1 00:00:00,240 --> 00:00:02,720 Imagine this. You're at the Swiss Hotel in 2 00:00:02,720 --> 00:00:06,399 Chicago surrounded by top executives from leading insurance 3 00:00:06,399 --> 00:00:08,099 companies and health systems. 4 00:00:08,480 --> 00:00:12,160 Welcome to Becker's Fall Pair Issues Roundtable, November 5 00:00:12,160 --> 00:00:13,859 4th through 6, 2024. 6 00:00:14,625 --> 00:00:17,345 Picture the excitement as you gather business cards 7 00:00:17,345 --> 00:00:20,005 from over 500 executive level attendees, 8 00:00:20,545 --> 00:00:22,164 building invaluable connections. 9 00:00:22,704 --> 00:00:25,345 Feel the energy as you participate in over 10 00:00:25,345 --> 00:00:29,285 26 educational sessions led by 90 elite speakers. 11 00:00:29,769 --> 00:00:32,969 Envision yourself engaging in lively discussions about new 12 00:00:32,969 --> 00:00:36,409 health plans, hospital at home models, behavioral health, 13 00:00:36,409 --> 00:00:37,549 and price transparency. 14 00:00:38,170 --> 00:00:41,690 Now imagine being inspired by keynotes from boxing 15 00:00:41,690 --> 00:00:45,045 legend, Sugar Ray Leonard, and 4 time NBA 16 00:00:45,184 --> 00:00:47,744 All Star, Chris Webber. Their stories will leave 17 00:00:47,744 --> 00:00:50,004 you motivated and ready to innovate. 18 00:00:50,384 --> 00:00:53,024 Don't miss out on this unique opportunity. Get 19 00:00:53,024 --> 00:00:55,939 registered today. Visit beckershospital hospitalreview.com 20 00:00:56,640 --> 00:00:58,904 and click on the events page to find 21 00:00:58,904 --> 00:01:00,820 the conference website. That's the beckershospitalreview.com events page. 22 00:01:00,879 --> 00:01:02,100 See you in Chicago. 23 00:01:03,199 --> 00:01:03,699 Hello, 24 00:01:04,239 --> 00:01:06,719 everyone. This is Jacob Emerson with the Becker's 25 00:01:06,719 --> 00:01:07,939 Payer Issues podcast. 26 00:01:10,875 --> 00:01:12,715 Thrilled today to be joined by a special 27 00:01:12,715 --> 00:01:15,515 guest. Piyush Khanna is the vice president of 28 00:01:15,515 --> 00:01:18,894 clinical services at CareFirst Blue Cross Blue Shield. 29 00:01:18,954 --> 00:01:20,715 Piyush, thank you so much for taking the 30 00:01:20,715 --> 00:01:22,075 time to be with me on the podcast 31 00:01:22,075 --> 00:01:22,575 today. 32 00:01:23,650 --> 00:01:25,430 Thank you, Jacob. Thank you for the opportunity. 33 00:01:26,129 --> 00:01:27,349 Excited to be here. 34 00:01:27,650 --> 00:01:29,090 Yeah. And we're excited to have you, and 35 00:01:29,090 --> 00:01:30,209 we have a lot we wanna talk with 36 00:01:30,209 --> 00:01:32,129 you about. So before we dive into all 37 00:01:32,129 --> 00:01:33,650 of that, can you talk to us a 38 00:01:33,650 --> 00:01:36,049 little bit more about yourself, your background in 39 00:01:36,049 --> 00:01:37,810 health care, and what it is that you're 40 00:01:37,810 --> 00:01:39,135 doing today at CareFirst? 41 00:01:40,174 --> 00:01:41,314 Absolutely, Jacob. 42 00:01:42,174 --> 00:01:44,015 So I've been in the health care industry 43 00:01:44,015 --> 00:01:46,495 for a little bit, spent the last, 20 44 00:01:46,495 --> 00:01:49,314 plus years in health care, working on provider 45 00:01:49,375 --> 00:01:49,875 systems, 46 00:01:50,495 --> 00:01:52,915 working in start ups, working at large companies. 47 00:01:54,390 --> 00:01:56,230 And at CareFirst, my role, 48 00:01:56,709 --> 00:01:59,290 is focused on the clinical services element. 49 00:02:00,069 --> 00:02:02,950 So supporting the medical management function, the value 50 00:02:02,950 --> 00:02:03,770 based stuff, 51 00:02:04,310 --> 00:02:05,370 within the company, 52 00:02:05,829 --> 00:02:06,969 supporting our 53 00:02:07,884 --> 00:02:10,685 nurses, supporting our care management staff, supporting our 54 00:02:10,685 --> 00:02:12,764 appeals and grievance teams. So I have a 55 00:02:12,764 --> 00:02:14,384 team of resources that 56 00:02:14,685 --> 00:02:15,344 are working 57 00:02:15,724 --> 00:02:18,305 and supporting the quality area, the risk adjustment 58 00:02:18,364 --> 00:02:20,444 area, the value based care area, and the 59 00:02:20,444 --> 00:02:21,824 medical management function. 60 00:02:22,900 --> 00:02:23,400 Fantastic. 61 00:02:23,860 --> 00:02:25,459 So, Piyush, we're here to talk with you 62 00:02:25,459 --> 00:02:28,419 a little bit about receiving timely data from 63 00:02:28,419 --> 00:02:32,120 provider networks to meet quality reporting requirements. So 64 00:02:32,259 --> 00:02:33,780 for our listeners who might not be as 65 00:02:33,780 --> 00:02:35,219 familiar as you are, can you give us 66 00:02:35,219 --> 00:02:38,264 a general overview of what the quality reporting 67 00:02:38,405 --> 00:02:41,525 requirements are today in terms of current challenges 68 00:02:41,525 --> 00:02:44,165 you're seeing and how you and CareFirst are 69 00:02:44,165 --> 00:02:46,824 preparing for any upcoming shifts in in regulations 70 00:02:47,125 --> 00:02:48,425 or reporting standards? 71 00:02:49,260 --> 00:02:50,219 Absolutely, Jacob. 72 00:02:50,860 --> 00:02:52,939 I think it's very important for the listeners 73 00:02:52,939 --> 00:02:54,080 to understand that 74 00:02:54,540 --> 00:02:57,439 the quality requirements is just not another reporting 75 00:02:57,580 --> 00:03:00,540 ex expectation, but it has some value for 76 00:03:00,540 --> 00:03:02,094 all parties involved. 77 00:03:02,555 --> 00:03:04,974 From a business value perspective, we look for, 78 00:03:05,594 --> 00:03:08,415 you know, if there is a quality expectation 79 00:03:08,474 --> 00:03:11,455 or requirement, how does that clinical quality 80 00:03:11,754 --> 00:03:14,574 improvement in the care delivery system lead to, 81 00:03:15,430 --> 00:03:18,650 medically necessary care, for example, being delivered. 