
  Excellent points, Karen. I'd love to add that
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  really when you're thinking about network strategy, it's
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  understanding where you're at in the market and
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  where do you wanna be when you grow
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  up. Do you really wanna focus in on
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  your broadest networks? Do you want to have
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  a high performance network? Are you focused in
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  on tiering? How do you ultimately help to
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  set up the the appropriate networks and product
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  benefit designs
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  that are ultimately helping the member to get
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  to the level of care that they need.
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  It's absolutely critical when you're thinking about data
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  and technology.
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  It's important that you're considering all avenues, not
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  only the network teams, but clinical quality, customer
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  service product, and that you're able
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  to utilize the dataset that can help a
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  variety of those health care verticals to ultimately
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  work together to utilize the data to make
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  informed decisions
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  to ultimately create the best experience for members.
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  Fascinating to hear, and great to have those
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  types of capabilities.
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  I I know everything you mentioned,
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  really is, you know, truly top of mind
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  for so many health plan leaders and executives
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  today.
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  Before we wrap up here, I'm curious. Is
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  there anything we didn't cover or final thoughts
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  you'd like to share? And, Bob, we'll start
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  with you. Great question, Lauren. One of the
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  things that's really critical when you're thinking about
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  innovation and really taking a step forward is
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  understanding
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  where you are and ultimately where you want
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  to go. When you think about competitive intelligence,
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  understanding what the competitors have,
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  being able to break down down that level
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  of information in terms of things about what
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  clinical outcomes, thinking about quality, thinking about costs,
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  thinking about
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  are the providers ultimately following things like clinical
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  practice guidelines?
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  Are they billing for additional services that those
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  members don't need?
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  The payers are very familiar with this space
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  knowing, working very closely with HEDIS performance measures,
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  star ratings, cap surveys. If you look at
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  those surveys and performance measures,
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  a lot of those are really driven by
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  ultimately the member experience. So it's not only
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  building that that appropriate member experience.
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  It's also being able to understand what are
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  the key differences
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  in your space and how do you ultimately
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  differentiate yourselves
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  from your competitors with the utilization of network
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  data.
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  That's fascinating. Thank you so much, Bob. And,
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  Karen, what are your final thoughts?
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  I think Bob hit on some really great
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  points.
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  In general, I think it's a really exciting
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  time for payers. Our industry is evolving and
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  growing, and there's more asked of us to
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  serve our members.
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  And so in general, I'm excited to see
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  how we can leverage any level of data
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  enhancement, if you will, or data filtering
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  in order for us to keep up because,
• 9:00
  again, that's just what our members require.
• 9:03
  Well, thank you, Bob and Karen, for your
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  time and insights today. We also want to
• 9:07
  thank our podcast sponsor, Quest Analytics.
• 9:10
  You can tune into more podcasts from Becker's
• 9:12
  Healthcare by visiting our podcast page at beckershospitalreview.com.