1 00:00:00,080 --> 00:00:02,399 Hi, everyone. This is Erica Spicer Mason with 2 00:00:02,399 --> 00:00:04,400 Becker's Healthcare. Thank you all so much for 3 00:00:04,400 --> 00:00:07,120 tuning into the Becker's Healthcare podcast series. So 4 00:00:07,120 --> 00:00:09,059 today we're going to talk about how innovative 5 00:00:09,119 --> 00:00:12,080 tech can connect payers, providers, and patients to 6 00:00:12,080 --> 00:00:13,779 improve outcomes and quality. 7 00:00:14,105 --> 00:00:16,265 And joining me for this conversation are two 8 00:00:16,265 --> 00:00:17,404 leaders from Veradigm. 9 00:00:17,864 --> 00:00:20,425 We have with us Courtney Yackel, Chief Product 10 00:00:20,425 --> 00:00:23,785 Officer, and Michael Moore, Chief Revenue Officer. Courtney 11 00:00:23,785 --> 00:00:25,324 and Michael, welcome to the podcast. 12 00:00:25,945 --> 00:00:28,379 Thank you. Thank you. We're so glad to 13 00:00:28,379 --> 00:00:30,300 have you both with us. But before we 14 00:00:30,300 --> 00:00:31,739 get into the questions, I wanted to see 15 00:00:31,739 --> 00:00:32,939 if you'd like to share just a little 16 00:00:32,939 --> 00:00:35,579 bit more about yourselves, your organization, whatever feels 17 00:00:35,579 --> 00:00:37,820 top of mind. Absolutely. Thank you so much, 18 00:00:37,820 --> 00:00:38,320 Erica. 19 00:00:38,780 --> 00:00:41,420 So I'm Courtney Yackel, chief product officer with 20 00:00:41,420 --> 00:00:44,434 Veradigm, and I started out my healthcare journey 21 00:00:44,434 --> 00:00:46,515 on the payer health plan side of the 22 00:00:46,515 --> 00:00:47,015 house, 23 00:00:47,475 --> 00:00:50,034 for about ten years. So everything from risk 24 00:00:50,034 --> 00:00:53,254 adjustment, quality analytics, strategic business unit, 25 00:00:53,875 --> 00:00:56,914 primarily focused on government programs. So whether that 26 00:00:56,914 --> 00:00:58,134 be Medicare advantage, 27 00:00:58,789 --> 00:01:01,750 Affordable Care Act, or the state specific Medicaid 28 00:01:01,750 --> 00:01:04,549 lines of business. So again, everything from analytics 29 00:01:04,549 --> 00:01:05,849 and financial reporting, 30 00:01:06,469 --> 00:01:08,630 to the lovely data submissions, and then of 31 00:01:08,630 --> 00:01:11,450 course, keeping up with the multiple CMS regulatory, 32 00:01:12,069 --> 00:01:14,844 guidance that, we all know and love. Yeah. 33 00:01:14,844 --> 00:01:17,405 You know payers inside and out. Absolutely. And 34 00:01:17,405 --> 00:01:19,885 then jumped over, to start up mode and 35 00:01:19,885 --> 00:01:22,045 have been, a part of the Veradigm family 36 00:01:22,045 --> 00:01:24,284 for about ten years now. So very much 37 00:01:24,284 --> 00:01:27,244 looking forward to the payer issues roundtable this 38 00:01:27,244 --> 00:01:30,299 week along my esteemed colleague here, Michael. 39 00:01:31,079 --> 00:01:33,640 So hi, everyone. This is Michael Moore. I 40 00:01:33,640 --> 00:01:37,099 am, the chief revenue officer for Veradigm Payer. 41 00:01:37,480 --> 00:01:39,799 And we were talking last night and getting 42 00:01:39,799 --> 00:01:41,560 ready for this that I can't believe it's 43 00:01:41,560 --> 00:01:43,334 been thirty five years since, 44 00:01:43,814 --> 00:01:45,515 I got into the, 45 00:01:46,454 --> 00:01:49,274 technology space and and health plans and, 46 00:01:49,734 --> 00:01:52,715 providers. So I've spent a career 47 00:01:53,174 --> 00:01:55,915 working in health care technology, helping 48 00:01:56,359 --> 00:01:57,979 get to that triple aim 49 00:01:58,359 --> 00:01:58,939 and connecting 50 00:01:59,400 --> 00:01:59,900 providers 51 00:02:00,280 --> 00:02:00,780 and 52 00:02:01,079 --> 00:02:03,959 payers so that we have the outcomes that 53 00:02:03,959 --> 00:02:06,200 we all seek, and that's healthier patients. So 54 00:02:06,200 --> 00:02:07,640 we're really glad to be here. This has 55 00:02:07,640 --> 00:02:09,985 been a great conference so far. See a 56 00:02:09,985 --> 00:02:11,745 lot of old colleagues and, 57 00:02:12,305 --> 00:02:14,385 new people getting into the industry, and we're 58 00:02:14,385 --> 00:02:15,745 just really excited to be a part of 59 00:02:15,745 --> 00:02:16,405 this podcast. 60 00:02:16,784 --> 00:02:18,465 Oh, I'm thrilled to have you both on 61 00:02:18,465 --> 00:02:20,545 the podcast with us today, and I love 62 00:02:20,545 --> 00:02:21,365 that we're addressing 63 00:02:21,860 --> 00:02:23,780 what's going to benefit both payers and providers. 