82 00:03:19,109 --> 00:03:21,129 And these quality reporting metrics 83 00:03:21,590 --> 00:03:22,969 are basically a parameter 84 00:03:23,269 --> 00:03:23,769 for 85 00:03:24,069 --> 00:03:25,449 all of us to assess 86 00:03:25,829 --> 00:03:28,155 the current operating system, how the care has 87 00:03:28,155 --> 00:03:30,094 been delivered to our members, to our populations. 88 00:03:30,875 --> 00:03:33,215 And and this provided data that we are 89 00:03:33,435 --> 00:03:36,495 looking to gather also helps us in selecting 90 00:03:36,555 --> 00:03:37,055 really, 91 00:03:37,594 --> 00:03:39,915 you know, how are we performing, what is 92 00:03:39,915 --> 00:03:42,254 happening within our health care ecosystem. 93 00:03:43,120 --> 00:03:44,659 So that's a very important, 94 00:03:45,280 --> 00:03:45,780 expectation. 95 00:03:46,639 --> 00:03:48,099 Quality reporting is, 96 00:03:48,879 --> 00:03:49,379 threefold. 97 00:03:50,080 --> 00:03:52,319 You know, obviously, they're talking about the measures, 98 00:03:52,560 --> 00:03:54,500 in the quality reporting are around 99 00:03:54,800 --> 00:03:55,939 clinical quality 100 00:03:57,284 --> 00:03:59,064 of how the care is being delivered. 101 00:03:59,444 --> 00:04:01,925 But it also has a patient experience component 102 00:04:01,925 --> 00:04:03,364 to us, which is becoming more and more 103 00:04:03,364 --> 00:04:05,864 important for the consumer assessment of, 104 00:04:06,405 --> 00:04:08,405 health care or our providers and systems that 105 00:04:08,405 --> 00:04:10,769 we have. And also to look at our 106 00:04:10,769 --> 00:04:13,250 processes internally from an operating model aspect. So 107 00:04:13,250 --> 00:04:14,310 there are 3 components 108 00:04:14,849 --> 00:04:16,769 that I look at from a quality reporting 109 00:04:16,769 --> 00:04:18,790 perspective that we are focused in on. 110 00:04:19,970 --> 00:04:22,069 Of course, some of the challenges, 111 00:04:22,654 --> 00:04:24,894 as you know very well, health care ecosystem 112 00:04:24,894 --> 00:04:25,394 is 113 00:04:25,774 --> 00:04:27,794 extremely fragmented, the data sources. 114 00:04:28,495 --> 00:04:30,894 Where this data lives is also spread out. 115 00:04:30,894 --> 00:04:32,274 Right? So we have multiple 116 00:04:32,974 --> 00:04:34,194 electronic health records 117 00:04:34,574 --> 00:04:35,875 where our members 118 00:04:36,389 --> 00:04:39,610 are interacting with clinicians. And how do we 119 00:04:40,069 --> 00:04:42,250 get that data from disparate sources 120 00:04:42,790 --> 00:04:44,870 into a central location for us to be 121 00:04:44,870 --> 00:04:46,090 able to better understand 122 00:04:47,110 --> 00:04:49,370 how the quality is being 123 00:04:50,074 --> 00:04:50,574 affected, 124 00:04:51,915 --> 00:04:53,995 and how do we understand as it's going 125 00:04:53,995 --> 00:04:56,014 through the journey, where are the gaps 126 00:04:56,395 --> 00:04:58,175 or the opportunity for care, 127 00:04:59,194 --> 00:05:01,675 how do we coordinate care. You know, there's 128 00:05:01,675 --> 00:05:02,975 data that comes in 129 00:05:03,439 --> 00:05:05,779 comes in all kinds of format and structured 130 00:05:05,839 --> 00:05:06,579 and unstructured, 131 00:05:08,240 --> 00:05:11,360 format. How do we collect that data, and 132 00:05:11,360 --> 00:05:13,039 how do we pull that data into a 133 00:05:13,039 --> 00:05:13,539 single 134 00:05:14,000 --> 00:05:16,240 data source so we can then report it 135 00:05:16,240 --> 00:05:16,800 back out to, 136 00:05:17,805 --> 00:05:20,365 from a HEDIS perspective, the NCK, for example, 137 00:05:20,365 --> 00:05:21,185 for accreditation, 138 00:05:21,485 --> 00:05:24,464 for us to better benchmark our operating processes, 139 00:05:24,685 --> 00:05:25,185 or 140 00:05:25,564 --> 00:05:28,625 the CMS are under stars for our our, 141 00:05:28,845 --> 00:05:30,285 government program business. So, 142 00:05:30,930 --> 00:05:33,330 these are very important elements for us to 143 00:05:33,330 --> 00:05:35,250 consider. These are some challenges that we are 144 00:05:35,250 --> 00:05:37,350 facing as well, and we are, 145 00:05:38,129 --> 00:05:41,430 aggressively working towards addressing some of these, 146 00:05:42,290 --> 00:05:44,230 these challenges. There are more regulatory, 147 00:05:46,584 --> 00:05:48,925 compliance requirements that are in front of us. 148 00:05:49,544 --> 00:05:51,324 For example, there is an initiative 149 00:05:51,625 --> 00:05:53,944 for here in the state to do the 150 00:05:53,944 --> 00:05:57,485 managed care organization that, say, provide Medicaid services 151 00:05:57,544 --> 00:05:59,084 and MCO plan for 152 00:05:59,479 --> 00:06:01,639 for in states have, you know, a quality 153 00:06:01,639 --> 00:06:03,879 reporting system, a rating system that's being put 154 00:06:03,879 --> 00:06:04,379 together, 155 00:06:05,479 --> 00:06:07,979 for for members who are trying to 156 00:06:08,279 --> 00:06:10,519 look at different products from health plans and 157 00:06:10,519 --> 00:06:12,039 try to assess which one they should be 158 00:06:12,039 --> 00:06:14,785 buying. So there is that quality rating system 159 00:06:14,785 --> 00:06:16,084 that will be put together 160 00:06:16,384 --> 00:06:17,444 for health plans. 161 00:06:18,305 --> 00:06:21,105 There is more requirements on home based care 162 00:06:21,105 --> 00:06:21,605 and 163 00:06:21,985 --> 00:06:24,544 rehab services within the community. So see a 164 00:06:24,544 --> 00:06:27,819 lot of movement and opportunity in the whole 165 00:06:27,819 --> 00:06:29,120 quality reporting system. 