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healthcare podcast.
I'm thrilled today to be joined by Casey
Hossa, chief information officer and security officer at
Health New England. Casey, it's a pleasure to
have you on the podcast today.
Laura, it's a pleasure to be here. Thanks
for the opportunity.
Well, absolutely. And I'm excited to have you
on the line today because I know there's
so much happening in changing in the digital
transformation
in the health care space and particularly
around security as well. Just being a big
focus this year, we've seen some really big,
breaches and challenges in the cybersecurity space. And
so I'm looking forward to learning a little
bit more about your perspective on how you're
thinking about,
you know, what you're doing today and and
growing in the future. But before we dive
into my discussion, can you tell me a
little bit more about yourself and, your background?
No. I'm happy to.
You know, I I,
I spent the last couple of decades in
health care, but, probably early in my health
in my career,
I spent a lot of time in almost
every industry outside of health care.
Right? And so a lot of it's been
focused on, you know, organizations like Deloitte and
Ernst, where we brought innovative solutions forward.
And so the past couple of decades, I've
really spent quite a bit of time across
a couple of different organizations in the healthcare
vertical.
I spent some time at, actually, here in
Chicago, one of the largest privately held loose
plans, HCSC.
And then I had the opportunity to be
a CIO,
for a provider system, a 9 hospital provider
system in Washington State,
then pivoted and took an opportunity to really
drive something different in the world of Medicaid,
specifically with duals and
behavioral health. And I was the CIO in
that space.
And I joined,
Health New England
just about 3 years ago.
And what's interesting with Health New England is
we're a provider owned payer
in Western Massachusetts. So it's a great opportunity
to think about how do you bring together
sort of
the relationship,
being a provider owned organization and and get
address some of the friction points and opportunities
to to really have a strong relationship with
the providers in this space, and specifically our,
you know, our parent company,
and have an impact for our members.
And so quite a bit of work across
a number of dimensions in this space.
Well, it's great to hear. You know? And,
certainly, I can imagine each different experience has
given you different tools and,
abilities to, you know, jump in and, as
you said, be primed for some of the
challenges and opportunities in the health care space
today. And I know, like you were mentioning,
that relationship between the providers and the, health
care organizations as well as the payers, it
seems like across the board is becoming more
and more essential to have that,
you know, kind of strong relationship
between them as health care continues to evolve.
So that's really fascinating to see.
From your vantage point, what are some of
the opportunities and headwinds that you have your
eye on right now?
You know, I I think all of us
are looking at some of the same areas,
but
specifically in our region,
right, we've got some unique opportunities and challenges.
And so I think Massachusetts
in particular really is a microcosm
of national trends,
because we're often very progressive in terms of
our policies,
and just early adoption of healthcare innovations.
And, I think the areas that we're focused
on in terms of potential opportunities are similar
to many of the other payers, I would
assume.
And a lot of this has been sort
of the onset recently of AI, right? And
I think there are some publications out there
that begin to talk about what AI can
potentially do in the payer space with some
significant savings on the administrative cost side,
savings on the medical cost side,
as well as improvement in revenue. And so
we're certainly like many other organizations thinking about
how do we get that established, what are
the opportunities and how do we begin to
understand how to apply those technologies to really
those broader problems that are out there?
You mentioned it, digital transformation,
right?
And I think for us, we live in
a region that's pretty tech savvy, and oftentimes
are early adopters.
They were early adopters of EHRs. So it
really provides a nice fertile ground for us
for additional innovation.
And so how do we we're looking at
how we continue to enhance customer experiences
and drive things that are focused on data
integration, so that we can take advantage of
the broader healthcare ecosystem
and provide a much more personalized experience.
The other areas that we're focused on are
things that are
you know, again, I had been out in
the market for a while, but I think
we're getting to a place where the maturity
and the tools have really helped us begin
to emphasize
things like, you know, value based care with
quality and cost effectiveness, right?
And, you know, developing much more,
I'll call it, robust risk adjustment models,
care management programs.
Again, looking at the region, you know, we've
got aging population, right? And so it creates
significant opportunities for Medicare Advantage Plans. And so
we're looking at how do we begin to
differentiate ourselves like others,
better understanding our members, offering up tailored products,
tailored benefits.
I think the other areas that are, again,
focused
on opportunities are telehealth and telemedicine. And I
think everybody is looking at and we are
as well at how can we kind of
expand on the promises that have been out
there, especially for rural areas,
things like clinically integrated
information exchanges, right? Again,
how do we take advantage of that and
bring that forward?
