Hello, everyone. This is Jacob Emerson with the
Becker's Health Care podcast.
Thanks so much for tuning in today where
we're excited to talk about navigating market dynamics,
innovation, and the future of member care.
Joining me today for our discussion is Rob
Duffy, who is the chief technology officer at
HealthEdge.
Rob, thanks so much for taking the time
to be with me on the podcast today.
Hey. Thank you for the invite. I really
appreciate it. Thank you for listening to the
conversation.
Absolutely. Likewise. And before we dive into everything
we wanna talk with you about, can you
tell us a little bit more about yourself
and your career background?
Yeah. My name's as you've introduced already, my
name's Rob Duffy.
I come from a background,
at, large tech companies like Amazon
and, Uber and Expedia and Salesforce, you know,
really
developing large scale platforms and and creating
these incredible pieces of technology that can be
leveraged to unlock huge amounts of innovation and
and velocity
with the with their consumers. And,
I joined HealthEdge
nine months ago, ten months ago. And when
I joined HealthEdge, it was,
undergoing a little bit of a platform transformation.
And, I brought with me,
the the sort of non health care,
technical
expertise that you would find at these large
companies, and the the job has been really
transforming
and bringing the the products that we have
together and creating, creating this platform
of converge technology.
Absolutely. So it sounds like a unique career
journey that brought you to HealthEdge, Rob.
Let let's get started today by talking about,
as you know, interoperability
and integration
becoming increasingly crucial in health care operations today.
Yeah. In this environment, what do you think
is the role of platform based technology, and
what are some of the key advantages
for health plans in particular?
So if you think about a a, you
know, a health plan,
they have thousands, if not tens of thousands
of different integrations and and pieces of data
flying around and different data models and ways
that they get,
data from one place to another.
And what we're looking at now is some,
regulation
that, is saying, well, we should we should
try and talk in a standard format. We
should try and talk in a in a
single way. And when you have lots of
in integrations and you have lots of pieces
of technology,
what you essentially have is is a large
piece of technical debt that you have to
deal with when you have to try and
get all of those things to speak the
same standard.
And I think
many people in the industry
have seen in the last, you know, five
years, maybe even ten years,
that an approach of sort of stringing
lots of different point solutions together
means that anytime you wanna change something, you
have to change it in many different places.
And now that we're seeing this broad, generalized
drive towards a standard data format and a
standard data model, it means that this string
of pearls approach is becoming increasingly difficult and
complex complex to manage. So I I think
when I think about platforms, I think about
taking it away from a large number of
point solutions and point tools that you have
to constantly change to keep up with changing
regulations and and changing standards and changing formats
and really moving that across to, you know,
a platform level approach.
That means that companies like HealthEdge can do
that work once we can do it in
in the right places, and then you don't
have to worry about trying to keep up
with all of these
changes in standards and formats and regulations.
As a health plan, you can really lean
more on these platform based technologies or or
technology platforms to do that work once.
Let me follow-up with you there, Rob. How
would you say that regulations
are driving the push for a more connected
health care ecosystem?
I mean, we obviously have, you know,
this buyer standard is coming on, coming on.
We have the, you know, the the auth
requirements,
and and those are really driving this
consolidation
around a a data model
and a way of communicating
across different health health care applications.
And it it's become not optional. You know?
It's become a thing that the the regulation
is driving.
People have to keep up with that regulation
and have to be compliant with it. And
what that means is that, you you know,
the CIOs and CTOs that I speak to
are really looking at a a large project
ahead of them to get all of their
different systems and tools compliant. And and that
means
that the the work to do that is
can sometimes feel overwhelming.
And what we're seeing is people are looking
for more converged solutions that talk to each
other, that work together, and can handle
the the changing regulatory environment,
because I don't think anyone thinks, you know,
this is gonna be a short journey,
towards interoperability,
but, they're looking for these converged technology platforms
that can handle that for them and and
allow them to keep up with the pace
of change without having to make constant investments
in in the technology.
And then they can focus their energy more
on helping their business users and helping their
their their internal customers and their external customers
with with more innovative products.
Absolutely. And I think the the natural question
to that, Rob, is what are some of
the biggest challenges you're seeing payer organizations face
when transitioning from that siloed technology to a
fully integrated platform? And and, ultimately, how can
they navigate that effectively?
Yeah. I think when you look at any
large,
ecosystem of tools that has been built up
over time,
anytime you you pick a tool and you
implement something and you model a business process,
you make some trade offs, you make some
assumptions,
and you have to, you know, change the
way you work because of something that that
tool does or doesn't do,
in a way that you'd like it to
do. And when you deal with that and
you have a we have a large ecosystem
of maybe twenty, twenty five, 30, 40 tools,
that's, you know,
a huge number of places where you have
made assumptions and made changes to your business
model, and you've made changes to your, internal
process and maybe even the staff mix. So
the the organization
becomes a reflection of the technology that that
you have in place.
And that is a,
hard thing to change because if you want
to swap out tools,
you can't just swap the tool out, replace
it with a new one because that new
tool will have,
you know, assumptions and things that it does
well and things does doesn't do. So you
really have to think about this as a
a transformation of the business and a transformation
of the business models and business processes as
well as just, a a technology transformation.
And and that is, I would say, one
of the biggest challenges, which is making like,
figuring out what to keep and and what
to throw out and what what is, you
know, broken and and needs fixing and should
be fixed and can be fixed.
And, you know, doing that and doing the
technology change is is a big challenge.
Understood. So this has to be an enterprise
wide approach. And
as you see health plans continue to adopt
a platform based approach,
are there change management principles that they should
be keeping in mind to ensure a smooth
transition
and to maximize their their impact? Any any
resources you'd recommend, Rob?
