1 00:00:00,410 --> 00:00:01,055 - Hello everyone. 2 00:00:01,155 --> 00:00:02,895 I'm Brian Zimmerman with Becker's Healthcare. 3 00:00:03,145 --> 00:00:05,855 Thank you for joining us for this podcast Today, 4 00:00:05,865 --> 00:00:08,175 we're thrilled to be joined by Danielle Schal, 5 00:00:08,405 --> 00:00:11,655 president Command Business Partners, inspire Innovations. 6 00:00:12,255 --> 00:00:13,455 Danielle, thank you so much for being here. 7 00:00:14,085 --> 00:00:16,175 - Yeah, thank you. I'm also thrilled to be here. 8 00:00:17,015 --> 00:00:18,275 - Uh, it's great to have you. 9 00:00:18,415 --> 00:00:21,035 And of course, we're gonna discuss some best practices and, 10 00:00:21,215 --> 00:00:22,955 and pragmatic approaches to achieve 11 00:00:22,975 --> 00:00:25,675 and maintain a CMS five star rating. 12 00:00:25,775 --> 00:00:27,115 So, with that, let's dive in here 13 00:00:27,175 --> 00:00:29,435 and just to, to, to lay the groundwork for, 14 00:00:29,435 --> 00:00:30,555 for the conversation to come 15 00:00:30,575 --> 00:00:32,915 to help listeners appreciate your perspective. 16 00:00:33,015 --> 00:00:35,035 Can you just introduce yourself a bit further and, 17 00:00:35,035 --> 00:00:36,555 and share a bit about your, your role, 18 00:00:36,555 --> 00:00:39,435 professional background, uh, the work you're doing 19 00:00:39,435 --> 00:00:40,595 with Inspire Innovations? 20 00:00:40,985 --> 00:00:43,955 - Yeah, sure. Thanks. Um, yeah, so, um, 21 00:00:44,175 --> 00:00:47,475 for several years I was a CIO, uh, of a home health agency 22 00:00:47,475 --> 00:00:48,715 and New York based health plan. 23 00:00:49,235 --> 00:00:52,795 I also worked for a business process management software 24 00:00:52,795 --> 00:00:55,115 company and consulting company for over 10 years 25 00:00:55,495 --> 00:00:58,835 before I started Command Business Partners in 2012. 26 00:00:59,655 --> 00:01:03,755 Um, and I've pretty much worked on everything from small 27 00:01:03,755 --> 00:01:06,915 scale process improvement projects, like transforming 28 00:01:06,975 --> 00:01:08,875 and automating complaints, appeals 29 00:01:08,875 --> 00:01:12,315 and grievance processes for a small 20,000 member plan, um, 30 00:01:12,375 --> 00:01:14,755 to really large scale global 31 00:01:14,755 --> 00:01:16,595 process standardization projects. 32 00:01:16,675 --> 00:01:19,315 I spent a number of years, um, working on a project 33 00:01:19,415 --> 00:01:22,355 for MetLife's Central Europe and Middle East operations. 34 00:01:23,175 --> 00:01:26,915 Um, today my company, which is Command Business Partners, 35 00:01:26,915 --> 00:01:29,875 along with my partner company, um, I'm a director 36 00:01:29,875 --> 00:01:30,995 with Inspire Innovations. 37 00:01:31,495 --> 00:01:33,915 Um, we work with our health plan clients 38 00:01:34,575 --> 00:01:38,795 to provide a variety of process improvement, optimization, 39 00:01:38,815 --> 00:01:40,355 and automation solutions. 40 00:01:40,975 --> 00:01:43,035 Um, and those solutions help, you know, 41 00:01:43,035 --> 00:01:45,995 alleviate the staffing challenges that companies are facing. 42 00:01:46,375 --> 00:01:49,555 Uh, of course reduce costs, um, but also improve member 43 00:01:49,575 --> 00:01:52,675 and provider experience and overall operations. 44 00:01:53,295 --> 00:01:55,995 Um, which as you know, directly impacts star ratings. 45 00:01:56,815 --> 00:01:59,225 - Yeah. A a absolutely have a direct 46 00:01:59,225 --> 00:02:00,465 correlation there for sure. 47 00:02:00,685 --> 00:02:02,225 And, and of course, those star ratings, 48 00:02:02,225 --> 00:02:04,865 those CMS star ratings carry, carry a lot of weight 49 00:02:04,865 --> 00:02:06,225 for both payers and providers. 