166 00:06:30,540 --> 00:06:33,580 Understood. So very clearly a complicated process, a 167 00:06:33,580 --> 00:06:36,379 lot of different challenges involved. You mentioned the 168 00:06:36,379 --> 00:06:37,120 the internal, 169 00:06:37,824 --> 00:06:40,084 operations that have to occur at at CareFirst 170 00:06:40,144 --> 00:06:41,904 to make sure this all happens. Can you 171 00:06:41,904 --> 00:06:43,745 give us an on the ground example from 172 00:06:43,745 --> 00:06:46,784 the company, in terms of the operational aspects 173 00:06:46,784 --> 00:06:49,604 of quality reporting? How are you handling staffing, 174 00:06:49,745 --> 00:06:50,245 timeliness, 175 00:06:50,704 --> 00:06:51,764 workflow efficiencies, 176 00:06:52,349 --> 00:06:54,289 to make sure the company meets these requirements? 177 00:06:55,949 --> 00:06:58,610 But I would break down the quality reporting, 178 00:06:59,229 --> 00:07:00,370 stuff into 3, 179 00:07:01,389 --> 00:07:03,629 3 major stages. Right? So first stage for 180 00:07:03,629 --> 00:07:06,194 me is actually collecting the data. Right? The 181 00:07:06,355 --> 00:07:08,035 the ability for us to go and collect 182 00:07:08,035 --> 00:07:09,654 the data so we can then 183 00:07:10,115 --> 00:07:12,435 put it into a quality engine and really 184 00:07:12,435 --> 00:07:14,595 try to understand how well or how poorly 185 00:07:14,595 --> 00:07:16,855 or how, you know, why are we regressing 186 00:07:16,915 --> 00:07:17,814 forward or progressing, 187 00:07:19,090 --> 00:07:21,490 or progressing forward or regressing backwards, if you 188 00:07:21,490 --> 00:07:23,250 will? How do we get that, 189 00:07:24,210 --> 00:07:27,029 that viewpoint into a system so we can, 190 00:07:27,410 --> 00:07:29,330 you know, from a staffing perspective, you know, 191 00:07:29,330 --> 00:07:31,009 if we are not doing well in a 192 00:07:31,009 --> 00:07:32,470 particular measure, do we 193 00:07:32,904 --> 00:07:35,064 invest more in the community? So for example, 194 00:07:35,064 --> 00:07:37,785 if if, you know, we in a diabetes 195 00:07:37,785 --> 00:07:39,165 management looking at hemoglobin 196 00:07:39,625 --> 00:07:40,685 a 1 c levels, 197 00:07:41,225 --> 00:07:43,944 getting that data timely is very, very critical 198 00:07:43,944 --> 00:07:45,865 for us. And then if we are seeing 199 00:07:45,865 --> 00:07:48,569 trends that are not covered, how do we 200 00:07:48,569 --> 00:07:50,889 engage the provider network to be able to 201 00:07:50,889 --> 00:07:53,149 help us in closing these gaps in care? 202 00:07:53,449 --> 00:07:55,850 How do we interact with them? So in 203 00:07:55,850 --> 00:07:56,509 my mind, 204 00:07:56,889 --> 00:07:58,649 as I said, these are kind of events 205 00:07:58,649 --> 00:08:00,750 that we are constantly looking and tracking, 206 00:08:01,345 --> 00:08:02,785 not waiting till the end of the year 207 00:08:02,785 --> 00:08:04,785 to say what has how do we know 208 00:08:04,785 --> 00:08:06,485 as it is happening in the 209 00:08:06,785 --> 00:08:08,865 in the environment, in the health care delivery 210 00:08:08,865 --> 00:08:11,105 ecosystem for our members? How do we make 211 00:08:11,105 --> 00:08:12,324 sure we are ready, 212 00:08:13,105 --> 00:08:14,245 to be able to, 213 00:08:16,099 --> 00:08:16,599 first, 214 00:08:17,300 --> 00:08:20,180 have timely action so we can make some 215 00:08:20,180 --> 00:08:23,060 changes and make sure that the the clinical 216 00:08:23,060 --> 00:08:24,839 quality aspects are addressed. 217 00:08:26,099 --> 00:08:28,099 How do we constantly look for ways in 218 00:08:28,099 --> 00:08:30,259 which we can automate some of these data 219 00:08:30,259 --> 00:08:30,759 gathering 220 00:08:31,495 --> 00:08:33,914 slash gaps in care, creating feedback 221 00:08:34,375 --> 00:08:35,995 loops. We are investing 222 00:08:37,174 --> 00:08:38,475 into into practice transformations, 223 00:08:39,254 --> 00:08:41,894 to actually engage our practices, reaching out to 224 00:08:41,894 --> 00:08:44,154 them, sharing these gaps, 225 00:08:44,639 --> 00:08:46,799 and making sure that they are working towards 226 00:08:46,799 --> 00:08:47,699 closing them. 227 00:08:48,399 --> 00:08:49,139 And also, 228 00:08:49,600 --> 00:08:50,259 of course, 229 00:08:50,720 --> 00:08:53,059 most important aspect is to make sure 230 00:08:53,440 --> 00:08:54,100 the members 231 00:08:54,879 --> 00:08:57,199 care delivery and quality of care is never 232 00:08:57,199 --> 00:08:57,699 compromised. 233 00:08:58,414 --> 00:09:00,174 So as I said, diabetes is a good 234 00:09:00,174 --> 00:09:00,674 example 235 00:09:01,375 --> 00:09:03,074 where we were looking at, 236 00:09:03,375 --> 00:09:04,914 you know, how do we look at 237 00:09:05,534 --> 00:09:07,375 the the lab dataset to be able to 238 00:09:07,375 --> 00:09:09,794 better predict whether diabetes is progressing? 239 00:09:10,220 --> 00:09:12,220 Can we hold some of our members into 240 00:09:12,220 --> 00:09:14,540 a type 1 diabetes situation versus all of 241 00:09:14,540 --> 00:09:16,620 them transition to type 2 or many of 242 00:09:16,620 --> 00:09:18,639 them transition to type 2? How do we 243 00:09:18,860 --> 00:09:20,460 how do we look at the data, look 244 00:09:20,460 --> 00:09:23,120 at the clinical quality, and help the providers, 245 00:09:24,394 --> 00:09:26,875 target some of the members that we believe 246 00:09:26,875 --> 00:09:30,254 are not progressing forward or regressing backwards. So, 247 00:09:30,634 --> 00:09:32,975 we we look at this as an example 248 00:09:33,035 --> 00:09:36,095 and constantly try to tweak our operational capability, 249 00:09:36,235 --> 00:09:39,569 whether it's looking for automation, looking for discrete 250 00:09:39,569 --> 00:09:40,069 data, 251 00:09:40,529 --> 00:09:42,769 and making sure, more data we can get 252 00:09:42,769 --> 00:09:44,149 timely so we can 253 00:09:44,610 --> 00:09:45,909 attack some of the problems. 