64 00:02:23,780 --> 00:02:25,620 You know, so often the conversation is kind 65 00:02:25,620 --> 00:02:28,020 of siloed, who's doing what, but I appreciate 66 00:02:28,020 --> 00:02:29,699 that this we have this perspective on the 67 00:02:29,699 --> 00:02:32,020 line of, alright, how are these groups working 68 00:02:32,020 --> 00:02:33,860 together to get the patient outcomes and quality 69 00:02:33,860 --> 00:02:35,240 outcomes that they wanna see. 70 00:02:35,724 --> 00:02:38,444 So as payer and provider partnerships evolve and 71 00:02:38,444 --> 00:02:41,025 we are seeing a more kind of conscious 72 00:02:41,165 --> 00:02:43,645 effort among these entities to collaborate and work 73 00:02:43,645 --> 00:02:44,145 together, 74 00:02:44,444 --> 00:02:47,344 what strategies have you both seen successfully reduce 75 00:02:47,485 --> 00:02:48,705 administrative complexity, 76 00:02:49,085 --> 00:02:49,585 especially 77 00:02:50,580 --> 00:02:52,260 doing so while being able to improve patient 78 00:02:52,260 --> 00:02:54,340 outcomes. Can you share us through any examples 79 00:02:54,340 --> 00:02:54,920 of that? 80 00:02:55,700 --> 00:02:57,400 Certainly. Thank you. It's 81 00:02:57,700 --> 00:03:00,260 it's really interesting when you look at, 82 00:03:00,900 --> 00:03:04,840 how these organizations, provider organizations and payer organizations, 83 00:03:05,805 --> 00:03:08,944 addressing the market and creating their strategies. Number 84 00:03:09,004 --> 00:03:11,504 one, you should keep in mind that 85 00:03:11,805 --> 00:03:14,525 all the government sponsored programs, these are the 86 00:03:14,525 --> 00:03:16,064 Affordable Care Act or Edge, 87 00:03:16,444 --> 00:03:18,465 Medicaid, and Medicare Advantage, 88 00:03:18,819 --> 00:03:21,480 are all becoming more and more complex. 89 00:03:22,020 --> 00:03:24,919 They are all focused on how to document 90 00:03:25,699 --> 00:03:26,680 your achievements 91 00:03:27,060 --> 00:03:29,699 as a provider or as a payer. And 92 00:03:29,699 --> 00:03:32,805 so our our first focus from a strategy 93 00:03:32,805 --> 00:03:34,025 standpoint is that 94 00:03:34,405 --> 00:03:35,625 an early adopter 95 00:03:36,245 --> 00:03:37,145 needs to 96 00:03:38,164 --> 00:03:38,664 learn 97 00:03:39,205 --> 00:03:42,564 what their organization needs to be compliant with 98 00:03:42,564 --> 00:03:44,835 the government as a payer or a provider 99 00:03:45,129 --> 00:03:47,610 for quality initiatives, etcetera. So they have to 100 00:03:47,610 --> 00:03:49,949 learn and be educated, educate themselves, 101 00:03:50,650 --> 00:03:54,009 and, they have to, number two, talk with 102 00:03:54,009 --> 00:03:54,509 their 103 00:03:54,969 --> 00:03:57,229 payer organizations. They have to understand 104 00:03:57,775 --> 00:04:00,275 what that payer organization is trying to accomplish, 105 00:04:00,655 --> 00:04:02,514 and then they have to 106 00:04:02,814 --> 00:04:05,375 execute. They have to get involved with that 107 00:04:05,375 --> 00:04:07,635 payer and collaborate with that payer. 108 00:04:08,175 --> 00:04:10,754 For a long time, there's always been 109 00:04:11,080 --> 00:04:14,759 a certain amount of animosity or adversity between 110 00:04:14,759 --> 00:04:15,819 payers and providers, 111 00:04:16,279 --> 00:04:16,779 and 112 00:04:17,240 --> 00:04:20,300 both parties should understand that we are here 113 00:04:20,600 --> 00:04:23,419 to solve both of their problems. And 114 00:04:23,964 --> 00:04:26,225 not engaging and not collaborating 115 00:04:26,605 --> 00:04:29,584 is just going to extend the problems further. 116 00:04:30,285 --> 00:04:31,345 Well signed, Michael. 117 00:04:31,725 --> 00:04:34,785 I think in terms of leveraging technology, so 118 00:04:34,925 --> 00:04:36,605 both Michael and I have been in the 119 00:04:36,605 --> 00:04:38,620 the health plan payer space for quite a 120 00:04:38,620 --> 00:04:41,740 long time. And working together at Veradigm, we're 121 00:04:41,740 --> 00:04:44,000 able to capitalize upon the technology, 122 00:04:45,100 --> 00:04:48,480 components from the large and growing provider network. 