1 00:00:00,240 --> 00:00:02,399 Hi, everyone. This is Lucas Voss with Becker's 2 00:00:02,399 --> 00:00:04,160 healthcare. Thanks so much for tuning in to 3 00:00:04,160 --> 00:00:05,700 the Becker's healthcare podcast 4 00:00:06,000 --> 00:00:06,500 series. 5 00:00:07,040 --> 00:00:10,419 A very exciting topic today, the new era 6 00:00:10,480 --> 00:00:11,939 of healthcare transformation 7 00:00:12,639 --> 00:00:15,404 and how payers can drive continuous improvement 8 00:00:15,865 --> 00:00:18,425 in the health care ecosystem by leveraging price 9 00:00:18,425 --> 00:00:19,724 transparency data, 10 00:00:20,024 --> 00:00:21,085 interop interoperability, 11 00:00:21,545 --> 00:00:23,564 and robust data analysis. 12 00:00:23,864 --> 00:00:25,884 And joining me for today's discussion, 13 00:00:26,344 --> 00:00:29,029 very excited to have her on, Arti Karamchandani, 14 00:00:29,570 --> 00:00:32,850 chief growth officer at Mackerel Health. Arti, thanks 15 00:00:32,850 --> 00:00:34,149 so much for being here today. 16 00:00:34,530 --> 00:00:36,309 Thanks, Lucas. Great to be here. 17 00:00:36,770 --> 00:00:37,270 Absolutely. 18 00:00:37,729 --> 00:00:39,649 And before we start, could you give our 19 00:00:39,649 --> 00:00:41,429 audience just a little bit of an overview 20 00:00:41,570 --> 00:00:44,024 of yourself and your background in health care? 21 00:00:45,145 --> 00:00:46,024 Sure. Yeah. 22 00:00:47,065 --> 00:00:49,545 I'm the chief growth officer here at Macro 23 00:00:49,545 --> 00:00:52,664 Health. Been here for a few years now, 24 00:00:52,664 --> 00:00:55,304 three plus years, and, been in the health 25 00:00:55,304 --> 00:00:57,005 care payer industry for, 26 00:00:57,329 --> 00:00:59,509 I hate to admit it, thirty five years. 27 00:01:00,369 --> 00:01:02,210 And, so I'm a I'm a bit of 28 00:01:02,210 --> 00:01:04,150 a veteran in this in this industry, 29 00:01:05,329 --> 00:01:05,829 working, 30 00:01:06,209 --> 00:01:08,629 within the blues for several years, 31 00:01:09,265 --> 00:01:12,145 working at IBM health care and helping to, 32 00:01:12,145 --> 00:01:13,665 you know, to bring a lot of the, 33 00:01:14,385 --> 00:01:17,045 the technology enablers that you hear about IBM, 34 00:01:17,825 --> 00:01:20,564 participating in, in health care on. 35 00:01:20,865 --> 00:01:23,105 And then spent a good chunk of time 36 00:01:23,105 --> 00:01:26,060 in the early stage kinda innovation arena 37 00:01:26,439 --> 00:01:27,340 with a few, 38 00:01:27,719 --> 00:01:28,219 companies, 39 00:01:29,079 --> 00:01:30,700 which kinda caught me the bug 40 00:01:31,000 --> 00:01:33,640 related to, you know, innovation in health care 41 00:01:33,640 --> 00:01:34,539 using technology. 42 00:01:35,879 --> 00:01:38,439 Three decades of experience. That's why that's why 43 00:01:38,439 --> 00:01:39,515 we have you on. 44 00:01:41,094 --> 00:01:42,454 And this is really one of one of 45 00:01:42,454 --> 00:01:44,694 my personal favorite topics because, again, without good 46 00:01:44,694 --> 00:01:46,295 data, we can't really do a whole lot. 47 00:01:46,295 --> 00:01:48,075 We need data. Data is important. 48 00:01:48,534 --> 00:01:50,395 And my first question is, 49 00:01:50,855 --> 00:01:54,989 how can payers effectively utilize, especially price transparency 50 00:01:54,989 --> 00:01:57,649 data, to really drive continuous improvements 51 00:01:58,269 --> 00:01:59,729 in the quality of care 52 00:02:00,030 --> 00:02:02,909 while, and this is important, also reducing health 53 00:02:02,909 --> 00:02:03,649 care costs? 54 00:02:04,349 --> 00:02:04,849 Yeah. 55 00:02:05,229 --> 00:02:06,369 Super great question. 56 00:02:07,069 --> 00:02:09,074 Well, the price transparency data, 57 00:02:09,615 --> 00:02:12,335 is kind of the newest form of data 58 00:02:12,335 --> 00:02:13,634 that has entered into, 59 00:02:14,655 --> 00:02:16,354 the health care data landscape. 60 00:02:17,294 --> 00:02:17,794 And, 61 00:02:18,655 --> 00:02:20,655 as as kind of is normal, we we 62 00:02:20,655 --> 00:02:22,080 see that being governed by 63 00:02:22,879 --> 00:02:23,939 the federal regulations, 64 00:02:25,040 --> 00:02:27,860 and those regulations have now resulted in, 65 00:02:28,319 --> 00:02:31,139 even a doubling down of that by the, 66 00:02:31,599 --> 00:02:32,659 the newest administration. 