50 00:02:06,245 --> 00:02:07,665 Mm-Hmm. , um, and Danielle, in, 51 00:02:07,665 --> 00:02:09,665 in your view here, what are, you know, sort 52 00:02:09,665 --> 00:02:12,625 of the key factors healthcare leaders should be considering 53 00:02:12,685 --> 00:02:15,025 as they strive to achieve that five star rating? 54 00:02:15,245 --> 00:02:16,345 Mm-Hmm. , um, what, 55 00:02:16,345 --> 00:02:17,625 what approach do you recommend here? 56 00:02:17,625 --> 00:02:18,985 What, what's been your experience? 57 00:02:19,255 --> 00:02:20,865 - Yeah. Such a key question, really. 58 00:02:21,045 --> 00:02:24,505 Um, so I think that, you know, it, to summarize it, 59 00:02:24,575 --> 00:02:27,425 it's definitely, you have to have a long-term strategy while 60 00:02:27,425 --> 00:02:31,585 you take immediate, you know, near term action, right? 61 00:02:31,845 --> 00:02:33,745 And so maybe let me elaborate on that a little. 62 00:02:33,845 --> 00:02:38,345 So with achieving five stars, right, A lot 63 00:02:38,345 --> 00:02:42,025 of times the approach is to analyze the various measures, 64 00:02:42,295 --> 00:02:45,345 determine where you are and where you have to be, right? 65 00:02:45,405 --> 00:02:48,265 And then focus initiatives to meet each of those measures. 66 00:02:49,145 --> 00:02:51,185 I think part of the challenge with just kind of a, 67 00:02:51,745 --> 00:02:54,705 a near term measure by measure approach is kind 68 00:02:54,705 --> 00:02:56,305 of like playing whack-a-Mole , right? 69 00:02:56,725 --> 00:02:58,105 You know, stars is a moving target. 70 00:02:58,745 --> 00:03:02,045 CMS will remove measures, they will replace them 71 00:03:02,075 --> 00:03:03,245 with different measures. 72 00:03:03,945 --> 00:03:06,765 The weightings shift, sometimes it, you're dealing 73 00:03:06,765 --> 00:03:09,365 with medical outcomes having heavier weighting than member 74 00:03:09,375 --> 00:03:11,445 experience, and that shifts back and forth. 75 00:03:11,985 --> 00:03:13,405 Um, and things like the cut marks 76 00:03:13,405 --> 00:03:15,405 or the benchmarks you have to achieve are 77 00:03:15,485 --> 00:03:16,685 continuously changing. 78 00:03:17,345 --> 00:03:19,645 So I think that, again, while you have to have 79 00:03:19,645 --> 00:03:23,165 that immediate near term focus of dealing with each measure, 80 00:03:23,805 --> 00:03:26,645 I think that you also have to, you know, combine that 81 00:03:26,645 --> 00:03:30,005 with this long-term strategic focus on operational 82 00:03:30,005 --> 00:03:33,405 excellence and a company wide understanding 83 00:03:33,425 --> 00:03:34,725 and commitment to stars. 84 00:03:36,435 --> 00:03:38,525 - Yeah. And Danielle, quick follow up for you. 85 00:03:38,525 --> 00:03:42,245 There, you, you, you laid out pretty, uh, pretty succinct, 86 00:03:42,305 --> 00:03:45,205 but pretty detailed in terms of how CMS star ratings, 87 00:03:45,305 --> 00:03:47,205 how these are sort of moving targets, right? 88 00:03:47,265 --> 00:03:49,845 Mm-Hmm. , um, is, is, is there sort of a way 89 00:03:49,945 --> 00:03:52,765 to, because I imagine, you know, we at Becker's are, are, 90 00:03:52,905 --> 00:03:54,805 um, well aware of sort 91 00:03:54,805 --> 00:03:56,765 of some Friday afternoon CMS 92 00:03:56,765 --> 00:03:58,005 updates from time to time . 93 00:03:58,225 --> 00:04:00,485 Um, so how, how they'll roll those out. 94 00:04:00,865 --> 00:04:03,845 Um, but is there, I guess my, my question is, is there a way 95 00:04:03,845 --> 00:04:06,045 to really try to get out in front of some of the trends? 