123 00:04:49,019 --> 00:04:51,279 So when you bring together some of those 124 00:04:51,339 --> 00:04:52,000 those objectives 125 00:04:52,379 --> 00:04:56,704 that both payers and providers are diligently working 126 00:04:56,704 --> 00:04:59,104 to strive to solve for, there's a couple 127 00:04:59,104 --> 00:05:01,204 of of key themes that you see fragmented 128 00:05:01,345 --> 00:05:04,225 data, right, in terms of how they interpret 129 00:05:04,225 --> 00:05:07,365 the data. Michael talks about establishing that dialogue 130 00:05:07,425 --> 00:05:09,009 together. Well, at first, we need to make 131 00:05:09,009 --> 00:05:10,949 sure that we're speaking the same language 132 00:05:11,330 --> 00:05:14,129 in terms of any datasets that we're looking 133 00:05:14,129 --> 00:05:17,810 at, benchmark reporting, financial reporting. The ways that 134 00:05:17,810 --> 00:05:21,115 payers are reimbursed is completely different than how 135 00:05:21,115 --> 00:05:23,294 our physicians are reimbursed. However, 136 00:05:23,675 --> 00:05:25,995 we are all striving to move towards more 137 00:05:25,995 --> 00:05:28,555 value based care arrangements, and that's really where 138 00:05:28,555 --> 00:05:30,714 you bring in the beauty of both risk 139 00:05:30,714 --> 00:05:32,415 adjustment and quality initiatives, 140 00:05:33,050 --> 00:05:35,790 leveraging that technology. So if you think about 141 00:05:36,089 --> 00:05:36,589 analytics, 142 00:05:37,050 --> 00:05:38,830 making sure that you're able to, 143 00:05:39,290 --> 00:05:40,350 have that trustworthy 144 00:05:40,730 --> 00:05:41,230 dataset 145 00:05:41,770 --> 00:05:43,930 at the point of care so that physicians 146 00:05:43,930 --> 00:05:45,949 are able to take action upon those. 147 00:05:46,334 --> 00:05:49,694 We're seeing it through this calendar year 2026 148 00:05:49,694 --> 00:05:52,514 regulatory guidance that was just released this month 149 00:05:52,975 --> 00:05:56,254 that is jam packed with some regulatory changes 150 00:05:56,254 --> 00:05:57,935 that are up and coming for this next 151 00:05:57,935 --> 00:06:00,490 year, very much focused on capitalizing 152 00:06:00,790 --> 00:06:02,970 both risk adjustment and quality initiatives 153 00:06:03,350 --> 00:06:05,209 that are impacting both payers 154 00:06:05,509 --> 00:06:06,329 and providers. 155 00:06:07,269 --> 00:06:09,029 At the end of the day, it's all 156 00:06:09,029 --> 00:06:11,850 in how we establish that trusting relationship 157 00:06:12,264 --> 00:06:14,665 that will ultimately benefit the health outcomes for 158 00:06:14,665 --> 00:06:16,904 the member or the patient. Yeah. Such a 159 00:06:16,904 --> 00:06:20,025 helpful overview. Thank you both for really painting 160 00:06:20,025 --> 00:06:21,805 the the picture for our listeners. 161 00:06:22,345 --> 00:06:24,525 And I know you had just mentioned, 162 00:06:24,904 --> 00:06:25,500 risk adjustment 163 00:06:34,060 --> 00:06:34,800 home assessments, 164 00:06:35,339 --> 00:06:38,295 tech driven strategies. So from your perspectives, how 165 00:06:38,295 --> 00:06:40,615 is that space evolving, and where is technology 166 00:06:40,615 --> 00:06:42,395 making the biggest difference right now? 167 00:06:43,014 --> 00:06:44,314 That's a perfect segue. 168 00:06:44,694 --> 00:06:45,915 We see that, 169 00:06:46,535 --> 00:06:49,595 risk adjustment and quality are becoming the same. 170 00:06:50,055 --> 00:06:50,875 Risk adjustment 171 00:06:51,335 --> 00:06:52,634 from, its 172 00:06:53,250 --> 00:06:56,610 traditional retrospective view will always be around from 173 00:06:56,610 --> 00:07:00,710 a a way to get paid properly for 174 00:07:01,170 --> 00:07:03,430 the risks that are in your patient population, 175 00:07:03,730 --> 00:07:06,370 getting the proper premium for bearing those risks 176 00:07:06,370 --> 00:07:08,150 as a health plan or an ACO. 177 00:07:09,224 --> 00:07:10,764 Likewise, though, shifting 178 00:07:11,464 --> 00:07:13,004 from a retrospective 179 00:07:13,305 --> 00:07:16,604 view to a prospective view will be a 180 00:07:17,224 --> 00:07:17,724 bigger 181 00:07:18,504 --> 00:07:19,004 ROI 182 00:07:19,544 --> 00:07:21,564 on the investment in 183 00:07:21,979 --> 00:07:24,060 the outcomes that you're gonna measure from a 184 00:07:24,060 --> 00:07:25,040 performance standpoint 185 00:07:25,579 --> 00:07:28,720 and from a client's health, both the quality 186 00:07:29,019 --> 00:07:31,360 of the care that they receive through metrics 187 00:07:32,139 --> 00:07:33,360 for things like HEDIS, 188 00:07:33,819 --> 00:07:36,060 but also from the outcomes are, do we 189 00:07:36,060 --> 00:07:39,125 have a healthier and happier patient population? 