254 00:09:46,370 --> 00:09:47,190 And then, again, 255 00:09:47,809 --> 00:09:50,129 we are constantly shifting where are we seeing 256 00:09:50,129 --> 00:09:52,529 the trends, which measure is falling behind, what 257 00:09:52,529 --> 00:09:54,209 are what is that measure trying to tell 258 00:09:54,209 --> 00:09:56,465 us. And then we staff whether it's, as 259 00:09:56,465 --> 00:09:58,884 I said, working in the community aspect, 260 00:09:59,425 --> 00:10:02,004 working internally with the care management teams. 261 00:10:02,945 --> 00:10:04,865 Depending on the problem at hand, we will 262 00:10:04,865 --> 00:10:06,785 basically come up with a game plan to 263 00:10:06,785 --> 00:10:08,325 address that particular gap. 264 00:10:09,269 --> 00:10:11,429 Sure. And I think a keyword in what 265 00:10:11,429 --> 00:10:14,169 you just said, Piyush, is is timely data. 266 00:10:14,309 --> 00:10:16,730 What what happens if there's delays 267 00:10:17,110 --> 00:10:19,190 or or gaps in the data that you 268 00:10:19,190 --> 00:10:19,690 receive? 269 00:10:20,070 --> 00:10:21,129 Can you can you 270 00:10:21,605 --> 00:10:23,705 explain to us how important it is, 271 00:10:24,085 --> 00:10:26,004 to to make sure that this data is 272 00:10:26,004 --> 00:10:27,625 timely from your provider network? 273 00:10:28,485 --> 00:10:30,884 I think it's it's absolutely critical. Right? I 274 00:10:30,884 --> 00:10:33,285 mean, getting access to that information so we 275 00:10:33,285 --> 00:10:34,825 can create a game plan. 276 00:10:36,089 --> 00:10:37,929 I mean, an example comes like, for example, 277 00:10:37,929 --> 00:10:39,629 in high-tech imaging. Right? So 278 00:10:40,330 --> 00:10:41,470 we are going through, 279 00:10:42,009 --> 00:10:42,509 so 280 00:10:44,009 --> 00:10:45,710 a member goes through an MRI. 281 00:10:47,210 --> 00:10:49,230 And if we are looking at that MRI, 282 00:10:49,894 --> 00:10:51,575 are we seeing a trend? Is there too 283 00:10:51,575 --> 00:10:53,995 many imaging studies being done on a particular 284 00:10:54,534 --> 00:10:56,615 member? Is there an opportunity for us to 285 00:10:56,615 --> 00:10:57,995 look at home care 286 00:10:58,375 --> 00:11:00,455 and see the clinical quality of the data 287 00:11:00,455 --> 00:11:03,839 coming back and saying, is the member progressing 288 00:11:03,839 --> 00:11:04,659 or regressing? 289 00:11:05,360 --> 00:11:08,000 The timeliness is critical because we want to 290 00:11:08,000 --> 00:11:09,139 interject ourselves 291 00:11:09,440 --> 00:11:11,860 to make sure that the transition of care 292 00:11:12,000 --> 00:11:13,839 as they move from a home care setting 293 00:11:13,839 --> 00:11:14,659 into a, 294 00:11:16,085 --> 00:11:18,085 to another setting or they went from an 295 00:11:18,085 --> 00:11:20,664 inpatient setting to a home health setting. 296 00:11:21,044 --> 00:11:22,725 How do we make sure that we are 297 00:11:22,725 --> 00:11:25,544 able to support these these kinds of, 298 00:11:26,245 --> 00:11:26,745 elements? 299 00:11:27,569 --> 00:11:29,970 And, again, as I said, timeliness is critical 300 00:11:29,970 --> 00:11:31,909 because you want to interject yourself. 301 00:11:32,289 --> 00:11:33,970 You want to share that data with the 302 00:11:33,970 --> 00:11:34,470 clinician 303 00:11:35,169 --> 00:11:37,970 early and often so they can make a 304 00:11:37,970 --> 00:11:39,110 plan that can 305 00:11:40,105 --> 00:11:42,764 alleviate some of the problems. Right? Within 48 306 00:11:42,825 --> 00:11:45,384 hours of a transition of care from a 307 00:11:45,384 --> 00:11:47,725 care setting is when most of the readmissions 308 00:11:47,785 --> 00:11:50,825 occur. Right? Within 48 hours. So how can 309 00:11:50,825 --> 00:11:53,144 we timeliness of getting that information, what was 310 00:11:53,144 --> 00:11:56,419 the discharge summary about? What was the medication 311 00:11:56,639 --> 00:11:57,139 reconciliation 312 00:11:57,519 --> 00:11:58,019 around? 313 00:11:58,720 --> 00:12:01,220 How quickly are we addressing those gaps 314 00:12:01,519 --> 00:12:03,940 is is is paramount important 315 00:12:04,320 --> 00:12:06,639 for us to have a good clinical outcome 316 00:12:06,639 --> 00:12:07,460 for our members? 317 00:12:08,144 --> 00:12:09,904 Absolutely. That makes sense. And it sounds like 318 00:12:09,904 --> 00:12:11,825 health outcomes are are literally on the line 319 00:12:11,825 --> 00:12:13,825 when it comes to receiving this this timely 320 00:12:13,825 --> 00:12:14,325 data. 321 00:12:14,945 --> 00:12:16,465 Let's let's switch gears here for a sec, 322 00:12:16,465 --> 00:12:18,245 Piyush, and talk a little bit about CareFirst 323 00:12:18,384 --> 00:12:20,325 current data exchange program. 324 00:12:20,970 --> 00:12:22,649 What is it? How does it work? And 325 00:12:22,649 --> 00:12:23,850 can you talk about some of the key 326 00:12:23,850 --> 00:12:25,870 successes you you've seen so far? 327 00:12:27,049 --> 00:12:29,450 So as I've said, you know, data in 328 00:12:29,450 --> 00:12:31,850 disparate formats and getting access to that data 329 00:12:31,850 --> 00:12:33,870 in a timely manner is absolutely critical. 330 00:12:35,035 --> 00:12:36,675 So what we have started with about three 331 00:12:36,675 --> 00:12:38,315 and a half, 4 years ago, we started 332 00:12:38,315 --> 00:12:39,055 in a program 333 00:12:39,595 --> 00:12:41,855 to really create a clinical data repository 334 00:12:42,715 --> 00:12:44,495 and work with our providers, 335 00:12:45,115 --> 00:12:48,075 community, and actually get access directly from their 336 00:12:48,075 --> 00:12:48,575 EHRs, 337 00:12:49,210 --> 00:12:50,909 being able to pull that information. 