67 00:02:33,680 --> 00:02:35,805 And that data has gotten better over time. 68 00:02:35,805 --> 00:02:38,044 Initially, it wasn't the best, but it was 69 00:02:38,125 --> 00:02:39,905 it has gotten better over time. 70 00:02:40,444 --> 00:02:41,664 And what we see, 71 00:02:42,284 --> 00:02:43,344 payers doing, 72 00:02:44,844 --> 00:02:47,004 leveraging that type of data is, you know, 73 00:02:47,004 --> 00:02:49,004 some of the the normalized use cases that 74 00:02:49,004 --> 00:02:49,644 you might, 75 00:02:50,044 --> 00:02:52,219 expect. We see payers and providers 76 00:02:52,840 --> 00:02:54,219 looking to leverage, 77 00:02:54,680 --> 00:02:55,819 that kind of data 78 00:02:56,439 --> 00:02:57,659 to do price negotiations 79 00:02:58,280 --> 00:02:58,780 or, 80 00:02:59,400 --> 00:03:01,000 you know, work through, like, what's what's a 81 00:03:01,000 --> 00:03:03,580 normalized cost for a particular type of service, 82 00:03:04,305 --> 00:03:04,805 mean, 83 00:03:10,584 --> 00:03:11,084 that's 84 00:03:16,864 --> 00:03:17,685 that's what, you know, some of the more 85 00:03:17,685 --> 00:03:17,987 normal use cases are that we're seeing, but, 86 00:03:18,310 --> 00:03:19,909 I mean, that's that's what, you know, some 87 00:03:19,909 --> 00:03:21,590 of the more normal use cases are that 88 00:03:21,590 --> 00:03:23,030 we're seeing, but I I think some of 89 00:03:23,030 --> 00:03:25,349 the more interesting ones that we're starting to 90 00:03:25,349 --> 00:03:28,329 experience and that we're helping, our clients with 91 00:03:28,629 --> 00:03:29,610 is combining, 92 00:03:30,629 --> 00:03:32,549 all the various forms of data that a 93 00:03:32,549 --> 00:03:33,930 customer might have, 94 00:03:34,935 --> 00:03:37,895 within their own four walls with that price 95 00:03:37,895 --> 00:03:38,395 transparency 96 00:03:38,694 --> 00:03:39,194 data. 97 00:03:39,735 --> 00:03:42,235 And by taking that data, those two datasets, 98 00:03:42,375 --> 00:03:43,115 if you will, 99 00:03:43,495 --> 00:03:45,495 and looking at them side by side, you 100 00:03:45,495 --> 00:03:47,575 can start to identify where there there might 101 00:03:47,575 --> 00:03:48,635 be cost variances, 102 00:03:49,729 --> 00:03:52,849 within the payer's own kinda cost structure, health 103 00:03:52,849 --> 00:03:53,830 care cost structure 104 00:03:54,289 --> 00:03:56,610 that kinda place their costs outside of the 105 00:03:56,610 --> 00:03:57,590 market norms. 106 00:03:58,050 --> 00:04:00,129 And then, you know, looking at different types 107 00:04:00,129 --> 00:04:00,949 of providers, 108 00:04:01,330 --> 00:04:02,650 networks, or even solutions that might be helpful 109 00:04:02,650 --> 00:04:03,189 in bringing 110 00:04:04,209 --> 00:04:04,544 that 111 00:04:13,185 --> 00:04:16,144 optimize them, so that their networks, their provider 112 00:04:16,144 --> 00:04:18,884 networks, which are, you know, the primary reason 113 00:04:19,105 --> 00:04:19,605 Americans 114 00:04:20,580 --> 00:04:22,740 look to health insurance is to be able 115 00:04:22,740 --> 00:04:24,680 to get access to high quality, 116 00:04:25,300 --> 00:04:26,600 affordable health care. 117 00:04:27,060 --> 00:04:29,080 And so by doing this kind of optimization 118 00:04:30,100 --> 00:04:32,520 allows the payers to be able to deliver 119 00:04:33,220 --> 00:04:34,120 a high quality, 120 00:04:34,580 --> 00:04:35,480 fully optimized, 121 00:04:36,225 --> 00:04:37,204 provider network 122 00:04:37,745 --> 00:04:40,064 and thereby, you know, starting to move the 123 00:04:40,064 --> 00:04:41,925 the total cost of care continuum 124 00:04:42,464 --> 00:04:45,584 towards at least market norms and hopefully over 125 00:04:45,584 --> 00:04:46,084 time 126 00:04:46,464 --> 00:04:48,964 to be just much more, cost effective. 127 00:04:49,620 --> 00:04:51,459 Then the the kind of the most interesting 128 00:04:51,459 --> 00:04:54,500 use case from my perspective is how we're 129 00:04:54,500 --> 00:04:55,879 seeing our clients, 130 00:04:56,899 --> 00:04:58,759 use that data to empower 131 00:04:59,379 --> 00:05:01,399 the the member or the consumer 132 00:05:02,084 --> 00:05:04,185 to make really effective decisions. 