190 00:07:39,585 --> 00:07:41,285 Another example of 191 00:07:41,665 --> 00:07:43,524 quality and risk adjustment 192 00:07:43,904 --> 00:07:45,365 commingling for the future 193 00:07:45,824 --> 00:07:48,004 is the use of in home assessments. 194 00:07:48,865 --> 00:07:52,329 In home assessments are sending a qualified caregiver 195 00:07:52,629 --> 00:07:54,009 to a person's home. 196 00:07:54,550 --> 00:07:56,649 And, traditionally, it has been 197 00:07:57,189 --> 00:07:58,490 very, very expensive 198 00:07:59,029 --> 00:08:01,610 to, in a rural situation, send 199 00:08:02,044 --> 00:08:04,685 a nurse practitioner or a doctor to someone's 200 00:08:04,685 --> 00:08:05,185 home 201 00:08:06,204 --> 00:08:09,165 for an annual wellness exam or for just 202 00:08:09,165 --> 00:08:12,225 an encounter. And so virtual care took 203 00:08:12,604 --> 00:08:15,185 the place of that for a few years. 204 00:08:16,100 --> 00:08:18,660 What we have seen the best value come 205 00:08:18,660 --> 00:08:19,639 out of IHAs 206 00:08:20,339 --> 00:08:23,300 is the gathering of social determinants of health 207 00:08:23,300 --> 00:08:26,259 data. When you're in a person's home, you 208 00:08:26,259 --> 00:08:28,935 can see that there are food insecurities 209 00:08:29,235 --> 00:08:32,054 or there are travel insecurities or there's medication 210 00:08:32,674 --> 00:08:35,894 rationing that's going on. These are all direct 211 00:08:36,035 --> 00:08:36,535 drivers 212 00:08:36,914 --> 00:08:40,674 of people's access to care that directly affects 213 00:08:40,674 --> 00:08:41,335 the outcomes. 214 00:08:42,080 --> 00:08:43,220 We've also seen 215 00:08:43,919 --> 00:08:45,539 that when surveyed, 216 00:08:46,480 --> 00:08:49,059 close to eighty percent of patients 217 00:08:49,600 --> 00:08:50,500 don't want 218 00:08:50,879 --> 00:08:53,600 a caregiver coming into their home. So you've 219 00:08:53,600 --> 00:08:54,340 got this 220 00:08:55,504 --> 00:08:56,644 dramatic need 221 00:08:57,024 --> 00:08:58,164 to address 222 00:08:58,625 --> 00:09:01,524 patients who aren't getting care due to access 223 00:09:01,585 --> 00:09:02,085 issues, 224 00:09:02,465 --> 00:09:04,325 at the same time not wanting 225 00:09:04,785 --> 00:09:06,485 a caregiver in their home 226 00:09:06,865 --> 00:09:07,524 out of 227 00:09:08,149 --> 00:09:09,610 fear or embarrassment 228 00:09:10,070 --> 00:09:12,809 or whatever the case might be. So 229 00:09:13,269 --> 00:09:15,370 we see IHAs as valuable, 230 00:09:15,830 --> 00:09:16,330 but 231 00:09:16,870 --> 00:09:18,950 the expense of them has to be driven 232 00:09:18,950 --> 00:09:19,929 toward quality 233 00:09:20,434 --> 00:09:21,875 and the values that you get out of 234 00:09:21,875 --> 00:09:25,254 quality results than you do necessarily for care. 235 00:09:25,794 --> 00:09:26,995 Yeah. And if you don't mind, could I 236 00:09:26,995 --> 00:09:28,674 just ask you a really quick follow-up question, 237 00:09:28,674 --> 00:09:31,954 Michael? You mentioned how risk adjustment and quality 238 00:09:31,954 --> 00:09:33,014 are kind of becoming 239 00:09:33,429 --> 00:09:34,410 one in the same. 240 00:09:35,509 --> 00:09:37,590 So how would you encourage organizations to really 241 00:09:37,590 --> 00:09:38,250 be viewing 242 00:09:38,550 --> 00:09:40,389 quality and risk adjustment as part of their 243 00:09:40,389 --> 00:09:43,370 strategic objectives? Do you recommend any shifts there? 244 00:09:43,670 --> 00:09:45,750 Well, the the biggest shift will be to 245 00:09:45,750 --> 00:09:47,910 focus on the patient, and and that's 246 00:09:48,595 --> 00:09:50,434 it shouldn't be a shift, really. Everybody should 247 00:09:50,434 --> 00:09:52,534 always be focused on the patient. 248 00:09:53,075 --> 00:09:54,534 But from a documentation 249 00:09:55,075 --> 00:09:57,254 process, these government programs 250 00:09:57,634 --> 00:09:58,134 are 251 00:09:58,595 --> 00:10:00,294 now requiring documentation 252 00:10:00,835 --> 00:10:01,495 to justify 253 00:10:02,299 --> 00:10:02,799 and, 254 00:10:03,419 --> 00:10:04,639 clearly report 255 00:10:05,339 --> 00:10:08,539 on the production that these programs have. In 256 00:10:08,539 --> 00:10:11,419 the past, we've seen a number of value 257 00:10:11,419 --> 00:10:12,559 based care contracts. 258 00:10:13,339 --> 00:10:16,514 While their their intent was to incent a 259 00:10:16,754 --> 00:10:19,095 provider organization for a certain performance, 260 00:10:19,715 --> 00:10:21,014 we've not seen them 261 00:10:21,554 --> 00:10:22,054 managed 262 00:10:22,355 --> 00:10:24,674 in the way that they need to to 263 00:10:24,674 --> 00:10:28,595 clearly document the encounters and the successes that 264 00:10:28,595 --> 00:10:30,514 you have and also the the the lack 265 00:10:30,514 --> 00:10:31,174 of success. 