Hi, everyone. This is Lucas Voss with Becker's
healthcare. Thanks so much for tuning in to
the Becker's healthcare podcast
series.
A very exciting topic today, the new era
of healthcare transformation
and how payers can drive continuous improvement
in the health care ecosystem by leveraging price
transparency data,
interop interoperability,
and robust data analysis.
And joining me for today's discussion,
very excited to have her on, Arti Karamchandani,
chief growth officer at Mackerel Health. Arti, thanks
so much for being here today.
Thanks, Lucas. Great to be here.
Absolutely.
And before we start, could you give our
audience just a little bit of an overview
of yourself and your background in health care?
Sure. Yeah.
I'm the chief growth officer here at Macro
Health. Been here for a few years now,
three plus years, and, been in the health
care payer industry for,
I hate to admit it, thirty five years.
And, so I'm a I'm a bit of
a veteran in this in this industry,
working,
within the blues for several years,
working at IBM health care and helping to,
you know, to bring a lot of the,
the technology enablers that you hear about IBM,
participating in, in health care on.
And then spent a good chunk of time
in the early stage kinda innovation arena
with a few,
companies,
which kinda caught me the bug
related to, you know, innovation in health care
using technology.
Three decades of experience. That's why that's why
we have you on.
And this is really one of one of
my personal favorite topics because, again, without good
data, we can't really do a whole lot.
We need data. Data is important.
And my first question is,
how can payers effectively utilize, especially price transparency
data, to really drive continuous improvements
in the quality of care
while, and this is important, also reducing health
care costs?
Yeah.
Super great question.
Well, the price transparency data,
is kind of the newest form of data
that has entered into,
the health care data landscape.
And,
as as kind of is normal, we we
see that being governed by
the federal regulations,
and those regulations have now resulted in,
even a doubling down of that by the,
the newest administration.
And that data has gotten better over time.
Initially, it wasn't the best, but it was
it has gotten better over time.
And what we see,
payers doing,
leveraging that type of data is, you know,
some of the the normalized use cases that
you might,
expect. We see payers and providers
looking to leverage,
that kind of data
to do price negotiations
or,
you know, work through, like, what's what's a
normalized cost for a particular type of service,
mean,
that's
that's what, you know, some of the more
normal use cases are that we're seeing, but,
I mean, that's that's what, you know, some
of the more normal use cases are that
we're seeing, but I I think some of
the more interesting ones that we're starting to
experience and that we're helping, our clients with
is combining,
all the various forms of data that a
customer might have,
within their own four walls with that price
transparency
data.
And by taking that data, those two datasets,
if you will,
and looking at them side by side, you
can start to identify where there there might
be cost variances,
within the payer's own kinda cost structure, health
care cost structure
that kinda place their costs outside of the
market norms.
And then, you know, looking at different types
of providers,
networks, or even solutions that might be helpful
in bringing
that
optimize them, so that their networks, their provider
networks, which are, you know, the primary reason
Americans
look to health insurance is to be able
to get access to high quality,
affordable health care.
And so by doing this kind of optimization
allows the payers to be able to deliver
a high quality,
fully optimized,
provider network
and thereby, you know, starting to move the
the total cost of care continuum
towards at least market norms and hopefully over
time
to be just much more, cost effective.
Then the the kind of the most interesting
use case from my perspective is how we're
seeing our clients,
use that data to empower
the the member or the consumer
to make really effective decisions.
So again, once you combine,
the payer's data with the price transparency data
and you can, you know, put that out
on a website,
members can start to look at,
any service that they're looking to get,
identify,
not only the the different prices that they
might be paying at various providers for those
services,
but then then also combining their own data
with, the the payers data with it. The
member can also see what their cost share
might be relative to those services.
So we're kind of bringing in the Amazon
like retail
experience
into into health care. And, ultimately,
all of us, kitchen table economics tells us
that we need to save money, and this
is a way to to help them do
that.
Yeah. And you mentioned a lot of different
pieces to this. There's a lot of movement.
There's comparisons that are happening. You mentioned sort
of the the the pieces that the gears
that sort of work together to make this
work and being able to make data available
to certain groups, to certain people.
And this goes into my next question that
I wanted to ask on on interoperability,
which is really important when we have all
of these moving pieces.
In what ways does improving that interoperability
help payers
really identify those areas for improvement, some of
which you've already mentioned, but then also optimize
work flows, and then really what we just
talked about benefit patients.
Yeah.
Well,
you know, health care is a rapidly changing
industry.