133 00:05:04,805 --> 00:05:06,425 So again, once you combine, 134 00:05:07,764 --> 00:05:11,064 the payer's data with the price transparency data 135 00:05:11,365 --> 00:05:13,125 and you can, you know, put that out 136 00:05:13,125 --> 00:05:13,944 on a website, 137 00:05:14,644 --> 00:05:16,584 members can start to look at, 138 00:05:17,050 --> 00:05:19,069 any service that they're looking to get, 139 00:05:20,169 --> 00:05:20,669 identify, 140 00:05:21,769 --> 00:05:24,649 not only the the different prices that they 141 00:05:24,649 --> 00:05:27,209 might be paying at various providers for those 142 00:05:27,209 --> 00:05:27,709 services, 143 00:05:28,889 --> 00:05:31,014 but then then also combining their own data 144 00:05:31,014 --> 00:05:33,814 with, the the payers data with it. The 145 00:05:33,814 --> 00:05:35,735 member can also see what their cost share 146 00:05:35,735 --> 00:05:37,675 might be relative to those services. 147 00:05:38,454 --> 00:05:40,634 So we're kind of bringing in the Amazon 148 00:05:40,694 --> 00:05:41,595 like retail 149 00:05:41,939 --> 00:05:42,439 experience 150 00:05:42,740 --> 00:05:45,319 into into health care. And, ultimately, 151 00:05:45,779 --> 00:05:48,340 all of us, kitchen table economics tells us 152 00:05:48,340 --> 00:05:50,819 that we need to save money, and this 153 00:05:50,819 --> 00:05:52,340 is a way to to help them do 154 00:05:52,340 --> 00:05:52,840 that. 155 00:05:53,220 --> 00:05:55,675 Yeah. And you mentioned a lot of different 156 00:05:55,675 --> 00:05:57,115 pieces to this. There's a lot of movement. 157 00:05:57,115 --> 00:05:59,514 There's comparisons that are happening. You mentioned sort 158 00:05:59,514 --> 00:06:01,754 of the the the pieces that the gears 159 00:06:01,754 --> 00:06:03,435 that sort of work together to make this 160 00:06:03,435 --> 00:06:06,014 work and being able to make data available 161 00:06:06,154 --> 00:06:08,095 to certain groups, to certain people. 162 00:06:08,475 --> 00:06:10,610 And this goes into my next question that 163 00:06:10,610 --> 00:06:12,789 I wanted to ask on on interoperability, 164 00:06:13,329 --> 00:06:15,009 which is really important when we have all 165 00:06:15,009 --> 00:06:16,149 of these moving pieces. 166 00:06:16,769 --> 00:06:19,269 In what ways does improving that interoperability 167 00:06:19,889 --> 00:06:20,629 help payers 168 00:06:21,009 --> 00:06:23,490 really identify those areas for improvement, some of 169 00:06:23,490 --> 00:06:25,729 which you've already mentioned, but then also optimize 170 00:06:25,729 --> 00:06:28,185 work flows, and then really what we just 171 00:06:28,185 --> 00:06:29,964 talked about benefit patients. 172 00:06:31,384 --> 00:06:31,884 Yeah. 173 00:06:32,665 --> 00:06:33,165 Well, 174 00:06:34,104 --> 00:06:36,685 you know, health care is a rapidly changing 175 00:06:36,824 --> 00:06:37,324 industry. 176 00:06:37,704 --> 00:06:39,704 And as you and many of your listeners 177 00:06:39,704 --> 00:06:40,204 know, 178 00:06:40,904 --> 00:06:42,939 US Health Care economy is on pace to 179 00:06:42,939 --> 00:06:43,439 be 180 00:06:43,979 --> 00:06:45,259 a 5,000,000,000,000 181 00:06:45,259 --> 00:06:47,019 industry in The United States by the end 182 00:06:47,019 --> 00:06:49,339 of twenty twenty five. Mhmm. You know, if 183 00:06:49,339 --> 00:06:52,560 you think about what health care payers' responsibility 184 00:06:52,939 --> 00:06:55,035 is in that industry, it's like they have 185 00:06:55,035 --> 00:06:56,654 this tremendous responsibility 186 00:06:57,035 --> 00:06:58,975 to figure out how they can, 187 00:06:59,914 --> 00:07:01,615 make health care more affordable 188 00:07:01,995 --> 00:07:03,375 for for their members, 189 00:07:04,074 --> 00:07:06,095 you know, the American people at large. 190 00:07:06,634 --> 00:07:07,035 And, 191 00:07:07,500 --> 00:07:09,980 we we are also very fortunate in our 192 00:07:09,980 --> 00:07:12,879 industry to have a barrage of innovation 193 00:07:13,660 --> 00:07:15,120 that is coming into 194 00:07:15,420 --> 00:07:16,879 our industry to help, 195 00:07:17,500 --> 00:07:18,000 control 196 00:07:18,379 --> 00:07:18,879 diseases, 197 00:07:19,900 --> 00:07:22,000 to help people live longer. 