338 00:12:51,450 --> 00:12:53,549 So we can create a single longitudinal 339 00:12:53,929 --> 00:12:56,009 record of the member. And, you know, a 340 00:12:56,009 --> 00:12:58,090 typical member of ours would see about 5 341 00:12:58,090 --> 00:13:00,169 to 6 physicians. And we would be able 342 00:13:00,169 --> 00:13:02,090 to collect all of that information and put 343 00:13:02,090 --> 00:13:03,855 it into a single longitudinal record. 344 00:13:04,254 --> 00:13:06,095 So now we can see on a daily 345 00:13:06,095 --> 00:13:08,894 basis as the member is interacting with the 346 00:13:08,894 --> 00:13:10,195 candidate every ecosystem, 347 00:13:10,654 --> 00:13:12,654 what is happening? What what are we doing? 348 00:13:12,654 --> 00:13:13,154 So 349 00:13:13,534 --> 00:13:16,815 that, data exchange program and that clinical data 350 00:13:16,815 --> 00:13:19,529 repository becomes a huge value add. And I 351 00:13:19,529 --> 00:13:20,809 said it's been a journey, and I did 352 00:13:20,809 --> 00:13:21,710 happen overnight. 353 00:13:22,330 --> 00:13:24,889 But we've been able to get majority of 354 00:13:24,889 --> 00:13:26,230 our our our, 355 00:13:27,370 --> 00:13:27,870 membership 356 00:13:28,250 --> 00:13:30,570 onto this particular platform with the support of 357 00:13:30,570 --> 00:13:31,230 our providers 358 00:13:31,754 --> 00:13:34,154 and actually get more real time access to 359 00:13:34,154 --> 00:13:34,894 that information. 360 00:13:35,514 --> 00:13:37,274 And again, it's been a game changer for 361 00:13:37,274 --> 00:13:37,774 us. 362 00:13:38,315 --> 00:13:40,394 I can imagine. And and I also am 363 00:13:40,394 --> 00:13:42,815 curious about some of the challenges you've encountered 364 00:13:43,035 --> 00:13:44,554 over the last 3 or 4 years. I 365 00:13:44,554 --> 00:13:46,174 imagine with all the different technology, 366 00:13:47,170 --> 00:13:50,050 different systems that providers are on, what have 367 00:13:50,050 --> 00:13:51,810 what have you encountered in terms of challenges 368 00:13:51,810 --> 00:13:53,009 with this program, and and how have you 369 00:13:53,009 --> 00:13:53,910 overcome them? 370 00:13:54,769 --> 00:13:56,690 So I I think, as as you said, 371 00:13:56,690 --> 00:13:59,810 right, we have, this clinical exchange program. We 372 00:13:59,810 --> 00:14:01,750 are connecting it to 47 different 373 00:14:02,125 --> 00:14:02,625 EHRs, 374 00:14:03,165 --> 00:14:04,705 47 different technology 375 00:14:05,165 --> 00:14:07,745 paradigms, 47 different data structures, 376 00:14:08,445 --> 00:14:11,264 47 different kinds of data output. So, 377 00:14:11,965 --> 00:14:14,445 choosing a a partner who can help, again, 378 00:14:14,445 --> 00:14:16,649 we don't we didn't want to be in 379 00:14:16,649 --> 00:14:19,289 the game of writing all these connect connectors 380 00:14:19,289 --> 00:14:22,090 and adapters to exchange that data with the 381 00:14:22,169 --> 00:14:24,669 within the provider ecosystem with their EHRs. 382 00:14:25,289 --> 00:14:27,929 So we actually worked closely with our partner, 383 00:14:27,929 --> 00:14:30,125 MRO, to actually pull all of that data 384 00:14:30,264 --> 00:14:32,845 using their technology, their adapters, their connectors, 385 00:14:33,544 --> 00:14:34,904 and being able to pull it into a 386 00:14:34,904 --> 00:14:37,544 consistent format. So we are able to get 387 00:14:37,544 --> 00:14:39,625 to a a CCDA, which is basically a 388 00:14:39,625 --> 00:14:41,945 continued care document, which gives us that clinical 389 00:14:41,945 --> 00:14:43,164 data exchange capability. 390 00:14:43,929 --> 00:14:46,330 Also merging. Right? Think about the MPI logic. 391 00:14:46,330 --> 00:14:49,370 Like, I've got my huge data sitting in 392 00:14:49,370 --> 00:14:51,529 6 different EHRs. How do you pull that 393 00:14:51,529 --> 00:14:52,910 data as it's being changed 394 00:14:53,290 --> 00:14:56,250 and bring it into a single repository and 395 00:14:56,250 --> 00:14:58,509 then creating a single longitudinal record? 396 00:14:59,235 --> 00:15:00,514 So I think those are some of the 397 00:15:00,514 --> 00:15:01,955 challenges that we saw. Right? How do we 398 00:15:01,955 --> 00:15:04,674 connect into 47 different EHRs, bringing them all 399 00:15:04,674 --> 00:15:05,894 into a single repository? 400 00:15:06,434 --> 00:15:08,674 But also working with the provider community, right, 401 00:15:08,674 --> 00:15:10,695 explaining to them why this data is important 402 00:15:11,090 --> 00:15:12,690 for the benefit of all of us, right, 403 00:15:12,690 --> 00:15:14,450 whether it's for risk adjustment, whether it is 404 00:15:14,450 --> 00:15:16,210 for heaters, whether it's for stars, whether it 405 00:15:16,210 --> 00:15:16,870 is for 406 00:15:17,490 --> 00:15:19,830 just the payment structures that we are constructing. 407 00:15:20,210 --> 00:15:22,549 I think it's critical and beneficial for everybody 408 00:15:23,009 --> 00:15:25,009 that the patient outcomes are improved when we 409 00:15:25,009 --> 00:15:26,824 have this data exchange availability. 410 00:15:27,524 --> 00:15:28,964 But we had to it took us a 411 00:15:28,964 --> 00:15:31,544 little bit while because we inserted ourselves as 412 00:15:31,764 --> 00:15:34,264 as contracts. So these providers were coming up. 413 00:15:34,404 --> 00:15:36,985 We inserted language to make sure everybody 414 00:15:37,845 --> 00:15:40,559 was complying with getting that information into this 415 00:15:40,559 --> 00:15:41,779 clinical data repository 416 00:15:42,639 --> 00:15:46,019 following a clinical data exchange format with, 417 00:15:46,480 --> 00:15:47,940 our our partner here, 418 00:15:48,399 --> 00:15:50,080 so that the data and information could be 419 00:15:50,080 --> 00:15:51,059 in a single repository. 