You know, change
management for me and the the dealing with
the people aspects of of technology transformation,
I think
is 70, if not 80% of the job.
I think I've I've been doing platform transformations
for
two and a half decades, and I think
I've come to the conclusion that
focusing
on the people and focusing on the people's
transformation and and helping people have agency and
decisions and ensuring that you're not forcing technology
on them that they're bought in. They understand
the why, and you really dial on dial
into the change management,
the human elements of change management. I I
think that is
one of the key things to adopt.
And I don't think any platform really is
ever successful when it focuses just on the
technology,
and and sort of underestimates
the amount of,
people change management and and human change management
that's gonna need to to go on. And,
you know, in terms of frameworks or resources,
I think
as you go through
this sort of change management process,
there's there's a large number of,
like a cloud migration is a good example.
And there's a large number of resources that
are are really applicable to any kind of
any kind of large scale
change management initiative that is put out by
companies like
AWS and Azure. And those those kind of
cloud hyperscalers that it's their bread and butter
to do large scale technology transformation. So they
often have playbooks and frameworks that will enable
you to do the cloud migration, but I've
often found that they're actually just as applicable,
if you're changing,
what what ticketing system people are using or,
you know, if you're changing Office or whatever.
It's it's the same principles to,
get people aligned, make sure people are bought
in, make sure people understand why things are
happening, make sure they have agency
in the decision making. And and those those
frameworks,
they're published on these websites. They're they're very
easy to consume. And,
often, the large scale of cloud migrations means
that they have to be very good and
very robust. So you can sort of copy
that as a template
and move it move it across. And I'll
say, like,
never underestimate the amount of times you have
to communicate with people. I think when you
are a a leader
leading change and leading transformation,
it is your
day to day
job to to constantly be thinking about the
transformation and constantly be thinking about the the
change management
and constantly be thinking about, like, how the
communications go out and the why, and you
probably are, you know, giving the same presentation
to 10 different people every week. But I
always think about it in terms of what
is that the person that I am talking
to or I'm communicating with or presenting to,
what is their worldview?
And oftentimes, their worldview is
thirty or twenty nine days out of the
month,
they are doing their day job and they
have fire drills and customers to deal with
and they need to,
work on that. And then one day a
month for, you know, thirty minutes, they hear
a status update on your big change management
approach. So while you feel like you're over
communicating
and you should communicate until you feel like
you're over communicating,
the people that you're communicating to are oftentimes
hearing what you're saying, you know, in in
a in a sea of other information that's
that's very noisy. So the biggest thing I
would say is treat everything,
when you're thinking about change management,
and you're thinking about adopting a platform approach.
Treat everything as a large scale transformation
because it is, and
communicate, communicate, communicate, communicate almost until you're sick
of communicating your message. You know?
It's a lot of great advice for for
our listeners. So so thank you, Rob.
If you were to look ahead into the
future, how do you see innovation then continuing
to unfold at health plans? What's exciting you
right now, and how can our audience listen
listening in? How can leaders prepare
for this future state?
I am incredibly
excited
about
the concept of having data in a consistent
data model and stored in in, you know,
systems that you can understand
the entire enterprise data portfolio.
I think once you have that, there are
tremendous amounts of things you can do from
a business intelligence and and data intelligence perspective.
And machine learning and AI are are, you
know, two obviously,
top of everyone's mind examples of that. But
you can also just start thinking about efficiency
and and monitoring customer journeys through the system.
And for us in this industry where we
have this, you know, mess of integrations with
thousands of different tools that we and then
systems and APIs and batch jobs and messaging.
For us to be able to consolidate that
data into a single platform where we can
start making really, really intelligent
decisions
about about the businesses that we're running is
really exciting. And I think it's not just
us making intelligent decisions about the business that
we're running, but it's pointing these ML and
these AI tools
at that data and then training those models
and and, you know, asking these agents to
to make,
decisions about about that data too and and
asking them for input and seeing patterns across
massive amounts of data. It's just it's incredibly
exciting concept given the amount of data that
that payers and health plans have. And then
I think if I I sort of play
that out in my mind,
you know, you can take that data and
you can take that intelligence
and, you know, combine that with cloud,
this the infinite scalability of cloud, and you
can start doing digital twins of that data
and digital twins of the plans and and
using that to to do what if modeling
and and planning out different scenarios and saying
if I change this this contract here or,
you know, I change this plan line item
here or this this, in our case, the
health rules,
you know, what impact would that have had
over the last twelve months? Where do we
think that's gonna go in the future? And
you you can have tens
of hundreds of or tens and hundreds of
these digital twins of your business
in the cloud that you're you're able to,
to model different scenarios and different tweaks and
different pieces of business efficiency and and different,
things that are gonna have a real impact
to your customer and their customer experience. And
that's something that is just
a vision that's almost unheard of right now
where your data is everywhere.
You have to, you know, cut a ticket
to a a a business,
analyst team or a business intelligence team. You
know, they'll put the dashboard together or they'll
put the report together. You know, you're looking
at two, three week cycle times, sometimes at
best.
And then you finally get the data, and
then you analyze it. You wrote something wrong.
You have to go back. You know, there's
this really long lead time on business intelligence
right now. And I think as we start
to consolidate data models and we start to
consolidate our data infrastructure,
we're gonna be able to, you know, get
answers
in in almost real time
to very, very complex business scenario modeling, and
that's gonna be incredibly powerful for for customers.
Well, clearly, a lot of really exciting things
on the horizon. So, Rob, I wanna thank
you for taking the time to sit down
with us and for sharing your insights with
our listeners. We really appreciate it. Thank you.
It's been a pleasure. I'd also like to
thank our podcast sponsor, HealthEdge.
You can tune in to more podcasts from
Becker's HealthCare by visiting our podcast page at
beckershospitalreview.com.