Latest / Becker’s Payer Issues Podcast / How Independent Providers Can Turn Insight Into Action

Transcript

How Independent Providers Can Turn Insight Into Action · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:03
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you. Today, we're talking about how independent
• 0:09
  providers can turn insight
• 0:11
  into action. I'm so excited to be joined
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  by Megan Zukruski. She's the vice president of
• 0:15
  product strategy at Veradigm. Megan, it's so great
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  to have you. Thanks for being here. Thank
• 0:18
  you. I'm excited to be here. Yes. It's
• 0:20
  great to have you. I do wanna start
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  off with introductions for those that might not
• 0:23
  know you yet. If you could just talk
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  a little bit about who you are, your
• 0:27
  role in health care, and your job at
• 0:29
  Veradigm. Yeah. I work in platform strategy at
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  Veradigm
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  in a really unique position between payers and
• 0:35
  providers.
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  So what I focus on today is making
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  sure we have a collaborative platform that can
• 0:40
  help our independent provider network succeed and also
• 0:43
  help our payer clients get the things that
• 0:45
  they need back from those independent providers.
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  It's been a really exciting time as the
• 0:50
  market really comes together and as both sides
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  are really trying to problem solve and make
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  sure that each is armed with the information
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  they need about the patients that they have,
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  combined. So it's just been a great, interesting
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  area of health care to really dive into
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  and and problem solve in. Yeah. We'll talk
• 1:06
  about some of the collaborative nature of this
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  here in a little bit, which is so
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  key as you've just mentioned. I do wanna
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  talk about,
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  perspective gap closure a little bit. I know
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  it's fairly specific,
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  but when we talk about perspective gap closure
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  in today's value based care environment,
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  can you explain what that means
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  and then why it's becoming such an important
• 1:26
  lever specifically
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  for independent providers?
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  Yeah. For a long time,
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  the delay of data transfer between payers and
• 1:35
  providers
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  left payers operating very retrospectively.
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  Right? So they're reviewing claims data that's six
• 1:42
  months or a year old and then trying
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  to course correct after the fact, get that
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  information back to providers maybe months or even
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  a year after they've actually seen the patient
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  face to face. So when we talk about
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  prospective strategies,
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  we're really looking to arm providers with the
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  information they need that payers might know about.
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  Right? Because payers have a good three sixty
• 2:02
  view of patients from a claims perspective.
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  But we're talking about arming providers with that
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  information while the patient's face to face with
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  them in the room.
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  We know that regulatory is really cracking down
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  on things like this as well. We wanna
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  make sure that the provider is
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  armed with the right information at the right
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  time in the right place, that they're capturing
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  the right things in the record,
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  and that needs to happen real time before
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  the claim is submitted. So when we're talking
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  about prospective,
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  it's really making sure that the provider can
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  act on the information that they have
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  before the claim is submitted. And that way,
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  we can make sure that, you know, gaps
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  are closed and the patient is getting the
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  best, most accurate depiction,
• 2:41
  captured into the EHR.
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  Obviously, the goal is to make this happen.
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  What are the barriers that you're still seeing
• 2:49
  that organizations are facing for making this happen?
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  I think for a long time, we focused
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  on really large health systems and really large
• 2:58
  payers
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  sharing data amongst each other with a lot
• 3:02
  of money and a lot of tech.
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  And I think when we get out into
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  the independent and rural space, it's just a
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  totally different ballgame.
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  You're talking about providers that are potentially off
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  the grid from an interoperability
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  perspective.
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  They may not have things like ADT interfacing
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  where they know whether their patient's been admitted
• 3:21
  to the hospital.
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  They could be using paper for labs still.
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  I mean, just the the technical disparity that
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  we see in the independent space can be
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  really significant,
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  and that can be a barrier. That can
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  be a barrier for the
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  data that they have access to for decision
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  making.
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  And we wanna make sure that those independent
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  providers are really armed with the best information.
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  So I think data and interoperability
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  has been a consistent barrier.
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  I think the second thing,
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  is probably just admin burden and just less
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  hands.