198 00:07:22,460 --> 00:07:24,824 And And ultimately, there's a there's a cost 199 00:07:24,824 --> 00:07:28,365 associated with that, and payers are combating those 200 00:07:28,665 --> 00:07:31,064 those initiatives that are, you know, could be 201 00:07:31,064 --> 00:07:33,705 considered as driving costs up. They have to 202 00:07:33,705 --> 00:07:35,464 figure out ways on how to they can 203 00:07:35,464 --> 00:07:37,004 drive those costs down. 204 00:07:37,625 --> 00:07:39,600 And there are plenty of innovators that are 205 00:07:39,600 --> 00:07:41,300 helping them do that as well. 206 00:07:42,399 --> 00:07:44,399 And and that's great. And it's it's a 207 00:07:44,399 --> 00:07:46,420 benefit that we enjoy in this industry. 208 00:07:47,279 --> 00:07:49,839 The challenge that we find our customers facing, 209 00:07:49,839 --> 00:07:52,180 our payer customers facing, is that 210 00:07:52,480 --> 00:07:53,644 there are so many 211 00:07:54,264 --> 00:07:55,964 innovations that they're not sure exactly 212 00:07:56,345 --> 00:07:58,685 which ones to pick that would be perfect 213 00:07:58,904 --> 00:08:01,324 for their their unique member populations. 214 00:08:02,425 --> 00:08:04,665 And, you know, what they do find is 215 00:08:04,665 --> 00:08:06,110 that their customers, 216 00:08:06,970 --> 00:08:07,470 employers, 217 00:08:08,569 --> 00:08:10,810 groups may start to, you know, have done 218 00:08:10,810 --> 00:08:12,410 some of the research and then come to 219 00:08:12,410 --> 00:08:13,629 them and tell them 220 00:08:14,009 --> 00:08:15,930 these are the partners that we want you 221 00:08:15,930 --> 00:08:17,629 to help us integrate with. 222 00:08:18,089 --> 00:08:19,455 And then all of a sudden, you're starting 223 00:08:19,455 --> 00:08:21,314 to look at multiple partners 224 00:08:22,095 --> 00:08:24,194 that the payer may want to integrate with, 225 00:08:24,334 --> 00:08:25,634 partners that their customers 226 00:08:26,175 --> 00:08:28,654 may want them to integrate with. And that's 227 00:08:28,654 --> 00:08:31,694 not easy for, you know, an industry that 228 00:08:31,694 --> 00:08:32,514 has been 229 00:08:32,909 --> 00:08:36,370 rattled with legacy systems. Right? And Yes. 230 00:08:36,750 --> 00:08:39,309 It's hard to connect with these, with these 231 00:08:39,309 --> 00:08:40,209 various partners. 232 00:08:40,909 --> 00:08:42,829 Forget about just connecting, but then to be 233 00:08:42,829 --> 00:08:44,370 able to truly interoperate 234 00:08:44,829 --> 00:08:47,470 with them, to serve the member better, to 235 00:08:47,470 --> 00:08:50,485 help drive down cost becomes an even greater 236 00:08:50,485 --> 00:08:53,365 challenge. And what our clients tell us and 237 00:08:53,365 --> 00:08:55,465 and what we try to help them with 238 00:08:56,004 --> 00:08:57,524 is to leverage an, 239 00:08:58,725 --> 00:08:59,384 an easy, 240 00:08:59,925 --> 00:09:00,425 integration 241 00:09:00,965 --> 00:09:01,465 capability 242 00:09:02,245 --> 00:09:04,820 that allows them to to not only identify 243 00:09:04,879 --> 00:09:07,279 those partners that might be best for their 244 00:09:07,279 --> 00:09:08,419 their member population, 245 00:09:08,879 --> 00:09:10,419 but that allows them to 246 00:09:10,799 --> 00:09:13,919 interoperate or connect with those members from a 247 00:09:13,919 --> 00:09:14,419 data, 248 00:09:14,959 --> 00:09:17,644 from a process, and from an insights perspective. 249 00:09:19,085 --> 00:09:21,965 So ultimately, all of that being surrounded and 250 00:09:21,965 --> 00:09:23,884 and focused in on the member so that 251 00:09:23,884 --> 00:09:25,345 the member can not only 252 00:09:25,805 --> 00:09:27,725 not feel the differences of all of these 253 00:09:27,725 --> 00:09:30,465 various disparate entities that might be serving them, 254 00:09:30,990 --> 00:09:32,830 but also be able to get the the 255 00:09:32,830 --> 00:09:36,049 right data and insights and the care ultimately 256 00:09:36,190 --> 00:09:37,809 that they that they deserve 257 00:09:38,350 --> 00:09:40,590 as they're working through a very complex health 258 00:09:40,590 --> 00:09:41,410 care ecosystem. 