420 00:15:52,095 --> 00:15:55,615 Yeah. Absolutely. And 47 different EHRs. That sounds 421 00:15:55,615 --> 00:15:56,674 amazingly complex. 422 00:15:57,214 --> 00:15:58,995 How would you say then that that advancements 423 00:15:59,054 --> 00:16:01,855 in data exchange through better technology, like you 424 00:16:01,855 --> 00:16:03,475 mentioned, through better collaboration 425 00:16:04,014 --> 00:16:06,620 with providers and other partners, How does that 426 00:16:06,659 --> 00:16:09,220 how is that shaping the future of quality 427 00:16:09,220 --> 00:16:11,159 reporting from your perspective, Piyush? 428 00:16:11,860 --> 00:16:13,379 Yes, Piyush. As I said, we started two 429 00:16:13,379 --> 00:16:14,899 and a half, four years ago. Right, Jacob? 430 00:16:14,899 --> 00:16:15,879 And I feel, 431 00:16:16,899 --> 00:16:17,399 that, 432 00:16:18,179 --> 00:16:19,940 you know, there weren't a lot of standards. 433 00:16:19,940 --> 00:16:20,839 So we had 434 00:16:21,144 --> 00:16:23,625 to pull data in whatever output format was 435 00:16:23,625 --> 00:16:24,845 accessible to us. 436 00:16:25,225 --> 00:16:27,225 But whereas the industry is moving towards more 437 00:16:27,225 --> 00:16:29,164 fire and interoperability standards, 438 00:16:30,504 --> 00:16:32,745 that's very exciting for us to be able 439 00:16:32,745 --> 00:16:34,985 to get access to that information in a 440 00:16:34,985 --> 00:16:36,960 consistent manner, whether it is 441 00:16:37,440 --> 00:16:39,440 EHR 1 or 2 or 3 or 4, 442 00:16:39,440 --> 00:16:42,259 it doesn't really matter. Everybody is exchanging data 443 00:16:42,559 --> 00:16:45,220 in a consistent way using FHIR standards. 444 00:16:45,840 --> 00:16:48,000 Very excited about the work that's happening from 445 00:16:48,000 --> 00:16:49,139 a DevCo perspective 446 00:16:49,519 --> 00:16:52,100 where there is now conversations to include, 447 00:16:53,095 --> 00:16:56,154 sorry, DEFCA stands for the Trusted Exchange Framework 448 00:16:56,774 --> 00:16:57,995 and Common Agreement. 449 00:16:59,254 --> 00:17:02,955 And basically, that is that is the abstraction 450 00:17:03,174 --> 00:17:06,000 or a or a a framework that has 451 00:17:06,000 --> 00:17:06,980 been put together 452 00:17:07,519 --> 00:17:09,759 on how to exchange data in a trusted 453 00:17:09,759 --> 00:17:12,099 way. Right? So if a provider sends information, 454 00:17:13,039 --> 00:17:16,000 how do we get that information out without 455 00:17:16,000 --> 00:17:18,339 having to create these point to point connections? 456 00:17:19,195 --> 00:17:22,394 How can we exchange information without requiring to 457 00:17:22,394 --> 00:17:24,394 know where the endpoint is and they don't 458 00:17:24,394 --> 00:17:26,315 need to know about us? But we are 459 00:17:26,315 --> 00:17:29,195 able to, in a trusted, secure manner exchange 460 00:17:29,195 --> 00:17:30,975 that information around the quality, 461 00:17:32,109 --> 00:17:34,509 quality measures that we need to exchange information 462 00:17:34,509 --> 00:17:36,529 around. So very excited about it. 463 00:17:36,990 --> 00:17:38,929 I think those are the kind of technology 464 00:17:38,990 --> 00:17:42,369 partnership paradigms that we are excited to participate 465 00:17:42,509 --> 00:17:43,009 in. 466 00:17:43,470 --> 00:17:45,890 CareFirst, for example, Jacob has, 467 00:17:46,269 --> 00:17:46,750 you know, about, 468 00:17:47,684 --> 00:17:50,105 has a a large out of area population 469 00:17:50,484 --> 00:17:51,625 as well that we manage. 470 00:17:52,244 --> 00:17:54,404 And if we can get that clinical data 471 00:17:54,404 --> 00:17:55,944 exchange through the TEFCA 472 00:17:56,244 --> 00:17:58,085 and as more and more QHANs come into 473 00:17:58,085 --> 00:18:00,005 being, I think that is something that will 474 00:18:00,005 --> 00:18:02,585 be, very important and valuable for us. 475 00:18:02,970 --> 00:18:05,369 Sure. Absolutely. And to bring it back to 476 00:18:05,369 --> 00:18:07,609 the most important part here, how do these 477 00:18:07,609 --> 00:18:08,669 technology partnerships 478 00:18:09,130 --> 00:18:11,710 contribute to better patient outcomes and also 479 00:18:12,009 --> 00:18:14,490 better operational efficiency, both for CareFirst and and 480 00:18:14,490 --> 00:18:15,710 for your provider network? 481 00:18:17,045 --> 00:18:17,545 Again, 482 00:18:17,924 --> 00:18:19,444 you know, as as I said, think of 483 00:18:19,444 --> 00:18:22,724 a provider. Right? Large, you know, number of 484 00:18:22,724 --> 00:18:26,164 CareFirst departments are reaching out for accessing the 485 00:18:26,164 --> 00:18:28,025 same information from these providers. 