96 00:04:06,045 --> 00:04:07,765 And I'm sure there that's true to an extent. 97 00:04:07,795 --> 00:04:10,205 Like you can, um, see some changes coming down the road, 98 00:04:10,305 --> 00:04:12,445 but then other things, other elements of 99 00:04:12,445 --> 00:04:14,445 that moving target are harder to predict. 100 00:04:14,675 --> 00:04:16,405 Yeah, for sure. Um, can, can, 101 00:04:16,505 --> 00:04:18,245 can you just share a little bit of insight about how 102 00:04:18,245 --> 00:04:20,485 that predictive element of this might work? 103 00:04:21,235 --> 00:04:24,485 - Yeah, I think, I think it kind of goes back to, uh, 104 00:04:24,605 --> 00:04:26,285 I think rather than trying to predict 105 00:04:26,545 --> 00:04:29,565 how a measure's gonna change, my philosophy is 106 00:04:29,565 --> 00:04:33,485 that if you're focused on operational excellence 107 00:04:34,065 --> 00:04:35,445 and you're focused on achieving 108 00:04:35,635 --> 00:04:38,405 that excellence across the board all the time, right? 109 00:04:38,405 --> 00:04:42,085 And the whole organization is focused on, uh, 110 00:04:42,085 --> 00:04:44,125 medical outcomes and member and 111 00:04:44,265 --> 00:04:47,925 and provider experience, it becomes less a question 112 00:04:47,925 --> 00:04:50,525 of where's the target moving, right? 113 00:04:50,825 --> 00:04:54,645 You're not as focused on trying to hit a specific target 114 00:04:55,065 --> 00:04:57,205 as much as you are just having a broad 115 00:04:57,525 --> 00:04:58,605 strategy, if that makes sense. 116 00:04:59,035 --> 00:05:01,605 - Yeah. Yep. No, that, that, that does make sense. 117 00:05:01,605 --> 00:05:04,245 And so just thinking about that excellence then, is 118 00:05:04,245 --> 00:05:05,845 that sort of that element would you say? 119 00:05:05,845 --> 00:05:07,525 Because, 'cause my next question is really 120 00:05:07,525 --> 00:05:10,605 how can leaders at at payer organizations embed these 121 00:05:10,605 --> 00:05:11,805 best practices Mm-hmm. 122 00:05:11,845 --> 00:05:12,685 in their teams for, 123 00:05:12,745 --> 00:05:13,885 for this quality improvement? 124 00:05:13,885 --> 00:05:15,205 And I imagine that that commitment 125 00:05:15,205 --> 00:05:17,125 to e excellence is a part of your answer. 126 00:05:17,485 --> 00:05:18,565 Absolutely. Are there any more specific, 127 00:05:18,785 --> 00:05:20,805 are there any more specific examples you can share there? 128 00:05:21,195 --> 00:05:22,765 - Yeah, for sure. I think so. 129 00:05:23,025 --> 00:05:25,165 You know, and probably people have heard this all the time, 130 00:05:25,185 --> 00:05:26,965 but I really do think it, it, it matters. 131 00:05:27,025 --> 00:05:28,965 People process technology, right? 132 00:05:28,965 --> 00:05:30,925 Those are the three things you always have to focus on. 133 00:05:31,345 --> 00:05:33,485 And with stars, I think it has to start with people. 134 00:05:34,145 --> 00:05:36,405 Um, I was recently at a Becker's conference 135 00:05:36,545 --> 00:05:39,165 and, uh, there was a woman speaking from UPMC, 136 00:05:39,865 --> 00:05:43,325 and I couldn't agree with her more completely in that 137 00:05:43,475 --> 00:05:46,485 what she was talking about was organizations have to, 138 00:05:46,955 --> 00:05:49,285 from top to bottom, you know, 139 00:05:49,285 --> 00:05:51,845 make sure everyone in the organization understands 140 00:05:51,955 --> 00:05:55,045 what stars is, why it's important. 141 00:05:55,505 --> 00:05:58,045 Um, and you, I think mentioned earlier, you know, 142 00:05:58,045 --> 00:06:00,285 it has a huge impact on revenue. 