266 00:10:32,179 --> 00:10:33,639 Quality thus then becomes 267 00:10:34,179 --> 00:10:38,259 an outcome of patient care and measured across 268 00:10:38,259 --> 00:10:41,480 those, we're we're going to see an extension 269 00:10:41,700 --> 00:10:43,940 and a broadening of the ways that we 270 00:10:43,940 --> 00:10:44,919 measure quality 271 00:10:45,485 --> 00:10:45,964 and, 272 00:10:46,524 --> 00:10:47,745 not only to include 273 00:10:48,365 --> 00:10:51,485 patient preferences or the happiness of the patient, 274 00:10:51,485 --> 00:10:53,424 but the sheer outcomes of the diagnoses 275 00:10:53,884 --> 00:10:54,365 and, 276 00:10:54,684 --> 00:10:57,024 service codes that we document in the encounter. 277 00:10:57,580 --> 00:10:59,980 So interesting. And I I know, Courtney, you've 278 00:10:59,980 --> 00:11:01,339 been in the payer space a long time 279 00:11:01,339 --> 00:11:03,360 too. So what would you add? Anything? 280 00:11:03,820 --> 00:11:06,860 I would add that bringing together both risk 281 00:11:06,860 --> 00:11:10,080 adjustment and quality really fosters that 282 00:11:10,654 --> 00:11:11,795 sense of accountability 283 00:11:12,335 --> 00:11:15,075 for both health plan payers and the physicians 284 00:11:15,134 --> 00:11:17,634 because, ultimately, they have the same objective, 285 00:11:18,095 --> 00:11:20,575 having the the member patient right at the 286 00:11:20,575 --> 00:11:23,154 center of care from a health plan perspective. 287 00:11:23,215 --> 00:11:24,815 Right? They want to make sure that they 288 00:11:24,815 --> 00:11:25,955 are able to 289 00:11:26,339 --> 00:11:29,879 retain the member and offering extremely rich benefits 290 00:11:30,339 --> 00:11:32,740 that will allow the the member to live 291 00:11:32,740 --> 00:11:33,879 that healthy independent 292 00:11:34,500 --> 00:11:35,000 life. 293 00:11:35,459 --> 00:11:37,779 Same goes for a physician. Right? That is 294 00:11:37,779 --> 00:11:39,539 their ultimate goal. If you if you take 295 00:11:39,539 --> 00:11:40,839 out all of the crazy 296 00:11:41,545 --> 00:11:43,725 acronyms of health care, ultimately, 297 00:11:44,105 --> 00:11:46,264 the care of the patient is where health 298 00:11:46,264 --> 00:11:49,304 plan payers and physicians come together, which is 299 00:11:49,304 --> 00:11:50,825 the beauty of why we all get out 300 00:11:50,825 --> 00:11:52,985 of bed each day and and do this. 301 00:11:52,985 --> 00:11:55,004 However, it's extremely challenging, 302 00:11:55,399 --> 00:11:56,460 But bringing together 303 00:11:56,840 --> 00:11:57,580 high stakes, 304 00:11:58,519 --> 00:12:01,799 functions across risk adjustment and quality, and Michael 305 00:12:01,799 --> 00:12:03,399 and I see this every day. And I 306 00:12:03,399 --> 00:12:05,320 can say this because I've been sitting in 307 00:12:05,320 --> 00:12:07,960 the health plan shoes. Right? Ensuring that you 308 00:12:07,960 --> 00:12:11,105 were you're talking and having those conversations in 309 00:12:11,105 --> 00:12:13,285 terms of your objectives and your strategies, 310 00:12:13,825 --> 00:12:16,804 not only from a a patient centric mode, 311 00:12:16,865 --> 00:12:19,024 but in terms of what types of vendor 312 00:12:19,024 --> 00:12:21,924 partnerships or what types of technology or datasets 313 00:12:22,384 --> 00:12:23,205 that you're utilizing 314 00:12:24,129 --> 00:12:26,370 to achieve both the objectives for risk and 315 00:12:26,370 --> 00:12:27,350 quality. Again, 316 00:12:27,970 --> 00:12:31,250 with that that total health, care outcome in 317 00:12:31,250 --> 00:12:33,889 mind. Yeah. Oh, fantastic. And, Courtney, I know 318 00:12:33,889 --> 00:12:35,569 you mentioned a bit earlier in the discussion 319 00:12:35,569 --> 00:12:37,409 too that technology is a really big part 320 00:12:37,409 --> 00:12:40,284 of the trans transformation of getting payers and 321 00:12:40,284 --> 00:12:43,245 providers to work collaboratively, get the shared outcomes 322 00:12:43,245 --> 00:12:44,544 and aims that they have. 323 00:12:45,164 --> 00:12:47,325 And AI is gaining momentum in the payer 324 00:12:47,325 --> 00:12:49,345 and provider operational space. So 325 00:12:49,644 --> 00:12:51,404 over the next year or so, what are, 326 00:12:51,404 --> 00:12:53,884 what are you seeing as realistic use cases 327 00:12:53,884 --> 00:12:54,384 where 328 00:12:54,899 --> 00:12:57,139 they will see measurable impact? That's something our 329 00:12:57,139 --> 00:12:59,459 our listeners are always wanting to know, or 330 00:12:59,459 --> 00:13:01,620 even an area where you're seeing strong potential. 