And as you and many of your listeners
know,
US Health Care economy is on pace to
be
a 5,000,000,000,000
industry in The United States by the end
of twenty twenty five. Mhmm. You know, if
you think about what health care payers' responsibility
is in that industry, it's like they have
this tremendous responsibility
to figure out how they can,
make health care more affordable
for for their members,
you know, the American people at large.
And,
we we are also very fortunate in our
industry to have a barrage of innovation
that is coming into
our industry to help,
control
diseases,
to help people live longer.
And And ultimately, there's a there's a cost
associated with that, and payers are combating those
those initiatives that are, you know, could be
considered as driving costs up. They have to
figure out ways on how to they can
drive those costs down.
And there are plenty of innovators that are
helping them do that as well.
And and that's great. And it's it's a
benefit that we enjoy in this industry.
The challenge that we find our customers facing,
our payer customers facing, is that
there are so many
innovations that they're not sure exactly
which ones to pick that would be perfect
for their their unique member populations.
And, you know, what they do find is
that their customers,
employers,
groups may start to, you know, have done
some of the research and then come to
them and tell them
these are the partners that we want you
to help us integrate with.
And then all of a sudden, you're starting
to look at multiple partners
that the payer may want to integrate with,
partners that their customers
may want them to integrate with. And that's
not easy for, you know, an industry that
has been
rattled with legacy systems. Right? And Yes.
It's hard to connect with these, with these
various partners.
Forget about just connecting, but then to be
able to truly interoperate
with them, to serve the member better, to
help drive down cost becomes an even greater
challenge. And what our clients tell us and
and what we try to help them with
is to leverage an,
an easy,
integration
capability
that allows them to to not only identify
those partners that might be best for their
their member population,
but that allows them to
interoperate or connect with those members from a
data,
from a process, and from an insights perspective.
So ultimately, all of that being surrounded and
and focused in on the member so that
the member can not only
not feel the differences of all of these
various disparate entities that might be serving them,
but also be able to get the the
right data and insights and the care ultimately
that they that they deserve
as they're working through a very complex health
care ecosystem.
That's where the data really helps. I was
gonna say it's that's where the data comes
in.
Yep. For sure. That's where the data comes
in. And and, ultimately, we're here to help.
We as a payer industry are here to
serve these members and make sure that they're
getting to the right place with their data
being available at the right place at the
right time.
So it's a it's a much better member
experience for for their members and the patients
ultimately.
Yeah. So we've collected the data. We now
have the data. We're working on the research
that you just mentioned to try to identify
those area. Now we have the data collected.
We have it there.
How
can
now
robust data analysis looking at that data really
be leveraged by payers to identify those trends
that you've that you've talked about, those insights
that we really are looking for that can
then drive long term improvements
for that ecosystem that we talked about.
Yeah. This is where the fun happens if
if we bring it all together. Right?
So if we had a system where,
you know, you can use the price transparency
data and your own payer data
to identify the areas where you have potential
for optimization
and cost reductions,
and you had the ability to identify partners
that can help service,
those cost areas and help not only provide
great quality care, but do it in a
in a in an affordable manner.
And if you had that system that could
then interoperate with all of these third parties
that are making up your system,
your healthcare ecosystem as a healthcare payer,
and it was centralized around the member and
patient experience
so that data is being shared in a
real time manner,
then what you would have
is a a continuous improvement
ecosystem
of common entities
working to service the member
and always looking to look you know, identify
areas for cost innovation or cost optimization.
Right? Because the data is flowing
seamlessly across this ecosystem
of partners,
that are, you know, working in collaboration with
the payer to look for areas of cost
optimization, identify those partners
that can help drive down those, the total
cost of care,
easily integrate and interoperate with those partners so
that the member is serviced
and the patient gets the care that they
need.
And then that data then continues to flow
through that system where it's continuously doing that
cost optimization or or outlook
to help drive down the the cost of
care.
And so that's, you know, to us,
at at Macro Health,
that is a,
a system that we envision and that we
aspire towards with our payer partners.
And,
it's, you know, it's something that we're looking
to bring to life,
on a day to day basis.
Yeah. If that's brought to life, then we
can take in that optimal process that we've
talked about. Right? And and we know this
isn't necessarily
always the case, and I think a a
lot of folks are in the process of
doing these things. We've touched a little bit
on sort of the third party piece and
bolt on solutions and trying to go here,
trying to go there, trying to integrate, right,
trying to find what works and what doesn't.