And then I would say,
like everyone, we're always exploring risk bearing arrangements,
right? Care coordination,
enhanced population health outcomes,
and all those, I think, really are just
good opportunities.
I think in the conversation, you talked a
little bit about headwinds,
right, as part of the question.
I would say,
you know, the health care industry is just
heavily regulated.
Right? And so
Massachusetts
often leads the way in terms of implementing
new policies.
And so, you know, like all organizations, we're
very much focused on compliance and regulatory, how
do we develop the expertise to navigate the
complex environments.
And I think as a CIO, what that
means is oftentimes we've got to be pretty
agile in responding to updates to IT systems.
You know, talent and retention
is a big part of what we were
focused on. There's always, you know, an opportunity
to take advantage
of talents and data analytics,
cybersecurity,
digital health.
You know, there's we I mentioned digital
transformation, but consumer expectations are
there's an easy button out there. Right? There's
a there's a rise in health care,
and health consumer expectations
around personal access, right, transparent services,
making sure that everything's offered in advance, right,
being insight, identifying the next steps,
you know, and the associated digital platforms
and messaging that comes along with that.
Because I think all of us, you know,
and I think retail has been ahead of
the game in a lot of ways,
just reset the customers and consumer expectations for
personalized care, convenient access,
right, transparency
and cost,
and making sure that and you've you mentioned
it at the start of this. Right? How
does all this maintain how do we maintain
sort of a security
and compliance associated with this critical space?
And and I think
there's a number of dimensions associated with that.
One of them actually is in the world
of AI, there's a lot more automation across
the tool sets in the security space that
allow us to
put more quickly understand patterns and
opportunities
to almost automatically
turn things off and turn off risk areas
and isolate, challenge areas where you might have
some unusual patterns that occur.
And so I think all of these really
provide a set of headwinds and opportunities, right,
hand in hand.
And so ourselves along with others are continuing
to look at and invest appropriately
to help us you know, in terms of
long term success and and, again, delivering value
to our members and and,
the community.
That's fascinating to hear, you know, and really
a lot of the things you mentioned, all
coming together, whether it's looking at some of
the areas where, you know, you can,
optimize the value based care, the quality, the
cost effectiveness,
and then integrating
systems, the digital transformation to be able to
better coordinate care and,
facilitate the flow of information.
And then to thinking about that consumerism aspect
and how patients and their,
you know, demand for care and the experience
that they want from their health care journey.
It's just it's been really fascinating to see
how all of those things,
are changing the way health plans and health
systems are operating and and, you know, thinking
about what they need in order to be
successful in the future.
You hit all the right buttons.
No question about it. And it's not not
an easy task to pursue. Right? There's a
lot of coordination, a lot of complexity to
all of it.
And, you know,
there's a there's a element of this associated
with personal privacy.
We're talking about we're not talking about, hey,
Casey is getting this pair of shoes on
Saturday that he ordered
on Amazon. We're talking about individual health care
and things that are very personal. And sometimes
disease management and chronic
disease management that gets
pretty complex.
And there's a lot of interactions across
caretakers and
the health payer, etcetera. So
a lot of complexities. If it was easy,
I think it would have been done already,
right. People would have figured it out and
there'd been an easy button.
Yeah. Absolutely.
You know, I I think a lot of
executives and leaders in the health care space
wish that easy button,
existed in front of them. But, you know,
I I know it's a lot more complicated
than that as you mentioned. Otherwise, you know,
we would be in a different place, today.
But how are you thinking about growth and
adding value overall in the future? What does
that look like for you, especially on the
technology and security side?
Yeah. For us, it's a continued focus on,
digital transformation
innovation.
Right?
You know, there's there's a lot of cloud
based platforms. There's a lot of automation with
AI that we're taking a look at and
thinking about.
And again, how do we deliver those through
mobile apps, telehealth services,
omnichannel capabilities.
I spent quite a bit of time early
in my career with in a number of
other industries.
And so these concepts have been around for
decades.
They just need to be implemented differently in
each of the industries.
Data analytics and AI,
in fact, I just finished
some individual coursework at the University of Chicago
because there's so much to be harnessed
with AI and some of the models, AIMO
and some of the data models that are
out there and the insights that you're able
to get. And so much of it is
really focused on making sure that you've got
good clean data
that you can make good decisions on. And
that's always been a constant struggle,
you know, for decades. And it's been in
almost any industry and health care even more
so just because of the privacy
associated with so much of that information
and the compliance and regulations that we need
to apply.
