The Becker's team is excited to announce the
launch of our new CFO and Revenue Cycle
podcast.
Tune in for conversations with finance experts from
the top hospitals and health systems. We'll discuss
key trends and ideas to drive meaningful change
in the industry. Look for Becker's CFO and
revenue cycle podcast wherever you listen to episodes.
This is Laura Dierdahl with the Becker's Healthcare
podcast.
I'm thrilled today to be joined by Richard
Clark, senior vice president and chief analytics officer
at Highmark Health. Richard, it's a pleasure to
have you on the podcast today.
Yeah, Laurel. Thanks so much for having me.
Now I'm excited to hear more about some
of the cool things you're doing at Highmark
Health. I know, you're in such a a
unique position and unique market as well there
at Pittsburgh. But before we dive in, I'm
wondering, can you tell us just a little
bit more about Highmark Health and what makes
it unique?
Yeah. I'd be, more than happy to. You
know, Highmark Health is a integrated,
health services company, and, you know, I think
one of the things that makes us unique
is with, the the different assets that we
have. Right? So we have Allian Health Network,
which is a network of 14 hospitals, ambulatory
surgery centers, health and wellness pavilions, and employed
physician organization,
many other assets. We have, of course, our
blue branded health plan,
with over 5,000,000 members, and we have a
number of diversified businesses. Our, national dental business
stop loss, our,
technology company engine, and, really, that just leads
to so many,
opportunities
to,
serve members, to improve health, to investigate and
understand,
how different interventions lead to positive outcomes, to
experiment,
and, really, overall to, you know, achieve the
goals of living health, our strategy, which is
really creating more health and creating more affordable
care.
Well, that's amazing to hear. I know there's
so much, to be done in in that
space and finding the best quality as well
as being cost efficient. Now in looking in
the last year or so, what accomplishment are
you most proud of?
Well, I'm gonna I'm gonna cheat a little
bit and give you, give you two. So,
you know, one really gets at that intersection
of payer and provider and, you know, Allegheny
Health Network in kind of the context of
Highmark Health is really our living laboratory for
our strategy. And, you know, we're doing a
ton of work to just investigate how payer
and providers can collaborate together to kind of
do exactly like you just said. Right? Really
meet that quintuple aim,
aim, and deliver,
you know, care that is high quality, more
affordable, equitable,
etcetera. And, you know, one of the things
in that vein that we're really proud of
is we implemented a,
quality and shared risk program between our health
plan and LA health network.
Last year, it's, you know, one of the
larger ones that we're aware of. It's, you
know, serves over 350,000,
members across every segment,
a commercial ASO, fully insured Medicare,
ACA, etcetera. We've just been learning so much
around the integrated economics, how to use that
blended data,
across payer and provider to lead to more
actual information,
earlier interventions, and ultimately,
achieve just a better outcome for our patients.
So that's been one that has been a
real journey,
in terms of learning and,
you know,
really excited about what that,
means, not only for the,
payer and provider,
Highmark and Alligator Health Network, but how we
can also then take that out to other,
provider partners,
of ours. And then the second is really
all about generative AI and the work that
we've,
been doing there, particularly around
the broad adoption,
of AI across our enterprise. You know, we,
we have
a AI center of excellence here that we're
really focused on making kind of, AI the
easy button,
within our our company. And, there's lots of
exciting things going on from large scale solutions,
like the ambient listening technology that we've been
rolling out across Allegheny Health Network to improve,
you know, the clinicians,
day to day work and kind of bring
a lot of joy back to practice,
but also,
the rollout of our at scale,
secure generative AI solution we call Sidekick,
for every single one of our 50,000 employees,
and that's just been amazing. We have,
over 10,000
active users on our internal platform. We just
surpassed
the 1,000,000,
prompt,
submitted,
threshold. And, you know, we've been out training
thousands of our employees
on prompt engineering,
how to use these tools,
every single director and up, we spent time
with. And just as as my time at
the company, I've I've never had so many
people stop me in the elevator or stop
me in the hall and tell me some
new cool way, that they're using this technology
to to create efficiencies to better serve our
patients and members, and it's just been
just such an exciting time.
That's amazing to hear. You know? And what
a a really cool way that you are
able to, weave generative AI into the things
you're doing every day to make life easier
for the clinicians.
And it it seems like as well, the
patient journey is more efficient. And I'm curious,
when you look at, you know, that,
unique position you have as you were talking
about that intersection of being a payer and
provider,
in in going more towards that,
quality based shared risk programs.
Is there something that you can share with
us that you've really learned over the last
few years,
that could, you know, really,
has helped you find that the right note
or or strike the right path, in terms
of, you know, how you're thinking about care
delivery and the type of data that you're
collecting and
ways that,
you are bridging that into the patient care
that our clinicians are delivering on a daily
basis?