143 00:06:00,825 --> 00:06:04,445 Um, and so each department, each person really has 144 00:06:04,445 --> 00:06:06,005 to understand their role in it. 145 00:06:06,505 --> 00:06:08,525 Um, and so I think there are some things, you know, it has 146 00:06:08,525 --> 00:06:10,005 to kind of become part of the DNA 147 00:06:10,065 --> 00:06:11,405 of a, of a culture of a company. 148 00:06:11,945 --> 00:06:13,365 Um, and I think that, you know, 149 00:06:13,805 --> 00:06:15,645 companies can do things like, you know, 150 00:06:15,645 --> 00:06:17,005 make sure every executive 151 00:06:17,005 --> 00:06:21,205 and manager knows what the measures are, um, have workshops, 152 00:06:21,385 --> 00:06:24,805 um, to educate people, um, make sure you have a champion, 153 00:06:25,305 --> 00:06:28,805 um, that understands not only medical outcomes, which is, 154 00:06:28,805 --> 00:06:31,485 you know, quality is a big part of it, but so is member 155 00:06:31,485 --> 00:06:32,685 and provider experience 156 00:06:33,545 --> 00:06:36,165 and, you know, look at ways to maybe reward 157 00:06:36,165 --> 00:06:39,405 and incent individuals, teams, managers, and so on. 158 00:06:39,745 --> 00:06:42,085 Um, and then the second part of that, of course, goes back 159 00:06:42,085 --> 00:06:44,805 to then process and technology, um, right. 160 00:06:44,905 --> 00:06:48,645 Uh, and making sure that you re-look at those processes 161 00:06:48,915 --> 00:06:50,845 that directly impact stars. 162 00:06:51,925 --> 00:06:54,455 - Yeah. Yeah. And, and so thinking about those processes 163 00:06:54,455 --> 00:06:57,015 and technologies, I, I guess my question then is 164 00:06:57,365 --> 00:06:59,735 what strategies or resources do you think 165 00:07:00,395 --> 00:07:02,855 are really effective at, at improving those processes 166 00:07:02,875 --> 00:07:04,175 as it re relates to, of course, 167 00:07:04,175 --> 00:07:05,335 achieving that five star rating? 168 00:07:05,565 --> 00:07:07,895 Yeah. Um, any specific success stories to call out here? 169 00:07:08,685 --> 00:07:11,815 - Yeah, I guess, um, I would say that, you know, first 170 00:07:11,875 --> 00:07:13,735 and foremost, I, I love this saying you have 171 00:07:13,735 --> 00:07:14,895 to slow down to speed up. 172 00:07:15,035 --> 00:07:16,655 Uh, you know, I don't know if you heard that, 173 00:07:16,675 --> 00:07:17,895 but it's just great. 174 00:07:17,955 --> 00:07:21,175 And, uh, I think sometimes we're also busy getting work 175 00:07:21,175 --> 00:07:24,975 done, you know, that as leaders, um, a lot of times we fail 176 00:07:24,975 --> 00:07:28,295 to revisit processes and redesign and optimize them. 177 00:07:29,195 --> 00:07:31,055 Um, you know, we kind of get stuck in this 178 00:07:31,055 --> 00:07:32,135 is the way it's always been done. 179 00:07:32,235 --> 00:07:34,615 And, you know, so we kind of stop asking the questions. 180 00:07:35,035 --> 00:07:37,615 Um, I'm trained in Lean Office Six Sigma, 181 00:07:38,575 --> 00:07:41,515 and while adopting like a formal methodology like that, 182 00:07:41,635 --> 00:07:43,435 I think is great, and it is very 183 00:07:43,435 --> 00:07:45,275 effective, it's not essential. 184 00:07:45,775 --> 00:07:47,395 Um, I think that you can 185 00:07:48,165 --> 00:07:50,995 apply process improvement methods without kind of 186 00:07:50,995 --> 00:07:52,315 that more rigid formality. 187 00:07:52,695 --> 00:07:54,715 Um, and I'll just mention a particular tool 188 00:07:54,715 --> 00:07:56,315 that's been really effective for me. 189 00:07:56,775 --> 00:07:58,435 Um, and it's called a cipo. 190 00:07:58,735 --> 00:07:59,995 Um, it's actually an acronym 191 00:08:00,415 --> 00:08:04,515 and it stands for supplier input, process Output and Custom. 