Hi, everyone. This is Elizabeth Gregersen with Becker's
HealthCare. I'm excited to be joined today by
Raj Rananki,
CEO of Lyric.ai.
Thank you so much for joining us.
Yeah. Lots of changes, Elizabeth. So, as you
know, Lyric was previously called Claims Extend, and
it's been a a storied utility in in
the health insurance and the health plan industry.
It's been around for, you know, thirty plus
years. And over the course of those thirty
years, it's, changed ownership
structures and various entities,
from, you know, from time to time.
Most recently,
it was part of Change Healthcare, and as
a part of the UnitedHealth
acquisition, it was divested into a independent company.
TPG acquired the company about, you know, a
little over two and a half years ago.
And, at that the point that I joined
the company.
And and, really, the goal was to to
really understand what made the company tick. And,
I think one of the first things that
I learned was that the culture of the
company
and and the customer obsession and orientation
were really just remarkable. There was not a
single customer that was dissatisfied with with the
state of the software or had any issues.
So
that was something that was very important for
us to preserve and build on. You know?
So what we did was then
combine sort of
that ethos of of a customer obsession that
sort of served customers with distinction
and really bought in some world class technology
to to kinda power that. So the last
couple years, that's what we've been doing. It's
just to
transform
Lyric and our flagship application, which was a
great point solution,
from that into a platform
that could then create multiple offerings and solutions
for our customers and deliver that as a
one stop shop for
end to end, you know, payment integrity.
Perfect.
Did you wanna talk a little bit about
what you're most looking forward to in the
future? Yeah. As as I as I look
ahead,
I think, there have been a few times
sort of in our in our history in
in the recent past.
I I think back to the Internet era,
the mobile era, where
the the tectonic shifts in technology
really propelled, you know, businesses forward.
And there was lots of disruption that happened,
but there was a lot of opportunities created.
So when I look at all that's happening
in the world of AI, Gen AI, and
how that's gonna disrupt pretty much every industry,
you know, health care included, you know, I
see tremendous opportunity for Lyric
to leverage those technologies, which we already are
to some extent,
and reshape how health care can happen in
our country, which is it could be more
real time.
I think we could be much more transparent.
I think we could drive a lot of
waste out of the system, create more value
and impact. And the tech is our friend,
you know, to be able to do all
of that. So most looking forward to the
next, you know, two to three years, you
know, Lyric sort of driving a greater degree
of impact with a greater amount of transparency
and ultimately
powering the transformation of the system to be
much more real time, much more transparent, much
more consumer friendly
with more access and equity to in health
care that, you know, has largely been missing
for the last couple of decades.
Perfect.
So I'd love to talk about ClaimShark.
Why was it the target of your first
major organization acquisition?
Great question. Very excited about that acquisition. And,
you know, in fact, last week, we had,
you know, some of our strategic customers in
for an advisory board meeting here in Chicago.
And we reviewed, you know, more, more of
the detailed product road map and the rationale
for the acquisition with them, and they'll be
very excited about,
you know, what we could bring in
together with Lyric, you know, what what we
can actually do in terms of impact for
them. The main reason we acquired them was
that, you know, it's twofold. One was we
wanted to strengthen our platform capabilities. So think
of that as the technical foundation, the plumbing,
and making things easier for us to develop
content,
not only us, but also other partners that
could develop content on our platform.
And they have capabilities that enable us to
do that. So our Lyric 42 platform, which
we announced several months ago, I think would
stand to to sort of have greater impact
and greater potential with the ClaimShark edition.
So together with them, we're setting out to
create a ERP, sort of an enterprise resource
planning system for payment integrity
that would combine real time analytics insights with
workflow
so that all the the, you know, sort
of the mess that our clients sometimes have
to deal with in terms of silos, in
terms
of fragmented sort of data and fragmented teams,
unify all that under one platform so that
all things payment integrity, all thing medical trend
could be in one place where you can
look at it globally and action it. So
ClaimShark allows us to do that. In addition,
we can also
leverage some of their post pay capabilities. So,
for example, they have a coordination of benefits
offering that's in post pay.
They have a claims audit, you know, function
that's in post pay and start to integrate
that into prepay so that we can drive
more yield and more impact, you know, for
our customers.
But also with that data,
ultimately, we'd be able to create more real
time intelligence on medical trend,
so that we won't have to just react
to the things that have happened in the
past, but proactively predict what could happen with
medical trend and mitigate it. And that was,
I think, a super exciting development for us
in terms of what we could do for
our customers
and I think the
transformative impact could have on the whole industry.