Yeah. Yeah. I mean, well, we could have
a really long conversation on that because I'll
tell you there's a lot there. But I
I would just offer two things. Right? You
know,
first is,
you know, payers and providers, frankly, they just
speak different languages. Right? And so we've been
spending a lot of time just educating
kind of both sides of that, but also
making sure that the data can sync. And,
you know, conceptually, it sounds easy,
but really understanding
how some of that faster moving clinical data
inside of the EMR
then relates to what ultimately,
we see in terms of the cost of
care inside of these value based programs is
not as easy as you think. It's actually
really hard,
but it's also really worthwhile because ultimately
what we want to get to,
as, you know, our kind of head of,
Alligator Health Network tells me all the time,
which I totally understand is, you know, we
want the fast moving clinical data to inform
the actions that we want to take, and
then we want the
claims data to ultimately confirm
that those actions are leading to that goal
of more, higher quality, lower,
you know, cost care. And, you know, that's
been a journey. We've learned a lot, you
know, for sure. And then the second thing
is, you know, it at the end of
day, it's all about workflow.
Right? And it's like, how do you get
into that workflow in the most seamless and
easiest way possible
so that we can drive adoption frontline. And,
and we're just not in a position nor
should we be to add any
administrative burden. In fact, we have to take
it off of the providers, but we have
to do so in a way that also
allows us to give them the insights they
need inside of these, quality,
you know, and risk programs so that they
can achieve those better outcomes.
That's amazing to hear. You know? And it
really, really fascinating to think about,
you know, aligning the different elements and size
of the provider, the payer, bringing them together,
and then, coming to that kind of,
space where you're able to work together to
align in a a meaningful way. Now looking
ahead, where do you see some of the
big growth opportunities
for your team in the next twelve months
or so?
Yeah. You know, there there there's a lot.
I'll I'll just highlight a couple that I'm
really excited about. You know, first is,
you know, I I'm
excited to see just really the huge value
realization from the scaled use of generative AI.
You know, we've seen it in a lot
of early areas of adoption. We've seen it
in a lot of the pilots,
and we're seeing it in,
starting to to be at scale. And it's
gonna happen. It's gonna happen for our clinicians,
certainly in the area of software developers and
certainly in the area of our contact centers,
really that kind of, you know, scaled impact.
You know, I think the second is,
you know, really how it kinda continues to
streamline our hospital operations leading to more efficient
care and really allowing clinicians to work at
the top of their license. We're liberating,
you know, many hours,
for our clinical staff by taking away some
of that,
administrative burden, and I'm excited
to see that,
you know, continue. And then I think the
next wave of innovation is, of course, what
everyone is talking about, agentic workflow.
And, you know, we're excited about that. We've
launched our first kinda single use agent.
We're really exploring,
you know, not only the technical aspects of
what has to be true to have a
broader ecosystem agents that are orchestrated against tasks,
but also the people aspects of that.
Not only, you know, building them within
the AI center of excellence, but really enabling
a broad swath of our, enterprise
to be reimagining
processes,
and workflows,
using AI as, you know, another piece of
the workforce. And that's gonna be the next,
you know, big step forward,
that, again, is gonna be a a real
source of growth and impact for us.
Fascinating
to hear. I think it's just,
seems so critical to find that right technology.
And interesting that you mentioned the agentic workforce
is something,
honestly, I've just been starting to write about
on the,
the the digital side as well, and it
it seems like so many opportunities, some really,
really cool things that you're able to do
once you have the technology and learn how
to harness it in the right way.
How do you make sure you're making the
right investments,
especially with so many different technologies and companies
coming out with applications,
that,
you know, promise big things? How do you
know that it's gonna have the right return
for the type of investment that you need?
Investment that you need?
Yeah. You know, it's a great question. I
think ROI is becoming an increasing,
you know, topic of conversation, you know, for
sure.
In some ways, I feel like, you know,
we've been lucky. We we,
invested in our secure Google Cloud platform in
late twenty twenty with a strategic partnership with
them. So that enabled us to really move
quickly
in terms of feeling confident
that we could turn on,
you know, some of these, you know, generative
AI solutions and connect them
safely and securely to our data. So we've
been doing a lot of that. And in
those spaces, I guess, I'm in some ways
less worried about whether or not this particular
use is the absolute highest ROI
use case. You know? We we see huge
strategic value in, you know, a broad swath
of our workforce, learning how to talk to
machines, getting very used to prompting, getting very
used to incorporating an AI assistant into their
work. I think when when it comes to,
you know, selecting additional,
you know, fit for purpose,
partners for some of those solutions, we're being
very intentional. You know, I mentioned the ambient
listening
component for our, you know, clinicians. We have
a we've been running a pilot with, you
know, nearly 500 clinicians with several different,
potential
Ambient partners in all sorts of different settings,
right, inpatient and ambulatory, etcetera, to make sure
that we are
selecting. But then I would also say at
the end of the day, making sure that
we are
working hard on our ecosystem to allow for,
onboarding of new options, integration of new solutions,
building, making sure the build by decision isn't
like a binary one that can never be
revisited because everything is changing so quickly
that to think that you can, like, pick
today and be perfect is is a fool's
errand. Right? I think you just have to
acknowledge that, you know, innovation is moving so
quickly. And so being able to have a
eco innovation ecosystem that allows for experimentation, rapidly
moving, you know, solutions in
you know, solutions in and out of the,
of the ecosystem, not only technologically, but also
in terms of the contracting that has to
come with that, etcetera, is is just really
important.