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  Providers that work under the umbrella of a
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  large health system tend to have teams that
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  are dedicated to things like gap closure and
• 3:59
  risk adjustment and quality initiatives. But when you
• 4:02
  talk about an independent provider, it's just a
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  totally different,
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  framework. So they're running shorter, with hands. They're
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  running shorter from a tech perspective,
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  and it feels like the odds are kinda
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  stacked against them. So when we are trying
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  to problem solve in that environment, we need
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  to make sure that we are creating tech
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  solutions that can help alleviate that admin burden
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  and not expect an entire team to help
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  carry some of that lift.
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  So I think that's another area.
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  And then finally,
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  attribution confusion.
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  So providers that are independent don't wanna have
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  to think about, hey. Is this a patient
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  for payer x and this one's a patient
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  for payer,
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  y? And and I have different workflows for
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  each payer. So I think when we're running
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  short from a just not as many hands
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  to help support and we're we have technical
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  barriers, on top of that, we wanna make
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  sure that workflows are
• 4:50
  agnostic to the payer behind the scenes. So
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  we wanna make sure that the provider is
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  armed with a strategy that allows them
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  to address gaps in care and make sure
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  that everything's well captured on a patient, but
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  decouple that from specific payer programs.
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  And I think that makes it a lot
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  easier for independent providers to navigate all of
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  the things that they need to do for
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  better patient outcomes.
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  If we can help create workflows that are
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  payer agnostic and similar, that really drives behavior
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  change and stickiness for the provider. So the
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  behavior change is really crucial, and we talk
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  a lot about, okay. There's data available. We
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  know that there's a ton of data available
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  in health care. The harder part is
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  using that data to then drive action, which
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  is so crucial.
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  What does it take to embed gap closure
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  capabilities directly into those provider workflows
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  natively,
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  and how does that shift then
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  engagement and outcomes?
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  It's great because many EHR vendors have started
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  to recognize
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  this need for a consolidated workflows to support
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  payer
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  gap closure.
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  So Veradigm is one of them, but there
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  are other EHRs, Epic, Athena,
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  eClinicalWorks.
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  They've all created workflows that are designed to
• 6:01
  corral payer content through one common workflow.
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  I think of this sort of like when
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  labs started becoming very commonly ordered in EHRs,
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  we had a lab module that would allow,
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  you know, the provider to choose a specific
• 6:15
  lab test. But behind the scenes, it would
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  do the thinking of which lab that the
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  procedure actually needed to be completed by, and
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  it would do that thinking for the provider.
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  We're looking to mirror that same concept when
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  it comes to payer gap closure. We wanna
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  be able to surface payer insights to providers
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  at the point of care, but through a
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  common channel, through a common workflow. And I
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  think when we think about how does the
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  EHR natively start to inject information,
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  it becomes strengthened if we have more volume
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  and more stickiness because of the repetition.
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  So if we're stripping down the nuances
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  between plans and saying, hey. We're gonna ask
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  you to send all of your gaps to
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  this standard format. And when we surface them,
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  it's gonna be the same every time for
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  the provider. It's gonna be the same workflow.
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  It's gonna be surfacing the similar
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  concepts so that we can start to drive
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  that behavior change and stickiness.
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  So I think that's, that's something that is
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  really important is it's that it's a common
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  workflow. And it also needs to feel intuitive
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  to the workflows that the provider has already,
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  you know, is already used to from a
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  charting perspective.
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  So we're looking at ways to meaningfully
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  surface insights to the provider during their normal
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  day to day, charting on a patient
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  without causing,
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  extra abrasion because they need to log in
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  to multiple systems or other portals. We wanna
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  try to bring all that information right into
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  the normal workflow and then remind providers in
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  areas that feel natural to them. So if
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  they're ordering a test, making sure that we
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  could, for example, trigger a prior authorization within
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  the orders workflow.
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  So it's things that when we're talking about
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  native, we need to make sure that it's
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  something that we have enough volume to drive
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  that stickiness and behavior change, but also that
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  we're thinking ahead as to how the provider
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  actually uses the system.