259 00:09:42,429 --> 00:09:43,884 That's where the data really helps. I was 260 00:09:43,884 --> 00:09:45,644 gonna say it's that's where the data comes 261 00:09:45,644 --> 00:09:46,144 in. 262 00:09:46,524 --> 00:09:48,445 Yep. For sure. That's where the data comes 263 00:09:48,445 --> 00:09:51,004 in. And and, ultimately, we're here to help. 264 00:09:51,004 --> 00:09:52,845 We as a payer industry are here to 265 00:09:52,845 --> 00:09:55,245 serve these members and make sure that they're 266 00:09:55,245 --> 00:09:57,165 getting to the right place with their data 267 00:09:57,165 --> 00:09:58,949 being available at the right place at the 268 00:09:58,949 --> 00:09:59,850 right time. 269 00:10:00,230 --> 00:10:02,149 So it's a it's a much better member 270 00:10:02,149 --> 00:10:04,870 experience for for their members and the patients 271 00:10:04,870 --> 00:10:05,370 ultimately. 272 00:10:06,709 --> 00:10:08,949 Yeah. So we've collected the data. We now 273 00:10:08,949 --> 00:10:10,789 have the data. We're working on the research 274 00:10:10,789 --> 00:10:12,649 that you just mentioned to try to identify 275 00:10:12,709 --> 00:10:15,054 those area. Now we have the data collected. 276 00:10:15,054 --> 00:10:16,035 We have it there. 277 00:10:16,575 --> 00:10:17,075 How 278 00:10:17,535 --> 00:10:18,035 can 279 00:10:18,415 --> 00:10:18,915 now 280 00:10:19,295 --> 00:10:22,815 robust data analysis looking at that data really 281 00:10:22,815 --> 00:10:25,819 be leveraged by payers to identify those trends 282 00:10:25,819 --> 00:10:28,379 that you've that you've talked about, those insights 283 00:10:28,379 --> 00:10:30,779 that we really are looking for that can 284 00:10:30,779 --> 00:10:32,720 then drive long term improvements 285 00:10:33,259 --> 00:10:35,600 for that ecosystem that we talked about. 286 00:10:36,059 --> 00:10:38,220 Yeah. This is where the fun happens if 287 00:10:38,220 --> 00:10:40,245 if we bring it all together. Right? 288 00:10:40,804 --> 00:10:43,464 So if we had a system where, 289 00:10:43,764 --> 00:10:45,544 you know, you can use the price transparency 290 00:10:45,764 --> 00:10:47,945 data and your own payer data 291 00:10:48,404 --> 00:10:51,144 to identify the areas where you have potential 292 00:10:51,365 --> 00:10:52,345 for optimization 293 00:10:52,725 --> 00:10:54,200 and cost reductions, 294 00:10:54,980 --> 00:10:58,040 and you had the ability to identify partners 295 00:10:58,100 --> 00:10:59,399 that can help service, 296 00:11:00,500 --> 00:11:03,540 those cost areas and help not only provide 297 00:11:03,540 --> 00:11:05,379 great quality care, but do it in a 298 00:11:05,379 --> 00:11:07,240 in a in an affordable manner. 299 00:11:07,644 --> 00:11:09,485 And if you had that system that could 300 00:11:09,485 --> 00:11:12,144 then interoperate with all of these third parties 301 00:11:12,684 --> 00:11:14,784 that are making up your system, 302 00:11:15,085 --> 00:11:18,065 your healthcare ecosystem as a healthcare payer, 303 00:11:18,605 --> 00:11:20,764 and it was centralized around the member and 304 00:11:20,764 --> 00:11:21,985 patient experience 305 00:11:22,605 --> 00:11:24,529 so that data is being shared in a 306 00:11:24,529 --> 00:11:25,990 real time manner, 307 00:11:26,529 --> 00:11:27,830 then what you would have 308 00:11:28,210 --> 00:11:30,389 is a a continuous improvement 309 00:11:30,850 --> 00:11:31,350 ecosystem 310 00:11:32,290 --> 00:11:33,590 of common entities 311 00:11:34,129 --> 00:11:35,910 working to service the member 312 00:11:36,529 --> 00:11:38,870 and always looking to look you know, identify 313 00:11:38,985 --> 00:11:41,644 areas for cost innovation or cost optimization. 