331 00:13:01,620 --> 00:13:03,539 Would you mind just elaborating a bit on 332 00:13:03,539 --> 00:13:06,279 your thoughts there? Sure. Absolutely. Happy to. There's 333 00:13:06,339 --> 00:13:09,299 so much going on in the AI space 334 00:13:09,299 --> 00:13:11,735 at this time. I will talk about a 335 00:13:11,735 --> 00:13:13,335 lot of the exciting things, and then I'll 336 00:13:13,335 --> 00:13:14,855 pass it over to Michael who will talk 337 00:13:14,855 --> 00:13:17,995 about the incredibly important pieces around data governance. 338 00:13:18,455 --> 00:13:20,615 However, what we are seeing right now in 339 00:13:20,615 --> 00:13:23,309 terms of the immediate impact is we we've 340 00:13:23,309 --> 00:13:25,710 talked a little bit about bringing those gaps 341 00:13:25,710 --> 00:13:26,370 in care 342 00:13:26,830 --> 00:13:28,110 at the point of care, whether they be 343 00:13:28,110 --> 00:13:30,350 for risk adjustment or quality. But how do 344 00:13:30,350 --> 00:13:32,850 we ultimately ensure that the documentation 345 00:13:33,389 --> 00:13:35,889 is complete, accurate, and timely, 346 00:13:36,674 --> 00:13:40,434 both from a physician education perspective. Right? We 347 00:13:40,434 --> 00:13:42,674 wanna make sure that we're not overburdening the 348 00:13:42,674 --> 00:13:43,174 physicians. 349 00:13:43,475 --> 00:13:46,115 We're not contributing to that fatigue. We wanna 350 00:13:46,115 --> 00:13:48,835 make it seamless and simple for them in 351 00:13:48,835 --> 00:13:52,230 terms of presenting those gaps in care. One 352 00:13:52,230 --> 00:13:54,149 piece of that in terms of leveraging the 353 00:13:54,149 --> 00:13:57,370 technology is natural language processing, so our NLP, 354 00:13:57,669 --> 00:14:00,709 and certainly our machine learning. We have access 355 00:14:00,709 --> 00:14:03,209 to an incredible depth of data, 356 00:14:03,584 --> 00:14:05,745 And how we use that is extremely important, 357 00:14:05,745 --> 00:14:06,804 whether we're utilizing 358 00:14:07,345 --> 00:14:10,644 case and disease registry data for predictive analytics. 359 00:14:10,784 --> 00:14:12,164 Right? It's establishing 360 00:14:12,544 --> 00:14:16,324 the the grounds of trust and transparency. Again, 361 00:14:16,659 --> 00:14:19,620 bridging that conversation between a health plan payer 362 00:14:19,620 --> 00:14:22,259 and a physician in terms of how did 363 00:14:22,259 --> 00:14:25,480 you determine these particular gaps in care. Right? 364 00:14:25,620 --> 00:14:28,659 What datasets did you utilize? And AI is 365 00:14:28,659 --> 00:14:29,399 a great, 366 00:14:29,940 --> 00:14:30,440 asset 367 00:14:30,745 --> 00:14:32,985 for health plans and physicians to leverage in 368 00:14:32,985 --> 00:14:34,125 that in those means. 369 00:14:35,304 --> 00:14:35,804 So 370 00:14:36,184 --> 00:14:36,684 Veradigm, 371 00:14:37,465 --> 00:14:40,985 has been involved in artificial intelligence and machine 372 00:14:40,985 --> 00:14:44,045 learning and natural language processing and other 373 00:14:44,720 --> 00:14:46,820 application of early stage AI, 374 00:14:47,600 --> 00:14:49,860 for quite some time. Through the process 375 00:14:50,240 --> 00:14:51,940 of of these technologies, 376 00:14:52,240 --> 00:14:53,540 we have created 377 00:14:54,160 --> 00:14:56,720 an artificial intelligence center of excellence at our 378 00:14:56,720 --> 00:14:58,500 company that brings in 379 00:14:59,014 --> 00:15:02,934 broad disciplines of people from functional areas of 380 00:15:02,934 --> 00:15:04,955 a health plan and a provider organization 381 00:15:05,735 --> 00:15:07,115 to look at applications, 382 00:15:07,975 --> 00:15:08,794 for leveraging 383 00:15:09,174 --> 00:15:09,674 AI. 384 00:15:10,134 --> 00:15:11,195 What we're immediately 385 00:15:11,575 --> 00:15:13,595 drawn to are the responsibilities 386 00:15:14,879 --> 00:15:18,100 that go with managing this kind of data 387 00:15:18,240 --> 00:15:20,879 and these types of tools. And so we 388 00:15:20,879 --> 00:15:21,540 have established, 389 00:15:22,080 --> 00:15:24,500 and continue to establish a level of governance 390 00:15:24,639 --> 00:15:27,600 around usage of this information, distribution of the 391 00:15:27,600 --> 00:15:28,100 information 392 00:15:28,799 --> 00:15:29,299 in 393 00:15:29,804 --> 00:15:30,544 our provider, 394 00:15:31,404 --> 00:15:33,804 segment, in our life sciences segment, and in 395 00:15:33,804 --> 00:15:34,784 our payer segment. 