192 00:08:05,415 --> 00:08:09,035 Um, and it's a specific way to facilitate taking a team 193 00:08:09,665 --> 00:08:12,475 through who supplies input to a process. 194 00:08:12,735 --> 00:08:15,555 Is it members, providers, you know, internal departments, 195 00:08:15,975 --> 00:08:18,715 um, what those inputs are, how they're processed, 196 00:08:18,945 --> 00:08:21,235 what the outputs and out expected outcomes are, 197 00:08:21,235 --> 00:08:22,755 and then who ultimately is the customer. 198 00:08:23,255 --> 00:08:27,075 And from my experience, I've done so many of these, 199 00:08:27,125 --> 00:08:30,475 these sessions, and you can do 'em in about a half a day, 200 00:08:30,895 --> 00:08:34,915 and people are al always blown away by the things 201 00:08:34,915 --> 00:08:36,475 that they didn't know, right? 202 00:08:36,695 --> 00:08:39,115 Um, it gives managers visibility into things 203 00:08:39,115 --> 00:08:41,715 that they're often unaware of, gives voice to people 204 00:08:41,785 --> 00:08:43,915 that may not otherwise, you know, speak up 205 00:08:43,915 --> 00:08:45,715 and have important things to contribute. 206 00:08:46,455 --> 00:08:50,675 And it just helps root out where there are inefficiencies. 207 00:08:51,095 --> 00:08:53,235 You know, and I'm just, I'm always astonished at 208 00:08:53,235 --> 00:08:55,805 how organizations, you know, can work against themselves 209 00:08:55,865 --> 00:08:57,285 by the sheer lack of the fact 210 00:08:57,285 --> 00:08:59,885 that they don't have good cross-departmental communication 211 00:09:00,225 --> 00:09:01,245 and process awareness. 212 00:09:01,465 --> 00:09:03,005 So I know it's kind of a broad statement, 213 00:09:03,185 --> 00:09:06,285 but I do think like just process improvement, um, 214 00:09:06,465 --> 00:09:10,085 is really a key to any operational excellence, which again, 215 00:09:10,085 --> 00:09:11,485 is at the bottom line of it all. Right? 216 00:09:12,245 --> 00:09:14,375 - Yeah. And that process improvement, as you sort 217 00:09:14,375 --> 00:09:17,215 of pointed out there, requires that, that sort 218 00:09:17,215 --> 00:09:19,415 of intentional communication that you detailed Mm-Hmm. 219 00:09:19,455 --> 00:09:22,055 it requires that cross collaboration. 220 00:09:22,215 --> 00:09:24,215 'cause as you mentioned, you know, people always are 221 00:09:24,215 --> 00:09:25,335 surprised at what they don't know. 222 00:09:25,335 --> 00:09:27,655 And it's, it is kind of astounding when you're not doing 223 00:09:27,655 --> 00:09:29,255 that regular communication, all the stuff 224 00:09:29,255 --> 00:09:30,735 that can be like floating under the radar 225 00:09:30,835 --> 00:09:32,975 or the redundancies that can exist, right? 226 00:09:33,895 --> 00:09:35,415 - Absolutely. It is, it is amazing. 227 00:09:35,485 --> 00:09:36,815 I've done so many of these sessions 228 00:09:36,835 --> 00:09:39,455 and I always include managers and executives 229 00:09:39,475 --> 00:09:42,895 and they, they'll walk away just, you know, amazed at 230 00:09:43,405 --> 00:09:44,535 what they didn't realize. 231 00:09:44,955 --> 00:09:47,535 Um, and they always come away with really great initiatives. 232 00:09:47,715 --> 00:09:49,735 Um, and so they're very effective, I think. 233 00:09:50,195 --> 00:09:51,975 - Mm-Hmm. it is some, 234 00:09:52,005 --> 00:09:54,935 some really good tips there for, for improving processes. 