314 00:11:41,945 --> 00:11:43,804 Right? Because the data is flowing 315 00:11:44,264 --> 00:11:46,365 seamlessly across this ecosystem 316 00:11:46,745 --> 00:11:47,404 of partners, 317 00:11:48,584 --> 00:11:50,825 that are, you know, working in collaboration with 318 00:11:50,825 --> 00:11:53,009 the payer to look for areas of cost 319 00:11:53,889 --> 00:11:56,070 optimization, identify those partners 320 00:11:56,610 --> 00:11:59,730 that can help drive down those, the total 321 00:11:59,730 --> 00:12:00,710 cost of care, 322 00:12:01,250 --> 00:12:05,009 easily integrate and interoperate with those partners so 323 00:12:05,009 --> 00:12:06,470 that the member is serviced 324 00:12:06,894 --> 00:12:08,735 and the patient gets the care that they 325 00:12:08,735 --> 00:12:09,235 need. 326 00:12:09,774 --> 00:12:12,095 And then that data then continues to flow 327 00:12:12,095 --> 00:12:15,134 through that system where it's continuously doing that 328 00:12:15,134 --> 00:12:17,235 cost optimization or or outlook 329 00:12:17,615 --> 00:12:19,455 to help drive down the the cost of 330 00:12:19,455 --> 00:12:19,955 care. 331 00:12:20,495 --> 00:12:22,309 And so that's, you know, to us, 332 00:12:22,850 --> 00:12:23,990 at at Macro Health, 333 00:12:24,450 --> 00:12:25,590 that is a, 334 00:12:26,050 --> 00:12:28,529 a system that we envision and that we 335 00:12:28,529 --> 00:12:30,870 aspire towards with our payer partners. 336 00:12:31,649 --> 00:12:32,149 And, 337 00:12:33,009 --> 00:12:35,024 it's, you know, it's something that we're looking 338 00:12:35,024 --> 00:12:36,084 to bring to life, 339 00:12:36,544 --> 00:12:37,924 on a day to day basis. 340 00:12:38,625 --> 00:12:40,784 Yeah. If that's brought to life, then we 341 00:12:40,784 --> 00:12:43,345 can take in that optimal process that we've 342 00:12:43,345 --> 00:12:45,345 talked about. Right? And and we know this 343 00:12:45,345 --> 00:12:46,084 isn't necessarily 344 00:12:46,464 --> 00:12:48,304 always the case, and I think a a 345 00:12:48,304 --> 00:12:50,250 lot of folks are in the process of 346 00:12:50,250 --> 00:12:52,009 doing these things. We've touched a little bit 347 00:12:52,009 --> 00:12:54,589 on sort of the third party piece and 348 00:12:54,809 --> 00:12:57,450 bolt on solutions and trying to go here, 349 00:12:57,450 --> 00:12:59,690 trying to go there, trying to integrate, right, 350 00:12:59,690 --> 00:13:01,629 trying to find what works and what doesn't. 351 00:13:02,570 --> 00:13:04,575 What are some of the key challenges 352 00:13:04,955 --> 00:13:07,855 that you're seeing that payers face right now 353 00:13:08,075 --> 00:13:09,754 to really implement some of these things that 354 00:13:09,754 --> 00:13:12,014 we've touched on, transparency, right, interoperability, 355 00:13:12,394 --> 00:13:14,475 and then ultimately improving their data? What what 356 00:13:14,475 --> 00:13:15,695 are those key challenges 357 00:13:16,075 --> 00:13:17,695 that you're seeing that are happening? 358 00:13:18,689 --> 00:13:20,709 Well, some of those challenges include, 359 00:13:21,649 --> 00:13:22,949 internal to the payer, 360 00:13:23,329 --> 00:13:23,829 obviously. 361 00:13:25,169 --> 00:13:27,169 We talked a little bit about touched on 362 00:13:27,169 --> 00:13:29,589 the the legacy systems that, 363 00:13:30,289 --> 00:13:32,929 payers have been fraught with. And, gosh, in 364 00:13:32,929 --> 00:13:35,674 my three plus decades of being in in, 365 00:13:35,995 --> 00:13:37,054 the healthcare industry, 366 00:13:37,434 --> 00:13:39,115 you know, it's every few years that I 367 00:13:39,115 --> 00:13:41,054 hear about the same payer potentially, 368 00:13:41,835 --> 00:13:42,654 looking at 369 00:13:42,955 --> 00:13:45,355 implementing a whole new, you know, claim system 370 00:13:45,355 --> 00:13:47,355 or a whole new finance system, and that 371 00:13:47,355 --> 00:13:48,980 sucks up a lot of resources. 372 00:13:50,160 --> 00:13:51,279 So I think this is one of the 373 00:13:51,279 --> 00:13:52,259 reasons why 374 00:13:52,639 --> 00:13:56,179 we see our, our payer partners looking to 375 00:13:56,240 --> 00:13:58,500 identify solutions that are outside, 376 00:13:59,120 --> 00:14:01,040 you know, their four walls to help drive 377 00:14:01,040 --> 00:14:01,540 down, 378 00:14:01,919 --> 00:14:04,934 the total cost of care. So internal organizational 379 00:14:05,235 --> 00:14:07,495 barriers can be a challenge for payers. 