All of us are focused, I think, on
cybersecurity and data privacy. It just has to
be, right. It's we've got to protect our
sensitive member data. We've got to ensure regulatory
compliance.
It's a top priority for all of us.
And there's a lot of sensitivity to it,
not only in the industry, but across the
leadership. And that's been
really positive. I think the one positive maybe
out of it is
everybody's focused on it, everybody recognizes the importance
of it. And I think it just puts
us in a much better place to put
you know, 0 trust security frameworks,
encryption safeguards across all platforms.
I think,
you know, I talked a bit about AI
and data.
And this particular industry is so rich in
information, right? And
different
organizations,
providers, payers, and the platforms, I think can
really
differentiate and create a level of growth and
value for organizations.
And we've talked about the other pieces, right,
member experience with technology, cloud computing platforms that
allow us to move some things forward.
We
those things are just not buzzwords, they're reality.
We've been able to see that. I've seen
this in many organizations as well as ours
today.
We're able to move things much quicker
and deliver solutions much more effectively
and reduce the cycle times
associated with some of these platforms and the
experiences and the learnings that have been had
over the course of time.
And so we've been able to do a
lot, I think, in a short window for
a small organization taking advantage of these,
you know, oftentimes off the shelf capabilities.
And then I would say maybe some of
the other things that are out there maybe
further out,
Laura, are things like,
I've I've been in technology for decades, so
I'm always a big fan of what you
can do.
But, you know, blockchain, again, because it enhances
security.
There's transparency.
There's an efficiency of transactions. And so, you
know, I'm hoping that, as we look a
little
I'm hoping that, as we look a little
further out, those are sort of the technologies
that we can begin to take advantage of.
And then the other piece that's out there
is there's been a pretty significant pivot over
the course of time here where a lot
of organizations,
especially tech companies, startups,
and in the Massachusetts
region, right, we just got so many of
those because it's a pretty tech rich area.
There's a lot of collaborations, not only across
peers, but with some of these, organizations
and
solutions that address
health coaching and chronic disease management. So
a pretty long winded answer to
sort of
the opportunities for for growth because I think
there's quite a few of them in this
particular space.
Well, that's exciting to hear. And, certainly, you
know,
having that ability as we've talked a little
bit about,
just the automation, the technology, the artificial intelligence,
then blockchain too, making come back into the
conversation in health care in a meaningful way,
is just fascinating. And I I can imagine
from your perspective looking on the technology side
and seeing all the challenges that we've talked
about in in ways that,
the technology can streamline that is really helpful.
But on the flip side, I I know
just thinking about the economics of health care
today, every dollar is precious. So, you know,
when you're looking at these growth opportunities and
technology and consuming,
optimize,
from the capabilities that you have, what is
one risk or investment that's still worth making
this year even if you even have a
tight budget?
In in my opinion, I think it's really
the,
risky but rewarding investment of continuing to expand
into value based care. Right?
It's just it's a high stakes investment, right,
for for for payers as you begin to
dive deeper into
VBC models, right,
because it's complex and it's a risky endeavor,
but the potential awards I think are substantial,
right.
The opportunity to improve
top health outcomes,
taking on more risk, greater incentive, the opportunity
to focus on preventative care, chronic disease management,
the integration of Cures and its corresponding solutions,
the stronger
provider
partnerships that can lead to better care and
delivery and overall,
hopefully, reduced cost. Right? And we've talked about
this, right, that the relevant communication
services
and anticipating member needs. So sort of that
personalized member experience, right?
That I think is important.
And I
believe that we've made so many strides forward
in data analytics,
right, that give us the opportunity to begin
to, especially with the interoperability and exchange of
some very important information,
the opportunity to do the analytics around it
and really begin to be better prepared
and understand the risk and understand the complexity
and respond appropriately and take actions. And a
lot of that takes
a level of trust that's developed,
across organizations,
to be able to do that effectively.
And so the tools and the information and
the insights that are coming out, if you
can begin to build that trust relationship and
leverage those tools, I think
it is the one investment that,
feels, I think, benefits.
And,
honestly, at the bottom line, right, improves the
patient's health and outcomes and and
a significant impact to quality. So I think
it's the one area that so many technologies,
we talked about
digital transformation
and AI and data and interoperability, but they
sort of all converge
to be able to
make this kind of an impact.
So, I I think it's the the one
space that's worth the worth investment
for for organizations.