235 00:09:54,995 --> 00:09:57,175 And you have talked about technology as well, 236 00:09:57,195 --> 00:09:59,495 and I wanna maybe zero in on that a little bit 237 00:09:59,495 --> 00:10:02,375 because of course, innovation is sort of essential here 238 00:10:02,375 --> 00:10:04,935 for this future of success of all healthcare organizations, 239 00:10:05,435 --> 00:10:06,575 payers included, of course. 240 00:10:07,045 --> 00:10:09,975 Yeah. Um, and how can you know, these organizations, 241 00:10:10,095 --> 00:10:12,495 I guess, prioritize new technology investments 242 00:10:12,495 --> 00:10:14,135 because there's just so much out there, you know, 243 00:10:14,395 --> 00:10:18,095 and how can you really tap into the technology that's going 244 00:10:18,095 --> 00:10:19,815 to support business needs 245 00:10:19,915 --> 00:10:21,215 and those quality initiatives 246 00:10:21,215 --> 00:10:23,735 that are gonna yield the results, uh, folks wanna see? 247 00:10:24,155 --> 00:10:25,455 So what would you recommend here? 248 00:10:26,035 --> 00:10:27,055 - So, yeah, so true. 249 00:10:27,475 --> 00:10:29,855 And I think one of the first things I think is 250 00:10:29,855 --> 00:10:31,735 that I think health plans should do 251 00:10:31,735 --> 00:10:32,815 proof of concepts, right? 252 00:10:32,815 --> 00:10:34,695 There's so much technology, as you said, 253 00:10:35,195 --> 00:10:38,295 and vendors that are confident in their technology will 254 00:10:38,295 --> 00:10:40,735 willingly, you know, do a proof of concept with you. 255 00:10:41,035 --> 00:10:43,855 Um, and it's a great way to learn more about the technology, 256 00:10:44,125 --> 00:10:46,415 what its benefits are, and minimize risk. 257 00:10:47,405 --> 00:10:50,495 Another thing, technique that I've used, you know, 258 00:10:50,495 --> 00:10:51,695 as when I was a CIO, 259 00:10:51,755 --> 00:10:53,375 we had many competing technology 260 00:10:53,375 --> 00:10:54,655 projects, as you can imagine. 261 00:10:55,235 --> 00:10:56,935 And so this may sound really simple, 262 00:10:57,075 --> 00:10:58,975 but we would take all the projects 263 00:10:59,315 --> 00:11:01,655 and we would plot them in a bubble chart, 264 00:11:01,685 --> 00:11:03,175 like on an XY axis. 265 00:11:03,715 --> 00:11:08,375 So we would get rough order of magnitude of complexity, risk 266 00:11:08,835 --> 00:11:10,815 of cost, and of business value 267 00:11:10,915 --> 00:11:12,735 or impact, and we would plot that. 268 00:11:13,155 --> 00:11:15,815 And it's amazing how that visualization of all those, 269 00:11:15,815 --> 00:11:18,055 those projects and initiatives, you know, 270 00:11:18,075 --> 00:11:21,215 can give you a really quick look at where's the biggest 271 00:11:21,245 --> 00:11:22,455 bang for the buck, right? 272 00:11:23,695 --> 00:11:26,855 I think organizations should invest in business analysts. 273 00:11:27,005 --> 00:11:28,775 They help bridge the gap, you know, 274 00:11:28,775 --> 00:11:31,055 between it, um, and business. 275 00:11:31,075 --> 00:11:33,335 And with technology playing such a more 276 00:11:33,335 --> 00:11:34,335 and more critical role. 277 00:11:34,955 --> 00:11:36,375 Um, I think that that's key. 278 00:11:36,875 --> 00:11:39,455 Um, and then the last point I guess I'll make is 279 00:11:39,675 --> 00:11:42,295 as both a process improvement consultant 280 00:11:42,995 --> 00:11:46,935 and a technologist, you know, I think process always needs 281 00:11:46,935 --> 00:11:49,495 to be revisited whenever ever you're undertaking a 282 00:11:49,495 --> 00:11:51,015 technology project, right? 283 00:11:51,295 --> 00:11:53,605 I think there's nothing worse than implementing new 284 00:11:53,605 --> 00:11:56,565 technology around old business processes, right? 