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  And that's what I think gives the EHR
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  vendor a unique,
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  perspective on this because we've designed how the
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  provider is charting on the patient, and then
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  we can also complement those existing workflows with
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  additional intelligence, from payer partners. And
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  outcomes that you're looking for? Is there any
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  measurable outcomes that you're looking to see, any
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  examples that you've seen actually make a difference
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  for health systems?
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  Yeah. I mean, so far, you know, it's
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  it's been very exciting in this space because
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  we work with
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  thousands of independent provider practices
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  that,
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  have significant patient panels that, like I said,
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  they might be off the grid and not
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  used to receiving this information inside of this
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  EHR.
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  And now that we've sort of opened those
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  pipes and we allow,
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  payer content to get to the point of
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  care, we have impacted,
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  since the program's inception,
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  over 2,000,000 patients in, you know, independent and
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  rural settings
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  that potentially may have gone, without preventative screenings
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  or gaps,
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  been been addressed because,
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  you know, historically, these things could have been
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  living in manual processes or portals that were
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  never getting logged into. So I think from
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  a, a volume perspective, we're we're upwards of,
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  like I said, over 2,000,000 patients impacted,
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  nearly 3,000,000 actual gaps that have been surfaced
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  to providers. And we're also tracking things like
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  program efficacy and making sure that providers are
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  actually looking at the information, they're interacting with
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  the information.
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  So we're able to track whether a provider
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  accepts the condition is present or rejects that
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  the condition is present, which gives us meaningful
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  insight and feedback back to payers to tell
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  them, you know, hey. This is working. This
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  isn't working. These are the practices that might
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  need a little bit more help.
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  So we can kinda track how they're using
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  the system and also just what types of
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  gaps are being surfaced for them. So I
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  think it's pretty,
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  it's pretty exciting. And so far,
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  we feel like we're really making an impact
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  in the area of the industry that's been,
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  you know, often overlooked.
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  The gap number speaks for itself, I feel
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  like. Yeah.
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  How is this going to evolve looking ahead?
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  Right? What are you expecting this to look
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  like, say, you know, five, ten years down
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  the road, and specifically when we're looking at
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  independent providers? Right? What do they need to
• 10:09
  prioritize right
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  now?
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  I think for independent providers, getting connected to,
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  the information superhighway and being able to exchange
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  data through things like TEFCA is really important.
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  So I think interoperability or the ability to
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  move data from point a to point b
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  inside of the healthcare ecosystem,
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  for me, is top of mind. I think
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  that's the most important thing. We need to
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  make sure that providers
• 10:31
  not only can receive data externally,
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  but that the data that they hold within
• 10:35
  their walls can make it to the acute
• 10:37
  care setting and to the local hospital if
• 10:39
  a patient was, unexpectedly admitted for an emergency.
• 10:42
  Those types of things really tackle the duplication
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  and waste that we see in the health
• 10:47
  care system and eventually tackle affordability and all
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  the things that are really dragging.
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  So I think that's an area that's really
• 10:53
  interesting. I think top of mind for me
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  for strength in the future is interoperability and
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  making sure that providers can be connected,
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  not just data out, but also data back
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  meaningfully to the point of care. And I
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  think, you know, payers provide a unique perspective
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  on that because they also have a tremendous
• 11:09
  amount of data that can meaningfully impact physician
• 11:12
  clinical decision making at the point of care.
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  So if we can create those rails and
• 11:17
  allow data to seamlessly move through the ecosystem,
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  I think it can help to give significant
• 11:22
  lift and impact
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  to patient outcomes and making sure that we
• 11:26
  are really driving down costs and some of
• 11:27
  the other things that are creating waste and
• 11:29
  drag on the system.
• 11:31
  Megan, so great to have you. Thanks again
• 11:32
  for your time and insights today. So excited
• 11:35
  to have you. We also want to thank
• 11:36
  our podcast sponsor, Veradigm. You can tune in
• 11:38
  to more podcasts from Becker's Healthcare visiting our
• 11:40
  podcast page at beckershospitalreview.com.