486 00:18:28,724 --> 00:18:29,545 We are asking, 487 00:18:29,899 --> 00:18:32,220 for example, for risk adjustment or for HEDIS 488 00:18:32,220 --> 00:18:34,220 or for stars or for quality measures or 489 00:18:34,220 --> 00:18:36,000 for other purposes as well. 490 00:18:36,539 --> 00:18:39,099 Now the providers can exchange that, share that 491 00:18:39,099 --> 00:18:41,039 information with us without having 492 00:18:41,579 --> 00:18:44,139 to answer 5 different questions from within the 493 00:18:44,139 --> 00:18:46,265 Help and ecosystem, and they can share that 494 00:18:46,265 --> 00:18:47,644 information, send it out. 495 00:18:48,184 --> 00:18:50,664 There's an opportunity that some of the provider 496 00:18:50,664 --> 00:18:51,164 networks 497 00:18:52,265 --> 00:18:52,924 are exploring 498 00:18:53,464 --> 00:18:54,984 is to be able to if they have 499 00:18:54,984 --> 00:18:57,164 already built a connector with, 500 00:18:57,944 --> 00:18:58,444 MRO, 501 00:18:59,119 --> 00:19:01,200 could they then use that data that they're 502 00:19:01,200 --> 00:19:03,519 already sending to MRO to other health plans 503 00:19:03,519 --> 00:19:05,119 as well beyond CareFirst? So I think there's 504 00:19:05,119 --> 00:19:07,440 some opportunities for us to really look for 505 00:19:07,440 --> 00:19:10,000 that operational efficiency, look for the workflow efficiency 506 00:19:10,000 --> 00:19:12,825 within the provider community as well. For us, 507 00:19:12,825 --> 00:19:14,345 again, as I said, I I mean, there 508 00:19:14,345 --> 00:19:16,105 are 3 things we are after. Right? Timeliness 509 00:19:16,105 --> 00:19:19,384 of data. We already discussed that accuracy of 510 00:19:19,384 --> 00:19:21,884 that information as well. Because as, 511 00:19:22,585 --> 00:19:25,169 as it goes through the the clinical data 512 00:19:25,169 --> 00:19:27,250 exchange, we are also able to validate certain 513 00:19:27,250 --> 00:19:29,750 information, put some checks and balances in place 514 00:19:30,130 --> 00:19:32,049 as the data is in transit and at 515 00:19:32,049 --> 00:19:34,289 rest to make sure the quality of the 516 00:19:34,289 --> 00:19:37,009 data is something that we can look at. 517 00:19:37,169 --> 00:19:39,009 You know, we are doing the audits in 518 00:19:39,009 --> 00:19:41,865 the clinical data exchange, to really look at 519 00:19:41,865 --> 00:19:43,164 the aggregator validation, 520 00:19:43,704 --> 00:19:45,085 doing PSV work. 521 00:19:45,464 --> 00:19:47,625 So there's a lot of opportunities that we 522 00:19:47,625 --> 00:19:49,884 are introducing under this process. So other parts 523 00:19:50,264 --> 00:19:52,105 within CareFirst don't have to go through the 524 00:19:52,105 --> 00:19:52,924 same exercise 525 00:19:53,640 --> 00:19:56,839 again. And also looking excited about the technology 526 00:19:56,839 --> 00:19:59,000 paradigm of maybe the feedback loop. Right? So, 527 00:19:59,000 --> 00:20:01,180 yes, we can collect the data and benefit 528 00:20:01,720 --> 00:20:03,640 the benefit CareFirst, but also how can we 529 00:20:03,640 --> 00:20:04,460 insert ourselves, 530 00:20:04,839 --> 00:20:06,279 look at the future state where we are 531 00:20:06,279 --> 00:20:08,519 able to push this information into the clinical 532 00:20:08,519 --> 00:20:10,204 workflow at the provider themselves 533 00:20:10,825 --> 00:20:12,345 so they can look at and find out, 534 00:20:12,345 --> 00:20:14,184 hey. I'm gonna order an MRI. There's already 535 00:20:14,184 --> 00:20:15,944 one existing. Or I can look at a 536 00:20:15,944 --> 00:20:17,704 gap in care and say, hey. Piyush hasn't 537 00:20:17,704 --> 00:20:19,724 come into the office, the primary care 538 00:20:20,025 --> 00:20:21,464 in the last 2 years. How can I 539 00:20:21,464 --> 00:20:23,224 put that information from? Because I think there's 540 00:20:23,224 --> 00:20:23,964 an opportunity 541 00:20:24,580 --> 00:20:26,820 for us to be able to, use this 542 00:20:26,820 --> 00:20:29,299 data not just in one direction, but also 543 00:20:29,299 --> 00:20:31,700 start pushing that information to clinical workflows or 544 00:20:31,700 --> 00:20:32,359 to clinical 545 00:20:32,740 --> 00:20:35,240 decisions decision support tools as well. 546 00:20:36,019 --> 00:20:38,505 So clearly, a lot of, industry leading work 547 00:20:38,585 --> 00:20:41,065 happening under your your leadership, Piyush, and in 548 00:20:41,065 --> 00:20:42,984 that vein there's a lot of health plan 549 00:20:42,984 --> 00:20:45,164 leaders listening in who are in different stages 550 00:20:45,224 --> 00:20:46,924 of their clinical data exchange 551 00:20:47,384 --> 00:20:49,144 journey. Like you mentioned, it is a journey 552 00:20:49,144 --> 00:20:50,845 and it's a it's a long process. 553 00:20:51,464 --> 00:20:53,980 Do you have any advice for those listening 554 00:20:54,039 --> 00:20:54,839 in terms of, 555 00:20:55,319 --> 00:20:57,179 how to how to build and, 556 00:20:57,480 --> 00:21:00,059 how to improve their own data exchange programs? 557 00:21:01,559 --> 00:21:03,339 I think I can share with our experiences. 558 00:21:03,480 --> 00:21:06,119 We started 3, 4 years ago and sort 559 00:21:06,119 --> 00:21:08,414 of in a hybrid model where we have 560 00:21:09,134 --> 00:21:11,075 data coming to us in in multiple, 561 00:21:12,815 --> 00:21:15,615 formats, PDF, and still we don't have everything 562 00:21:15,615 --> 00:21:17,775 through the clinical data repository that we have 563 00:21:17,775 --> 00:21:18,275 constructed. 564 00:21:18,894 --> 00:21:20,575 So I would just advise that there are 565 00:21:20,575 --> 00:21:23,394 4 stages for me, right, in a program. 566 00:21:23,929 --> 00:21:26,349 One is just a digital introduction. Right? Let's 567 00:21:26,809 --> 00:21:30,009 stop getting access to EHRs, people logging into 568 00:21:30,009 --> 00:21:32,109 EHRs, trying to decipher that data. 569 00:21:32,490 --> 00:21:34,650 How do we give that digital introduction to 570 00:21:34,650 --> 00:21:36,650 be able to pull this information without any 571 00:21:36,650 --> 00:21:38,190 manual processes of, 572 00:21:38,964 --> 00:21:41,684 you know, getting, you know, paying vendors to 573 00:21:41,684 --> 00:21:43,764 go out and collect that information on behalf, 574 00:21:43,764 --> 00:21:46,345 getting PDF data, trying to synchronize that information. 575 00:21:46,724 --> 00:21:48,644 Can we do an inventory of the clinical 576 00:21:48,644 --> 00:21:49,384 data sources? 