Makes a lot of sense. I I appreciate
the insights there and, you know, a lot
of opportunities ahead. Really fascinating to see some
of the cool things that are coming down
the pipe, but I know there are headwinds
as well. Some what are some of the
big challenges that you're anticipating and starting to
navigate through?
Yeah. You know, with any large scale transformation,
and that's exactly what this is. Right? This
is kind of digital
kind of AI transformation at scale. There's always
a bunch of,
you know, of challenges.
Obviously, a lot of opportunity too, but but
I would highlight two here. Right? One one
is, you know, the kind
of the challenge that is always present. And
just because it's, generative AI now, it's really
no different, and and that's behavior change.
You know, at the end of the day,
we're talking about people and at
scale creating behavior change, both of our, staff
internally that are working on this, but also
then our members and patients to, to get
to kind of more health. Right? And so
that's hard, and that requires a lot of
thought around incentives,
around structures,
you know, around,
you know, how we frame and deliver information.
So there's a huge change management comport component
of this,
that we think a lot about. In fact,
you know, the
my lead of our AI program, that's that's
her background is really around change and around
change management.
And then the second, of course, is the
just the business environment. Right? It is, there's
a lot of,
near terms pressures. There's a lot of headwinds.
There are a lot of challenges in the
environment right now. And so how we serve
that dual mission of,
you know, creating,
near term business impact while still investing kinda,
quote, unquote, through the cycle, if you will,
to make sure that we can kinda get
to those longer term, you know, strategies and
successes is really important.
And that comes down to just,
you know, really good prioritization,
really good thoughts around,
again, balancing strategy
and some of the near term execution,
but certainly does make this a little harder
than maybe trying to do it when there
were fewer pressures.
Absolutely. I think that makes a lot of
sense, and and really helpful to think through
that near versus long term strategies.
How do you balance both of those with
yourself as well as your teams in keeping,
you know, the main thing the main thing,
but not losing sight of where you're going
as well?
Yeah. You know, it it it's like communication,
communication, communication.
Right? You know, we really, you know, value,
you know, the interactions and the ability to
have that and, you know, doing our absolute
best to create a flat organization,
where we're bringing,
you know, cross functional teams together. You know,
there there is nothing that I've done in
my career
that is more cross functional than, you know,
this AI work recently. It truly requires
all aspects of the organization,
operations,
IT,
the, you know, advanced analytics teams, legal, compliance,
you know, you name it to come together
to figure out how to make this work.
And,
you know, the good news on that is
we're building all sorts of new,
strong relationships because the best way to do
that is, you know, do hard things together.
You know? But it's also everyone learning,
you know, different components of the organization that
maybe they didn't see as much before. So
I think that's a big,
piece of it. And then it is just,
you know, a lot of grit and frankly
continued focus because it's also hard and you
can't get distracted
just because maybe it didn't work in the
second or in this moment. Right. And just
the determination to say no, but we do
think the future direction is clear. And, you
know, as the
And, you know, as, David Holmberg, our CEO,
says all the time, the strategy is a
series of s curves, and we're certainly
navigating one of those s curves, you know,
right now, but we have to keep our
eyes towards that, you know, that end goal
of delivering,
you know, more health and more affordability for
the communities we serve.
Really, really helpful advice. Thank you again so
much,
Richard. This has been amazing. Before we wrap
up here, I'm wondering, what is the number
one thing that you're doing right now to
set yourself up for success in the long
term?
Yeah. It's a great question. I mean, I'm
sure everyone has many of the things I've
talked about on their strategic plans. Right? So
I don't think we're,
you know,
you know, we're we're not we don't fool
ourselves and think that we somehow are, you
know, thinking about things that are necessarily different,
than everyone else. I think what we really
just focus on is, you know, how we're
creating a culture of execution, a culture of
continuous learning, and really building with people so
that,
it is a resilient organization that can can
continue to react to change, continue to embrace
change, to create, better outcomes. In the moment,
we're doing that with a bunch of things
we talked about here today.
You know, but really for us, it's all
about the model
that we're,
we're creating that hopefully will allow us to
continue to
embrace innovation, embrace change, and and,
translate that to to more impact. Again,
keeping the the customer at the center and
saying, how can we create more more health,
more affordability, more impact for that member? You
know, I think that ultimately will will set
us apart.
That's amazing to hear. Richard, thank you so
much for joining us on the podcast today.
This has been a fun discussion to have,
and I look forward to connecting with you
again soon. Yeah. Absolutely. Thank you so much.
This has been great. Really appreciate it.