396 00:15:35,325 --> 00:15:38,384 And we will continue to see that evolve, 397 00:15:38,764 --> 00:15:40,284 and it's a little bit of a a 398 00:15:40,284 --> 00:15:43,004 an oxymoron of of governance because right now, 399 00:15:43,004 --> 00:15:46,110 there's just very little governance in the AI 400 00:15:46,110 --> 00:15:47,410 world. And so, 401 00:15:48,110 --> 00:15:49,490 we are treading 402 00:15:50,190 --> 00:15:50,690 cautiously 403 00:15:50,990 --> 00:15:52,050 but very optimistically 404 00:15:52,590 --> 00:15:56,029 at using our current capabilities and looking at 405 00:15:56,029 --> 00:15:58,590 new capabilities for the functional areas we just, 406 00:15:59,070 --> 00:16:01,009 we just talked about. But 407 00:16:01,445 --> 00:16:02,904 it it's more than that. 408 00:16:03,684 --> 00:16:05,544 We are we are applying 409 00:16:06,804 --> 00:16:09,625 artificial intelligence to the way we do business 410 00:16:09,684 --> 00:16:10,424 to assist, 411 00:16:11,284 --> 00:16:11,784 physicians 412 00:16:12,085 --> 00:16:14,424 and health plans in improving 413 00:16:15,125 --> 00:16:15,945 their time 414 00:16:16,409 --> 00:16:18,110 or improving their engagement. 415 00:16:18,570 --> 00:16:21,610 To particularly illustrate an example is we have 416 00:16:21,610 --> 00:16:23,389 the ability for providers 417 00:16:24,089 --> 00:16:24,829 to speak 418 00:16:25,129 --> 00:16:29,049 into a microphone and us ambiance scribe their 419 00:16:29,049 --> 00:16:29,549 information 420 00:16:30,009 --> 00:16:33,754 into a coding structure that automatically codes a, 421 00:16:34,075 --> 00:16:36,014 a claim at the point of care, 422 00:16:36,554 --> 00:16:37,054 vastly 423 00:16:37,915 --> 00:16:38,415 facilitating 424 00:16:38,875 --> 00:16:42,095 the documentation time that a provider may have. 425 00:16:42,315 --> 00:16:43,934 Similarly, we have, 426 00:16:44,920 --> 00:16:49,080 capabilities that can automate how a patient gets 427 00:16:49,080 --> 00:16:50,200 scheduled for, 428 00:16:50,680 --> 00:16:53,800 available appointments in a in a doctor's office. 429 00:16:53,800 --> 00:16:55,560 If we know a patient is looking for 430 00:16:55,560 --> 00:16:57,560 a doctor of this type and for this 431 00:16:57,560 --> 00:17:00,134 type of treatment service, we can scan the 432 00:17:00,134 --> 00:17:03,495 available providers and availability on their appointments and 433 00:17:03,495 --> 00:17:06,875 automatically schedule those patients for those encounters, 434 00:17:07,734 --> 00:17:10,375 dramatically improving the front office operation of a 435 00:17:10,375 --> 00:17:11,515 physician office. 436 00:17:12,590 --> 00:17:16,529 So we're using AI to address current functional 437 00:17:16,590 --> 00:17:18,670 areas. And in the future, we hope to 438 00:17:18,670 --> 00:17:19,809 be moving to 439 00:17:20,430 --> 00:17:20,930 where 440 00:17:21,390 --> 00:17:23,730 AI will provide us decision points. 441 00:17:24,269 --> 00:17:26,289 And those decision points meaning 442 00:17:26,984 --> 00:17:27,484 recommended, 443 00:17:28,345 --> 00:17:29,724 diagnoses or recommending, 444 00:17:30,585 --> 00:17:31,484 certain services 445 00:17:31,785 --> 00:17:33,164 or recommending certain 446 00:17:33,785 --> 00:17:36,924 follow-up visits based on treatment protocols. So 447 00:17:37,305 --> 00:17:39,384 the world is wide open for AI, but 448 00:17:39,384 --> 00:17:41,724 we have to proceed very cautiously 449 00:17:42,390 --> 00:17:43,130 but optimistically 450 00:17:43,750 --> 00:17:46,410 to address physician and payer problems. 451 00:17:46,950 --> 00:17:49,349 Yeah. And that that cautious optimism, it really 452 00:17:49,349 --> 00:17:51,509 comes through. Everything that you just outlined is 453 00:17:51,509 --> 00:17:53,430 so exciting to think about that future state, 454 00:17:53,430 --> 00:17:55,269 but having something like the center of excellence 455 00:17:55,269 --> 00:17:57,795 that Veradigm has sounds essential for this for 456 00:17:57,795 --> 00:18:00,295 this time when governance is at a minimum. 