What are some of the key challenges
that you're seeing that payers face right now
to really implement some of these things that
we've touched on, transparency, right, interoperability,
and then ultimately improving their data? What what
are those key challenges
that you're seeing that are happening?
Well, some of those challenges include,
internal to the payer,
obviously.
We talked a little bit about touched on
the the legacy systems that,
payers have been fraught with. And, gosh, in
my three plus decades of being in in,
the healthcare industry,
you know, it's every few years that I
hear about the same payer potentially,
looking at
implementing a whole new, you know, claim system
or a whole new finance system, and that
sucks up a lot of resources.
So I think this is one of the
reasons why
we see our, our payer partners looking to
identify solutions that are outside,
you know, their four walls to help drive
down,
the total cost of care. So internal organizational
barriers can be a challenge for payers.
Obviously,
price transparency
data has not been,
the best.
And,
and while it's getting better and the Trump
administration
is focusing in on that
much more robustly,
it's still we we still find there to
be gaps in the data. And so supplementing
that data with the clients' with the payer's
own, information and other third party
vendor partners that have data,
available to them that's, you know, publicly available,
helps really create this robust
dataset that can then be utilized.
So now you have a good dataset, integrating
it into a into into the system is
is,
difficult.
And, you know, that's that those are areas
where where payers are challenged with as well.
And then,
you know, interoperability is a challenge in and
of itself as well.
You know, we don't have great standards in
the payer industry.
We tried that with,
the, you know, the EDI transactions that we
had back in, gosh, I hate to say
back in, like, the nineties and February.
And what we know now is that you've
seen one EDI transaction, you've seen one EDI
transaction. And so, you know, you have to
meet the payers where they're at and help
them.
They they need to kinda be thinking about
interoperability and API standards are certainly something that's,
becoming a critical enabler
and having, data standards like FHIR and others
that can help get payers to that to
that place
using the transaction sets that they're currently at,
you know, helping them mobilize into that into
the new modern world,
is a challenge. And and, you know, they
look for,
for individuals and partners who can help them
kind of achieve those infrastructure challenges themselves. So
that's what we see as some of the
the challenges that our pair partners face.
Yeah. And with what you're seeing. Right? If
you had to
if there was one thing that you could
tell them, like, hey, here's what I want
you to do. This is the one thing
that you need to start doing.
What is the one thing that they can
do to overcome
some of these barriers or the barriers that
you are seeing? Yeah.
Well,
you know, it's a it's an interesting question
because,
it does require a bit of a of
a of a shift in mindset, right, to
be thinking about rather than, you know, solving
an individual
problem to now solving a a series of
issues and creating a system
where you, you know, you are, like, continuously
improving and being able to integrate with and
and constantly be looking at,
ways to reduce cost, create innovation,
drive patient satisfaction, you know, seamless member experience.
We call that platform based thinking. Right? So
thinking more from a platform based perspective
and and really shifting towards that more modern
mindset, if you will, and
and and thinking about things, related to how
can I use that platform based thinking to
to get to more data standardization,
to get to real time connectivity,
and to take a holistic approach to managing
the health care problems and challenges that my
unique member population has and the ever changing
needs that they're gonna constantly
have and building in, you know, strategic insights
into that?
We we call that a a system that
is
that has those capabilities,
that is a platform based approach to solving
healthcare's largest problems.
We call that a marketplace
and one that is constantly,
you know, looking for economic efficiencies
within the marketplace,
that, you know, embeds data interoperability,
data and analytics, and real time insights Mhmm.
And easy integration. We call that an intelligent
health marketplace.
And those and the platforms that service that,
you know, sir can certainly,
help to drive down the the kind of,
I guess, the retail mindset that we see,
our consumers employ in in platform based businesses
like Uber or like Amazon
and,
bring those those realities to to our industry.
Yeah. And I think the key is, as
you said, that this isn't going anywhere. Right?
That consumer mindset is most likely going to
continue. And I love that you mentioned the
mindset piece because that's something that needs to
change for a lot of folks is really
thinking about those type of trends, those types
of issues and being able to do that.
Arty, thank you so much for being here
today. I feel like we could go on
for another half hour. I love this topic.
It's so interesting because it really shapes the
future. Thanks so much for being here today.
Yeah. No problem. It's great to be here.
Great to have you. And we also want
to thank our podcast sponsor, Mackerel Health. You
can tune into more podcast episodes from Becker's
Healthcare by visiting our podcast page at beckershospitalreview.com.