380 00:14:08,115 --> 00:14:08,615 Obviously, 381 00:14:09,634 --> 00:14:10,534 price transparency 382 00:14:10,914 --> 00:14:12,375 data has not been, 383 00:14:12,754 --> 00:14:13,495 the best. 384 00:14:14,034 --> 00:14:14,284 And, 385 00:14:15,320 --> 00:14:17,879 and while it's getting better and the Trump 386 00:14:17,879 --> 00:14:18,379 administration 387 00:14:18,759 --> 00:14:20,459 is focusing in on that 388 00:14:20,759 --> 00:14:21,740 much more robustly, 389 00:14:22,759 --> 00:14:24,600 it's still we we still find there to 390 00:14:24,600 --> 00:14:26,779 be gaps in the data. And so supplementing 391 00:14:27,000 --> 00:14:29,745 that data with the clients' with the payer's 392 00:14:29,745 --> 00:14:32,485 own, information and other third party 393 00:14:32,945 --> 00:14:34,725 vendor partners that have data, 394 00:14:35,264 --> 00:14:37,684 available to them that's, you know, publicly available, 395 00:14:38,705 --> 00:14:40,884 helps really create this robust 396 00:14:42,039 --> 00:14:44,379 dataset that can then be utilized. 397 00:14:45,000 --> 00:14:47,740 So now you have a good dataset, integrating 398 00:14:47,799 --> 00:14:50,360 it into a into into the system is 399 00:14:50,360 --> 00:14:50,860 is, 400 00:14:51,240 --> 00:14:51,740 difficult. 401 00:14:52,200 --> 00:14:54,325 And, you know, that's that those are areas 402 00:14:54,325 --> 00:14:56,585 where where payers are challenged with as well. 403 00:14:57,205 --> 00:14:57,924 And then, 404 00:14:58,565 --> 00:15:00,725 you know, interoperability is a challenge in and 405 00:15:00,725 --> 00:15:02,105 of itself as well. 406 00:15:02,644 --> 00:15:04,804 You know, we don't have great standards in 407 00:15:04,804 --> 00:15:05,865 the payer industry. 408 00:15:06,565 --> 00:15:07,660 We tried that with, 409 00:15:08,220 --> 00:15:10,940 the, you know, the EDI transactions that we 410 00:15:10,940 --> 00:15:13,259 had back in, gosh, I hate to say 411 00:15:13,259 --> 00:15:16,000 back in, like, the nineties and February. 412 00:15:16,700 --> 00:15:18,860 And what we know now is that you've 413 00:15:18,860 --> 00:15:21,340 seen one EDI transaction, you've seen one EDI 414 00:15:21,340 --> 00:15:23,684 transaction. And so, you know, you have to 415 00:15:23,684 --> 00:15:26,004 meet the payers where they're at and help 416 00:15:26,004 --> 00:15:26,504 them. 417 00:15:26,964 --> 00:15:29,444 They they need to kinda be thinking about 418 00:15:29,444 --> 00:15:32,725 interoperability and API standards are certainly something that's, 419 00:15:32,964 --> 00:15:34,584 becoming a critical enabler 420 00:15:35,204 --> 00:15:38,245 and having, data standards like FHIR and others 421 00:15:38,245 --> 00:15:40,879 that can help get payers to that to 422 00:15:40,879 --> 00:15:41,700 that place 423 00:15:42,240 --> 00:15:46,100 using the transaction sets that they're currently at, 424 00:15:46,320 --> 00:15:48,720 you know, helping them mobilize into that into 425 00:15:48,720 --> 00:15:49,860 the new modern world, 426 00:15:50,399 --> 00:15:52,399 is a challenge. And and, you know, they 427 00:15:52,399 --> 00:15:53,139 look for, 428 00:15:53,735 --> 00:15:56,075 for individuals and partners who can help them 429 00:15:56,295 --> 00:15:59,415 kind of achieve those infrastructure challenges themselves. So 430 00:15:59,415 --> 00:16:01,035 that's what we see as some of the 431 00:16:01,175 --> 00:16:03,435 the challenges that our pair partners face. 432 00:16:04,055 --> 00:16:07,029 Yeah. And with what you're seeing. Right? If 433 00:16:07,029 --> 00:16:08,090 you had to 434 00:16:08,470 --> 00:16:10,470 if there was one thing that you could 435 00:16:10,470 --> 00:16:12,230 tell them, like, hey, here's what I want 436 00:16:12,230 --> 00:16:14,309 you to do. This is the one thing 437 00:16:14,309 --> 00:16:15,929 that you need to start doing. 438 00:16:16,629 --> 00:16:18,389 What is the one thing that they can 439 00:16:18,389 --> 00:16:19,450 do to overcome 440 00:16:20,070 --> 00:16:21,975 some of these barriers or the barriers that 441 00:16:21,975 --> 00:16:23,914 you are seeing? Yeah. 442 00:16:24,454 --> 00:16:24,934 Well, 443 00:16:25,735 --> 00:16:27,894 you know, it's a it's an interesting question 444 00:16:27,894 --> 00:16:28,394 because, 445 00:16:29,174 --> 00:16:30,934 it does require a bit of a of 446 00:16:30,934 --> 00:16:33,575 a of a shift in mindset, right, to 447 00:16:33,575 --> 00:16:36,695 be thinking about rather than, you know, solving 448 00:16:36,695 --> 00:16:37,350 an individual 449 00:16:38,230 --> 00:16:41,269 problem to now solving a a series of 450 00:16:41,269 --> 00:16:43,049 issues and creating a system 451 00:16:43,829 --> 00:16:46,809 where you, you know, you are, like, continuously 452 00:16:47,269 --> 00:16:50,069 improving and being able to integrate with and 453 00:16:50,069 --> 00:16:51,884 and constantly be looking at, 454 00:16:52,684 --> 00:16:55,424 ways to reduce cost, create innovation, 455 00:16:55,965 --> 00:16:59,264 drive patient satisfaction, you know, seamless member experience. 