That makes a lot of sense. And, you
know, it's just fascinating to see how,
the value based care,
has evolved, especially in the last 5 to
6 years or so. I know in the
past, there's been energy around it and then,
you know,
not as much movement, and actually implementing it
on the provider side for many organizations than,
you know, still having to be in the
fee for service world to some degree and
not moving
as quickly as they probably could into value
based care. And so, you know, when you
look at,
what's happening today, is there anything that, you
know, you're doing differently or that you're seeing
a different,
type of,
approach to, I guess, in order to really
make sure that, you know, these types of
investments and, the move towards value based care
in more risk based models is something that,
you know, is gonna stick and be meaningful
for organizations in years to come.
Yeah. I mean, I think it's the,
it's the advantages that some of the technologies
and some of the data and some of
the insights,
are are bringing,
And and some of the AI components as
well. Right? I mean, we all behave differently.
We all respond differently. And and the the
the patient engagement and and their active engagement
in the process is so critical.
And so I think that's sort of
the the pivot. Right?
The the opportunity to to gain more insight,
to be able to to to set the
right incentives, right, to be able to make
the right connections.
And then I I think the other element,
and I mentioned this a bit about,
the data outside of it. Right? We're also
so focused on
integrating information and, oftentimes, clinical information. But in
addition to that,
there's been quite a bit of focus on
social determinants of health, right, and addressing social
needs,
the things you would expect, housing, food and
security, transportation,
but also, you know, collaboration with
local organizations and
and, trying to track the effectiveness of some
of these initiatives that sort
of adds
to, I think, the overall success,
that you can create in this space.
But a lot of it is just evolving
to a place that's much better. And I
actually think there's
a space
having spent some time in the provider world,
there's,
and so there's this Utopian precision medicine opportunity.
But I think there's also
an opportunity on the payer side
to get to
a much more view of
a position plan almost, right?
And one that
fits
the individual that fits the need.
And so I think
there's an opportunity
as a in the marketplace, right,
that begin to think about how do we
do that and what does that take
us in the long term.
That makes a lot of sense. And I
I feel like, as you mentioned, just the
type of, technology and insights and ability to
really make strong decisions based on that information
and data,
it does make a difference. Now, Casey, before
I wrap up here, I'm wondering,
what are some of the opportunities you're most
excited about for the future? How are you
looking at growth and,
really, moving forward over the next couple of
years?
You know, for us,
it's really the the digital transformation
opportunity. Right? It's understanding how we can begin
to take advantage of,
I'll just say, AI.
And a lot of this is gonna be
a bit of,
I don't know, maybe trial and and and
testing and,
figuring out where it makes the most sense
and what we can begin to do with
it.
But I would say,
when you take a look at it, there's
there's opportunities
across
care management,
care coordination,
improving our,
I'll call it, our overall medical cost. There's
opportunities
in reducing some of the administrative,
and friction that's associated with
some of the existing processes that are oftentimes
very manual
and paper based to some degree and maybe
not paper, but
faxes that are still used in the industry,
etcetera.
And then I mentioned a bit about tailored
or maybe more precision plans, right? But I
think
in optimizing how you
create you know your member and you know
the communities and you know the market.
How do you begin to
improve and bring that information together and deliver
a much more
insightful set of products and plans
and do the right outreach
with the right connection and digital experience
to maintain
the number retention and and to build on
that relationship and to really create a trusting
relationship. Because I think in this particular space,
there's,
so much that so much good that that
is being done and that can continue to
be done.
And being able to highlight that
and to share that and to build that
relationship versus
a transactional
relationship, right?
I get an EOB or I get a
bill from a provider and
how do you take it forward, right? How
do you begin to look at what detail
is done in terms of understanding where you
left off and what you might be looking
for next?
And so
I think those are just areas for growth
as we go forward.
And I'm pretty excited about the opportunity to
bring these things and these technologies together and
see how we can impact
them in a positive way, our member base
and and the quality of the quality of
health and and the outcomes associated with it.
That's amazing to hear it. Casey, thank you
so much for joining us on the podcast
today. This has been such a fun and
informative conversation, and I look forward to connecting
with you again soon.
Laura, it's been it's really been a pleasure.
I always love talking about this.
It's it's been a space that I've been
focused on for
way longer than I wanna admit.
And, it's just such a space that, you
know, all of us experience
and need, right,
at different levels at different points in our
life. But,
it's so important. And,
I'm looking forward to seeing what we're going
to be able to do in the future
and really appreciate the opportunity to come on
here today and
share a little bit of my thoughts with
you in the audience.