285 00:11:56,595 --> 00:11:58,845 It's not a great way to optimize your investment. 286 00:11:59,805 --> 00:12:01,735 - Yeah. They, the two go hand in hand. 287 00:12:01,795 --> 00:12:03,735 You can't, you can't do one without the other. Correct. 288 00:12:03,945 --> 00:12:05,175 - You'd be surprised. , 289 00:12:06,055 --> 00:12:09,535 - , I, I, you know, uh, a lot of will, can, 290 00:12:09,595 --> 00:12:11,055 can achieve a lot, I'm sure. 291 00:12:11,575 --> 00:12:13,575 Danielle, uh, thank you so much for, 292 00:12:13,605 --> 00:12:15,375 it's been such a treat speaking with you today. 293 00:12:15,395 --> 00:12:17,455 Is there anything else our, our listeners should know? 294 00:12:18,005 --> 00:12:19,575 - Yeah, I guess I, I would like 295 00:12:19,575 --> 00:12:21,055 to take this opportunity just 296 00:12:21,055 --> 00:12:23,775 to talk about very briefly two technologies that we, 297 00:12:23,915 --> 00:12:25,415 we do offer and, and, um, 298 00:12:25,635 --> 00:12:27,455 and we provide to our, you know, customers 299 00:12:27,455 --> 00:12:29,695 that are really beneficial in transformations. 300 00:12:30,315 --> 00:12:32,615 Um, one is a technology called Data Velocity. 301 00:12:33,195 --> 00:12:36,935 Uh, it uses AI machine learning, natural language processing 302 00:12:37,315 --> 00:12:40,615 to automate the intake of unstructured documents and data. 303 00:12:41,035 --> 00:12:42,695 Um, you know, with health plans, there's 304 00:12:42,695 --> 00:12:45,775 so much information coming in, scan documents, emails, 305 00:12:46,105 --> 00:12:47,655 faxes, phone calls, um, 306 00:12:47,955 --> 00:12:52,575 and these types of technologies can really help, um, improve 307 00:12:53,115 --> 00:12:54,855 the member or provider's journey, right? 308 00:12:54,855 --> 00:12:56,335 That's the first point of that journey. 309 00:12:56,675 --> 00:12:59,375 And if you can, you know, process that quickly, 310 00:12:59,585 --> 00:13:01,815 categorize it, you know, get it pre-processed, 311 00:13:01,815 --> 00:13:03,495 you can really help improve customer service 312 00:13:03,835 --> 00:13:06,375 and that can improve things like your CAP scores in terms of 313 00:13:06,395 --> 00:13:07,775 how members will rate you. 314 00:13:08,795 --> 00:13:11,375 Um, the second technology, I'll try not 315 00:13:11,375 --> 00:13:12,855 to be too long-winded, uh, 316 00:13:13,035 --> 00:13:15,015 is insurance process automation suite. 317 00:13:15,035 --> 00:13:16,135 We call it IPAs. 318 00:13:16,565 --> 00:13:19,015 It's a technology that's been used in the traditional 319 00:13:19,015 --> 00:13:21,055 insurance industry for a really long time. 320 00:13:21,595 --> 00:13:23,255 Um, and we're starting to finally see 321 00:13:23,255 --> 00:13:24,575 some adoption in healthcare. 322 00:13:25,035 --> 00:13:27,695 Um, but it's basically a layer of technology that 323 00:13:28,425 --> 00:13:29,575 works with the systems. 324 00:13:29,755 --> 00:13:32,935 You have to orchestrate the movement 325 00:13:32,935 --> 00:13:35,215 of information in accordance with the business 326 00:13:35,815 --> 00:13:37,055 procedures and policies. 327 00:13:37,715 --> 00:13:39,935 Um, and a use case that I'll apply that 328 00:13:39,935 --> 00:13:41,135 to is appeals and grievances. 329 00:13:41,795 --> 00:13:45,585 So in appeals and grievances, you have all these documents 330 00:13:45,585 --> 00:13:47,945 and things coming in, and the caseworker has 331 00:13:47,945 --> 00:13:50,185 to get data from a lot of different systems. 