577 00:21:50,244 --> 00:21:51,605 Can we also, as we are doing the 578 00:21:51,605 --> 00:21:54,000 digital introduction, look at these data sources, see 579 00:21:54,000 --> 00:21:55,359 if we can go to a more open 580 00:21:55,359 --> 00:21:58,000 standard, more interoperable standard like FHIR as an 581 00:21:58,000 --> 00:21:59,460 example I was giving earlier. 582 00:21:59,919 --> 00:22:02,159 And then get familiar with some of the 583 00:22:02,159 --> 00:22:04,240 second stage would be to start to digitally 584 00:22:04,240 --> 00:22:05,759 enable some of this. So why do I 585 00:22:05,759 --> 00:22:06,259 get, 586 00:22:07,024 --> 00:22:08,404 you know, this unstructured 587 00:22:08,704 --> 00:22:10,944 content? Why do I still have access to 588 00:22:10,944 --> 00:22:13,105 EHR to be whoever to pull that manual 589 00:22:13,105 --> 00:22:13,605 data? 590 00:22:13,984 --> 00:22:16,565 So start digitizing a lot more of, 591 00:22:17,424 --> 00:22:20,484 of of the dataset that you are getting, 592 00:22:20,849 --> 00:22:22,150 whether it's through access, 593 00:22:22,769 --> 00:22:23,269 through, 594 00:22:23,809 --> 00:22:25,990 a QHIN in the future or through HIEs 595 00:22:26,690 --> 00:22:28,710 or getting that information through 596 00:22:29,170 --> 00:22:30,929 the the CDR that we have there for 597 00:22:30,929 --> 00:22:32,150 clinical data exchange. 598 00:22:32,529 --> 00:22:34,710 You've gotta start moving to the digital enablement 599 00:22:35,089 --> 00:22:37,505 aspect. Then I would say the next stage 600 00:22:37,505 --> 00:22:38,865 for us that we are trying to push 601 00:22:38,865 --> 00:22:39,684 for is to 602 00:22:39,984 --> 00:22:42,404 really go fully digital. Right? We have about, 603 00:22:42,865 --> 00:22:43,365 1,500,000 604 00:22:43,825 --> 00:22:46,305 member data today. We want to continue to 605 00:22:46,305 --> 00:22:48,990 push that to 2,000,000 and beyond. So as 606 00:22:48,990 --> 00:22:50,950 we are adding more and more member data 607 00:22:50,950 --> 00:22:53,029 into the ecosystem, I think that's gonna help 608 00:22:53,029 --> 00:22:55,289 us and really want to go fully digital 609 00:22:56,150 --> 00:22:57,769 in sort of a phase 3. 610 00:22:58,789 --> 00:22:59,450 And then 611 00:23:00,150 --> 00:23:03,525 everything we discussed in in the phase 4 612 00:23:04,065 --> 00:23:06,865 is looking at technologies like CQL, looking at 613 00:23:06,865 --> 00:23:07,365 NLP. 614 00:23:08,065 --> 00:23:09,904 You know, there is a clinical query language 615 00:23:09,904 --> 00:23:11,825 which allows us some of the flexibility that 616 00:23:11,825 --> 00:23:13,924 we've been looking for, not just looking at 617 00:23:14,065 --> 00:23:16,545 a year long worth of quality measures. Can 618 00:23:16,545 --> 00:23:17,045 we 619 00:23:17,809 --> 00:23:20,130 can we query that data to look at 620 00:23:20,130 --> 00:23:22,849 certain stages? Say, you know, we get a 621 00:23:22,849 --> 00:23:25,250 lot of wellness data beginning of the year. 622 00:23:25,250 --> 00:23:27,490 We how how can we look at it 623 00:23:27,490 --> 00:23:28,230 for certain 624 00:23:28,849 --> 00:23:29,349 demographic 625 00:23:29,650 --> 00:23:31,990 data, for certain geographic data, 626 00:23:32,375 --> 00:23:34,934 and being able to query that data digital 627 00:23:34,934 --> 00:23:37,914 data set to understand how quality is progressing 628 00:23:38,055 --> 00:23:39,674 throughout the year on in a particular 629 00:23:40,455 --> 00:23:40,955 geography, 630 00:23:42,455 --> 00:23:44,955 is is something of interest that I feel 631 00:23:45,409 --> 00:23:47,009 would be sort of a stage for all 632 00:23:47,009 --> 00:23:48,769 the benefits that you would accrue from this 633 00:23:48,769 --> 00:23:51,250 investment that you're gonna make over the the 634 00:23:51,250 --> 00:23:51,750 journey. 635 00:23:53,009 --> 00:23:55,329 Fantastic. Well, Piyush, what else are we missing? 636 00:23:55,329 --> 00:23:57,730 Any other final thoughts you wanna offer our 637 00:23:57,730 --> 00:23:58,230 listeners? 638 00:24:00,164 --> 00:24:01,765 I think exciting times for us in the 639 00:24:01,765 --> 00:24:04,325 health care ecosystem, I'm very, excited, as I 640 00:24:04,325 --> 00:24:06,325 said, for the changes that are coming, 641 00:24:06,724 --> 00:24:08,904 around the TEFCA and the QN work, 642 00:24:09,204 --> 00:24:10,825 around the FHIR and then probability 643 00:24:11,125 --> 00:24:13,384 capabilities that we are being built. So, 644 00:24:14,164 --> 00:24:14,904 as the 645 00:24:15,259 --> 00:24:16,720 as the provider pair 646 00:24:17,099 --> 00:24:19,419 divide is becoming smaller and smaller, I think 647 00:24:19,419 --> 00:24:20,399 working and collaborating 648 00:24:21,339 --> 00:24:23,579 to truly give that best experience for a 649 00:24:23,579 --> 00:24:24,399 member patient, 650 00:24:25,579 --> 00:24:27,659 is is sort of exciting. And I think 651 00:24:27,659 --> 00:24:30,394 the quality area and this clinical data exchange 652 00:24:30,394 --> 00:24:32,095 is going to be absolutely critical 653 00:24:32,714 --> 00:24:36,095 for a accurate, timely, and quality data exchange. 654 00:24:37,115 --> 00:24:39,434 Wonderful. Well, Piyush, thank you so much for 655 00:24:39,434 --> 00:24:41,035 taking the time to be with us and 656 00:24:41,035 --> 00:24:43,434 for sharing your insights with our listeners. We 657 00:24:43,434 --> 00:24:44,575 truly appreciate it. 658 00:24:44,929 --> 00:24:45,829 Thank you, Jacob. 659 00:24:46,289 --> 00:24:48,130 If you'd like to listen to more podcasts 660 00:24:48,130 --> 00:24:50,549 from Becker's Health Care, you can visit beckershospitalreview.com.