457 00:18:00,595 --> 00:18:02,515 So well, thank you both so much. I've 458 00:18:02,515 --> 00:18:03,735 so enjoyed this conversation. 459 00:18:04,115 --> 00:18:05,975 Any final thoughts before we close? 460 00:18:06,994 --> 00:18:07,494 Yes. 461 00:18:07,955 --> 00:18:09,174 Every time we, 462 00:18:09,795 --> 00:18:12,769 we get involved with a physician organization 463 00:18:13,230 --> 00:18:13,730 or 464 00:18:14,429 --> 00:18:16,750 a a payer organization, whether it's any type 465 00:18:16,750 --> 00:18:18,669 of risk bearing ACO or, 466 00:18:19,549 --> 00:18:20,769 subgroup of a payer, 467 00:18:21,389 --> 00:18:23,009 the one thing we have recognized 468 00:18:23,389 --> 00:18:24,109 is that, 469 00:18:24,509 --> 00:18:25,250 our businesses 470 00:18:25,924 --> 00:18:27,544 are still operating in silos. 471 00:18:27,924 --> 00:18:28,404 And, 472 00:18:28,964 --> 00:18:31,845 we still have people within our clients that 473 00:18:31,845 --> 00:18:34,565 we are introducing to one another, that they 474 00:18:34,565 --> 00:18:35,065 are 475 00:18:35,684 --> 00:18:38,804 they are struggling to reach within their own 476 00:18:38,804 --> 00:18:39,304 organizations 477 00:18:39,684 --> 00:18:40,424 and collaborate 478 00:18:40,724 --> 00:18:41,544 among themselves 479 00:18:41,899 --> 00:18:44,139 and each other. And so one of our 480 00:18:44,139 --> 00:18:44,639 biggest 481 00:18:45,019 --> 00:18:47,119 efforts is to make sure that our 482 00:18:47,500 --> 00:18:48,799 clients are dialoguing 483 00:18:49,179 --> 00:18:50,639 within their own walls, 484 00:18:51,419 --> 00:18:52,480 and that are, 485 00:18:52,859 --> 00:18:54,619 whether they be a a provider or a 486 00:18:54,619 --> 00:18:55,919 payer, that they are 487 00:18:56,284 --> 00:18:58,284 educated on the decisions they're trying to make 488 00:18:58,284 --> 00:19:00,204 and the options that are available to them. 489 00:19:00,204 --> 00:19:02,125 And they only get that through a proper 490 00:19:02,125 --> 00:19:02,625 dialogue, 491 00:19:03,404 --> 00:19:04,784 between payers and providers. 492 00:19:05,085 --> 00:19:08,044 Yeah. Such an important point. Courtney, any final 493 00:19:08,044 --> 00:19:08,544 thoughts? 494 00:19:09,244 --> 00:19:10,544 As you think about 495 00:19:10,845 --> 00:19:11,345 bringing 496 00:19:12,179 --> 00:19:13,559 and leveraging technology 497 00:19:13,859 --> 00:19:16,419 and then, of course, the human component to 498 00:19:16,419 --> 00:19:19,879 health care, I think now is an incredibly 499 00:19:20,339 --> 00:19:23,139 exciting and invigorating and certainly an inspiring time, 500 00:19:23,139 --> 00:19:25,159 especially as we sit here this week, 501 00:19:26,019 --> 00:19:27,079 to put 502 00:19:27,605 --> 00:19:32,085 these ideas, thoughts, business cases, the technology into 503 00:19:32,085 --> 00:19:34,404 action. We have all of the pieces and 504 00:19:34,404 --> 00:19:36,325 ready to rock and roll. The only thing 505 00:19:36,325 --> 00:19:39,525 that's keeping us from doing that, right, is 506 00:19:39,525 --> 00:19:42,005 that relationship between the payer and the provider. 507 00:19:42,005 --> 00:19:45,519 And, again, because Veradigm is uniquely positioned in 508 00:19:45,519 --> 00:19:48,500 that aspect and having the expansion 509 00:19:48,880 --> 00:19:51,200 of provider network and then coupled with the 510 00:19:51,200 --> 00:19:52,099 payer experience, 511 00:19:52,880 --> 00:19:55,779 bringing those gaps at the point of care 512 00:19:56,134 --> 00:20:00,075 to ultimately drive improved health outcomes is incredibly 513 00:20:00,375 --> 00:20:00,875 meaningful 514 00:20:01,335 --> 00:20:03,494 to our industry. And I just am so 515 00:20:03,494 --> 00:20:05,035 thrilled to be a part of it. 516 00:20:05,494 --> 00:20:07,755 Well, it's been great hearing from you both. 517 00:20:07,815 --> 00:20:09,759 Such good thought leadership in this short amount 518 00:20:09,759 --> 00:20:11,359 of time together. So thank you both so 519 00:20:11,359 --> 00:20:12,880 much for making the time for Becker's. It 520 00:20:12,880 --> 00:20:15,220 was great having you. Thank you. Thank you. 521 00:20:15,519 --> 00:20:17,279 And we'd also like to thank our podcast 522 00:20:17,279 --> 00:20:18,740 sponsor for today, Veradigm. 523 00:20:19,305 --> 00:20:21,305 Listeners, be sure to tune into more podcasts 524 00:20:21,305 --> 00:20:23,705 from Becker's by visiting our podcast page at 525 00:20:23,705 --> 00:20:25,805 beckershospitalreview.com.