332 00:13:50,725 --> 00:13:54,185 And so the first thing a technology like this does is it can 333 00:13:54,185 --> 00:13:56,425 aggregate data from many places, right? 334 00:13:56,425 --> 00:13:58,385 So I can aggregate the member data 335 00:13:58,445 --> 00:14:00,545 and the claim information, benefit information, 336 00:14:00,545 --> 00:14:03,625 and all of that into what we call a single pane of glass. 337 00:14:04,375 --> 00:14:06,585 From there, you know, these types 338 00:14:06,605 --> 00:14:09,345 of platforms can apply processing rules. 339 00:14:09,845 --> 00:14:11,945 So to ensure things like timeliness, 340 00:14:11,975 --> 00:14:13,345 make sure this gets acknowledged 341 00:14:13,345 --> 00:14:15,705 or resolved on time, uh, routing rules, 342 00:14:15,725 --> 00:14:17,265 what's the next step in this process? 343 00:14:17,725 --> 00:14:19,945 Um, does it need to be submitted to an IRE? 344 00:14:19,945 --> 00:14:23,105 And by when, uh, and things like data validation rules 345 00:14:23,685 --> 00:14:25,545 and, you know, how does that all tie back 346 00:14:25,565 --> 00:14:26,665 to something like stars? 347 00:14:27,455 --> 00:14:30,305 Well, you know, ensuring meeting appeals, timeliness, 348 00:14:30,355 --> 00:14:32,025 which is a measure, um, 349 00:14:32,255 --> 00:14:35,705 utilizing things like historical data to predict, you know, 350 00:14:35,805 --> 00:14:38,025 if you should or should not submit an IRE 351 00:14:38,205 --> 00:14:40,265 to an independent us, submit a case 352 00:14:40,265 --> 00:14:41,865 to an independent review entity. 353 00:14:42,285 --> 00:14:45,305 Um, and then using all that great analysis data 354 00:14:45,565 --> 00:14:48,865 to provide operational insights, um, to root causes 355 00:14:48,865 --> 00:14:51,165 of member dissatisfaction, um, you know, 356 00:14:51,165 --> 00:14:52,685 around things like access to care 357 00:14:52,745 --> 00:14:55,525 and care coordination, uh, and customer service. 358 00:14:56,065 --> 00:14:58,365 Um, so I know I kind of put a lot out there, 359 00:14:58,745 --> 00:15:01,165 but again, I think there's a lot of great technologies 360 00:15:01,165 --> 00:15:03,525 that can help, but it definitely goes back 361 00:15:03,525 --> 00:15:04,645 to those three key points. 362 00:15:04,645 --> 00:15:06,885 People, process, technology, you know, that's the only way 363 00:15:06,885 --> 00:15:08,605 to drive any kind of transformation 364 00:15:09,025 --> 00:15:10,485 and operational excellence. 365 00:15:10,485 --> 00:15:12,085 And I think that that's what's key to Stars. 366 00:15:13,145 --> 00:15:14,835 - Yeah. A a and Daniel, thank you so much 367 00:15:14,835 --> 00:15:15,995 for, for laying all that out. 368 00:15:16,115 --> 00:15:18,435 I think we really, um, try to, 369 00:15:18,455 --> 00:15:20,715 to bring solutions oriented conversations to, 370 00:15:20,775 --> 00:15:22,795 to our audience, and I think you've really helped 371 00:15:22,795 --> 00:15:23,875 us achieve that goal today. 372 00:15:23,875 --> 00:15:25,715 So thank you so much for, for coming on the podcast. 373 00:15:26,795 --> 00:15:27,835 - Excellent. Thank you so much for 374 00:15:27,835 --> 00:15:29,115 having me. I really appreciate it. 375 00:15:29,625 --> 00:15:30,875 - Yeah, it's been a real pleasure. 376 00:15:31,015 --> 00:15:33,475 And I also want to thank of course our sponsor Inspire 377 00:15:33,475 --> 00:15:35,595 Innovations for helping us put this podcast together. 378 00:15:35,975 --> 00:15:37,355 You can tune to more podcasts 379 00:15:37,355 --> 00:15:39,035 and virtual events from Becker's Healthcare 380 00:15:39,135 --> 00:15:41,275 by visiting Becker's hospital review.com.