Absolutely. I had a panel that was actually
talking about how to get all your different
silos of data and merge them together. So
it sounds really important. Yeah. How does Lyric
balance the need to deliver high value services
with the goal of achieving scalability
and higher margins through technology and automation?
Yeah. For no. For us, in our case,
I think those things are not,
at odds with with each other. In other
words, driving more impact, driving more scale. You
know? You know? Since Lyric is already at
a hundred plus helpline customers, you know, we
already have,
you know, sort of achieved escape velocity in
terms of scale.
So now what we're doing is is looking
at all the things that we do internally
that require, you know, human horsepower to go
drive. And we're saying, well, let's give AI
the right of first refusal in doing anything.
So before we add any single person, we'd
say, well, can AI solve this problem? Or
even if, let's just say, we wanna drive
a little bit more productivity across the the
company, we're asking everyone to use AI in
their in their day to day life so
that we can get that five, ten, fifteen,
twenty percent, you know, productivity list. Right? So
that's
pretty much most companies are doing that. What's
unique about but but Lyric is that where
are we going next with that is this
notion of creating autonomous operations.
So
automation is, you know, taking a task, a
process, you know, or an end to end
sort of workflow and saying, how could we
automate that?
Autonomous would mean that not only are we
automating a process with a set of agents,
but those agents could talk to other workflow
and other processes. And then
through that discussion
that could happen, you know, a settlement or
a outcome could be reached. So it's autonomous
automation.
So where could that be applied? So we
look at things like coordination of benefits or
itemized bill reviews or or
reviewing a medical chart, all of which require
human sort of judgment and understanding.
But what if we could train agents to
go do all of those tasks
and then ultimately
deliver
normally the functions that require people,
but deliver that, through software? So
call that delivering,
services software.
That was something we're very excited about. But,
over the course of the next two or
three years, I think you could go from
automation to autonomy to complete autonomy, which means,
we're probably gonna require very few people to
to do the things that are routine administrative
tasks, and then focus instead the human attention
to the things that matter around clinical decisions,
clinical care,
things that always should be you know, we
should have a human in the loop.
Absolutely.
How does Lyric prioritize
product development and road map decisions to ensure
alignment with the shift left approach? And what
are the key criteria for determining which products
and content areas to invest in?
Yeah. For us, it's it starts and ends
with, you know, what what our customers are
asking us to do. And because we're so
intimately involved in in and integrated in real
time with with a lot of the claims
operations and claims systems of our our customers
sort of, you know, operational architectures,
the needs kinda surface themselves and as to
what we need to what we need to
build. So that sort of serves as kinda
one source of input,
in in shaping our road map. The second
is we are proactively researching what's out there.
Obviously, the data that we have access
to,
Obviously, the data that we have access to
informs new features and functions that we need
to build, you know, in our product. You
know? So I think of that as a,
you know, another source of of innovation.
And then there's what can tech do, and
how is that gonna disrupt and that gonna
disrupt and reshape what's happening,
in our industry.
And and that's a little bit of combination
of of experimentation.
You know? It could be r and d
in several areas to figure out, you know,
what could be feasible to go productize for
us,
as well as, you know, continuous customer feedback.
You know, as we are doing small pilots,
you know, beta and alpha programs,
getting early and and frequent feedback from our
customers so that we're all all very tightly
linked with what customer needs are,
And then innovate within that sort of sphere
of customer need driving innovation.
Also, us pushing some outside in ideas to
make sure that, we're challenging our customers to
think ahead, you know, rather than just kind
of,
you know, building everything exactly to their specs.
You know? So that's sort of the process
by which we prioritize. And then,
the the number one thing that drives it
at Lyric and the single metric that matters
for us is the value that we're creating
for customers. So of all the things that
we do, we rank order things that by
the things that create the most most impact,
and that's how we we get after it.
Could you discuss Lyric's partner strategy and its
importance in your overall strategy?
Yeah. So so think of partners
and developers and our own teams
all sort of being participants on our on
our platform.
So Lyric forty
two, technical plumbing and the thing that maps
data and does all of the the hard
work of of being integrated in in real
time environment with with our clients.
Based on that position
in a processing architecture of claims,
we can do a lot more in terms
of, real time prepay, you know, sort of
solutions. Clearly, you
know,
flagship prepay applications that we're we're rolling out
and continuing to enhance.
But we know that innovations happen
across, you know, the industry. There's lot of
money going into new AI startups, new
partners that have unique capabilities that may be
somewhat niche.
But perhaps, you know, some of those companies
have found it hard to scale and get
into break into the helpline ecosystem.
So by working with us, we we're able
to, a, verify that what they're saying they
do actually happens.