456 00:17:00,044 --> 00:17:02,845 We call that platform based thinking. Right? So 457 00:17:02,845 --> 00:17:05,345 thinking more from a platform based perspective 458 00:17:06,259 --> 00:17:09,159 and and really shifting towards that more modern 459 00:17:09,299 --> 00:17:11,000 mindset, if you will, and 460 00:17:11,859 --> 00:17:14,980 and and thinking about things, related to how 461 00:17:14,980 --> 00:17:17,379 can I use that platform based thinking to 462 00:17:17,379 --> 00:17:19,079 to get to more data standardization, 463 00:17:19,539 --> 00:17:21,285 to get to real time connectivity, 464 00:17:21,904 --> 00:17:24,484 and to take a holistic approach to managing 465 00:17:25,184 --> 00:17:28,305 the health care problems and challenges that my 466 00:17:28,305 --> 00:17:31,184 unique member population has and the ever changing 467 00:17:31,184 --> 00:17:32,759 needs that they're gonna constantly 468 00:17:33,140 --> 00:17:35,380 have and building in, you know, strategic insights 469 00:17:35,380 --> 00:17:36,200 into that? 470 00:17:36,819 --> 00:17:39,539 We we call that a a system that 471 00:17:39,539 --> 00:17:40,039 is 472 00:17:40,339 --> 00:17:41,720 that has those capabilities, 473 00:17:42,019 --> 00:17:45,095 that is a platform based approach to solving 474 00:17:45,154 --> 00:17:47,095 healthcare's largest problems. 475 00:17:47,714 --> 00:17:48,855 We call that a marketplace 476 00:17:49,474 --> 00:17:51,015 and one that is constantly, 477 00:17:51,634 --> 00:17:53,815 you know, looking for economic efficiencies 478 00:17:54,275 --> 00:17:55,255 within the marketplace, 479 00:17:56,275 --> 00:17:58,214 that, you know, embeds data interoperability, 480 00:17:58,849 --> 00:18:01,330 data and analytics, and real time insights Mhmm. 481 00:18:01,570 --> 00:18:04,070 And easy integration. We call that an intelligent 482 00:18:04,369 --> 00:18:05,269 health marketplace. 483 00:18:06,049 --> 00:18:08,789 And those and the platforms that service that, 484 00:18:09,250 --> 00:18:10,549 you know, sir can certainly, 485 00:18:11,410 --> 00:18:13,184 help to drive down the the kind of, 486 00:18:13,664 --> 00:18:16,245 I guess, the retail mindset that we see, 487 00:18:16,945 --> 00:18:20,644 our consumers employ in in platform based businesses 488 00:18:20,705 --> 00:18:23,125 like Uber or like Amazon 489 00:18:23,985 --> 00:18:24,384 and, 490 00:18:24,865 --> 00:18:27,924 bring those those realities to to our industry. 491 00:18:28,960 --> 00:18:30,320 Yeah. And I think the key is, as 492 00:18:30,320 --> 00:18:32,400 you said, that this isn't going anywhere. Right? 493 00:18:32,400 --> 00:18:34,720 That consumer mindset is most likely going to 494 00:18:34,720 --> 00:18:36,640 continue. And I love that you mentioned the 495 00:18:36,640 --> 00:18:38,720 mindset piece because that's something that needs to 496 00:18:38,720 --> 00:18:40,720 change for a lot of folks is really 497 00:18:40,720 --> 00:18:44,505 thinking about those type of trends, those types 498 00:18:44,505 --> 00:18:46,684 of issues and being able to do that. 499 00:18:46,984 --> 00:18:48,904 Arty, thank you so much for being here 500 00:18:48,904 --> 00:18:50,184 today. I feel like we could go on 501 00:18:50,184 --> 00:18:52,585 for another half hour. I love this topic. 502 00:18:52,585 --> 00:18:54,904 It's so interesting because it really shapes the 503 00:18:54,904 --> 00:18:57,484 future. Thanks so much for being here today. 504 00:18:57,919 --> 00:18:59,859 Yeah. No problem. It's great to be here. 505 00:19:00,159 --> 00:19:01,759 Great to have you. And we also want 506 00:19:01,759 --> 00:19:04,240 to thank our podcast sponsor, Mackerel Health. You 507 00:19:04,240 --> 00:19:06,720 can tune into more podcast episodes from Becker's 508 00:19:06,720 --> 00:19:11,779 Healthcare by visiting our podcast page at beckershospitalreview.com.