And then if if that's the case,
then we can start to kinda match them
up against customer needs and take them to
our our customers to sort of integrate them
into our our ecosystem and deliver
value through a set of a one stop
shop, one integration, make it easy for our
customers to do business with us. So that's
the partner strategy. And there's a new one
that we're we're gonna launch this year, which
is around developers.
So much like, you know, Apple has a,
you know, developer program for iOS and Microsoft,
you know, obviously been a leader in partner
developer programs for the last fifty years.
We're gonna use Lyric's platform to make it
available to third party developers that could create
applications on our platform, and then we'd integrate
that and make it available to our customers.
So those would be the three sources. One,
our own developers creating content,
part established partners that have an existing go
to market that
perhaps are looking, you know, to shift left
and and do more in prepay. So we'd
be a conduit for that. And then lastly,
it'd be things that don't exist that developers
wanna create. We become platform for that as
well.
So what are the key differentiators of a
Lyric solution and the payment integrity market,
and how does the company ensure its offerings
provide a unique value?
Is the is the last thing you said.
And it's a unique value is the scale
of of the savings that we create and,
for our customers through,
essentially what we call payment accuracy,
payment accuracy solutions. You know? So which is
our interest is in not, you know, either
upcoding or downcoding or detecting that as much
as
making sure whatever is built, you know, by
the provider community is accurate.
And without judgment as to whether they should
get paid more or the same or less
than, you know, what what what they're describing
in in in their bill.
So if you've if you kinda start with
that premise and then say our unique sort
of position in the in the health care
ecosystem is the amount of value that we
create, which is,
last year, I think when we benchmarked, it
was nearly $20,000,000,000.
So it's it's really building on that and
then saying, what else could we do? So
given that we serve over a hundred customers
and we have visibility into, you know, claims,
representing over a 80,000,000
lives, we have a very longitudinal sort of
view as to what's happening in with with
with claims across the country.
So we take that and we can say,
well, what does medical trend look like next
day, next week, next month? Then, you know,
eventually, we'll start to get to the point
of predicting medical trend and helping our customers
ultimately mitigate it more proactively.
So how does Lyric plan to leverage next
generation AI applications
to further enhance its payment integrity solutions,
drive intelligent value creation, or transparency
at scale?
All diddough.
So, so, I mean, in many ways, we're
already, you know, have been incorporating AI for
the last, you know, two plus years.
We've got a you know, one of the
leading teams, I think, in the industry when
it comes to, you know, AI and sort
of a good combination of AI machine learning
and and, you know, sort of awareness of
data and
a deep sort of expertise in in the
plumbing and data, which is, you know, about
80% of the work of any, you know,
AI initiative. So if you take all that,
what we're able to do with it is,
one, increased transparency. So think
of solutions like, a Lyric Copilot that could
explain,
payment accuracy rules
to providers and eventually to to consumers via
the health plan channel.
We could start to create autonomous operations, as
I mentioned, through,
automating the work of of humans that typically
kinda do functions like coordination of benefits or
itemized bill reviews
and,
and deliver that differently and and deliver that
in real time in prepay.
But, also, I think,
the biggest thing I think we could, end
up doing is that,
health care is always intended to be kinda
settled transactions in real time,
much like fintech, you know, has done about,
you know, a decade ago.
But there have been various challenges along the
way. It's inertia. It's legacy tech on the
provider side, on the payer side.
You know, I think leadership lack of sort
of awareness around kinda what tech can do.
All that's kinda starting to change slowly but
surely, and I think it's gonna accelerate in
the next, few years.
So Lyric is uniquely positioned to facilitate that.
In other words, we can take all of
our AI and all of our algorithms, all
of our rules, and embed it directly into
the point of care,
where as,
you know, the physician, the provider community is
delivering care, and then they're recording that care
in the form
of in the EMRs in our chronic medical
records,
we could essentially be a service
that then could verify that what's being
translated in terms of what care was provided
into stuff that, you know, payers understand is
accurate. And if we can do that in
real time at the point of care, then
once the transaction gets to the payer's footsteps,
then the rest of the steps could be
done relatively quickly versus
it taking
sometime two hundred plus days, you know, for
for a claim to get settled, which in
today's age, in today's tech, there's no reason
for that. So our view is that that's
the biggest impact we can have, which is
that more transparency upfront, more accuracy upfront, and
then
straight through processing through the rest of the
system,
ultimately getting at that half a trillion in
waste that happens because of all these issues
across the system.
Thank you so much, Raj, for your time
and insights today. I also wanna thank Lyric
dot AI for sponsoring today's podcast and invite
our listeners to tune in to more podcasts
from Becker's Healthcare by visiting our podcast page
at beckershospitalreview.com.
I hope you all have a wonderful rest
of your day.