1 00:00:00,080 --> 00:00:02,159 Hi, everyone. This is Lucas Voss with Becker's 2 00:00:02,159 --> 00:00:04,319 Healthcare. Thanks so much for tuning in to 3 00:00:04,319 --> 00:00:06,639 the Becker's Healthcare podcast series. It's great to 4 00:00:06,639 --> 00:00:08,800 have you. Today, we're talking about how health 5 00:00:08,800 --> 00:00:11,679 plans can build scalable high performance infrastructure to 6 00:00:11,679 --> 00:00:12,179 support 7 00:00:12,734 --> 00:00:13,234 growing 8 00:00:13,855 --> 00:00:16,015 complexity, enable AI, and stay ahead in the 9 00:00:16,015 --> 00:00:18,754 certainly rapidly evolving landscape that we're all facing 10 00:00:18,894 --> 00:00:20,994 right now. And joining me for today's discussion, 11 00:00:21,054 --> 00:00:22,894 very excited to have him is Rob Duffy. 12 00:00:22,894 --> 00:00:25,375 He's the chief technology officer at HealthEdge. Rob, 13 00:00:25,375 --> 00:00:26,574 thanks so much for being here today. It's 14 00:00:26,574 --> 00:00:28,789 great to have you. Yeah. Welcome, to Ben's 15 00:00:28,789 --> 00:00:30,230 point. Thank you very much. I really, really 16 00:00:30,230 --> 00:00:32,010 appreciate the opportunity to talk to you today. 17 00:00:32,229 --> 00:00:34,390 Yeah. Absolutely. I do wanna start with introductions 18 00:00:34,390 --> 00:00:36,310 here really quickly before we hop into the 19 00:00:36,310 --> 00:00:37,369 meat of this conversation. 20 00:00:37,909 --> 00:00:39,989 If you just wanna briefly introduce yourself, who 21 00:00:39,989 --> 00:00:41,450 you are, what you do at HealthEdge, 22 00:00:41,895 --> 00:00:44,074 and, what's going on with you. 23 00:00:44,375 --> 00:00:46,375 Amazing. So I'm Rob Duffy. I'm the chief 24 00:00:46,375 --> 00:00:47,754 technology officer at HealthEdge. 25 00:00:48,295 --> 00:00:50,774 My role is really to execute on it 26 00:00:50,854 --> 00:00:52,534 on the product road map in the most 27 00:00:52,534 --> 00:00:55,289 efficient and the high velocity way. And what 28 00:00:55,289 --> 00:00:57,530 we do is we, you know, as an 29 00:00:57,530 --> 00:00:59,690 engineering team, we really think about how we 30 00:00:59,690 --> 00:01:01,609 can leverage AI, how we can leverage cloud 31 00:01:01,609 --> 00:01:04,010 native infrastructure, how we can leverage all the 32 00:01:04,010 --> 00:01:05,770 things that are out there and available to 33 00:01:05,770 --> 00:01:08,890 us to really scale our operations and meet 34 00:01:08,890 --> 00:01:09,549 our customers 35 00:01:10,034 --> 00:01:12,114 through their scaling journey and make sure that 36 00:01:12,114 --> 00:01:14,275 they're getting the most leverage out of, the 37 00:01:14,275 --> 00:01:17,634 underlying technology and then also AI and anything 38 00:01:17,634 --> 00:01:20,194 that we build, from an AI perspective. So 39 00:01:20,194 --> 00:01:22,194 HealthEdge, for those those of you that aren't 40 00:01:22,194 --> 00:01:25,129 familiar with us, we are a, initially, we 41 00:01:25,129 --> 00:01:27,450 were a core admin platform, that does claims 42 00:01:27,450 --> 00:01:30,009 processing. We're a company called HealthEdge at the 43 00:01:30,009 --> 00:01:30,509 time. 44 00:01:30,969 --> 00:01:34,409 We acquired three other companies, GuidingCare, utilization management, 45 00:01:34,409 --> 00:01:35,629 and care management platform, 46 00:01:36,104 --> 00:01:37,364 Source, a, 47 00:01:37,704 --> 00:01:39,004 payment integrity platform, 48 00:01:39,305 --> 00:01:41,244 and then Wellframe, a member engagement platform. 49 00:01:41,545 --> 00:01:43,405 And then recently, we merged with Healthproof, 50 00:01:44,265 --> 00:01:46,665 who are a business process as a service, 51 00:01:46,984 --> 00:01:49,704 organization. And together, we have become HealthEdge's combined 52 00:01:49,704 --> 00:01:50,204 entity. 53 00:01:50,640 --> 00:01:53,200 And what that enables us to do is 54 00:01:53,200 --> 00:01:56,480 provide claims processing as a commodity to our 55 00:01:56,480 --> 00:01:58,319 customers. And what we can do because of 56 00:01:58,319 --> 00:02:00,159 our scale and because of our technology and 57 00:02:00,159 --> 00:02:01,780 because of our labor arbitrage, 58 00:02:02,079 --> 00:02:03,459 we can actually guarantee 59 00:02:03,855 --> 00:02:06,435 outcomes, guarantee the same claims processing outcomes 60 00:02:06,814 --> 00:02:08,835 for a a discounted rate, 61 00:02:09,375 --> 00:02:12,254 than the the ability for our our plans 62 00:02:12,254 --> 00:02:14,254 to actually process on their own. So, you 63 00:02:14,254 --> 00:02:16,594 know, on a per member per month basis, 64 00:02:16,735 --> 00:02:17,794 we are able to 65 00:02:18,230 --> 00:02:20,870 guarantee the same outcomes from claims processing to 66 00:02:20,870 --> 00:02:21,610 our customers, 67 00:02:22,150 --> 00:02:23,530 and do that at a discount. 68 00:02:23,990 --> 00:02:26,150 And the large portion of that, obviously, which 69 00:02:26,150 --> 00:02:27,349 we'll talk about in a little bit here 70 00:02:27,349 --> 00:02:29,449 is not only scale, but also, 71 00:02:29,909 --> 00:02:32,164 our ability to leverage AI in order to 72 00:02:32,164 --> 00:02:34,564 make bring more and more efficiency to the 73 00:02:34,564 --> 00:02:36,884 claims processing and claims operations. Yeah. I was 74 00:02:36,884 --> 00:02:38,884 gonna say we'll we'll walk through the way 75 00:02:38,884 --> 00:02:40,324 this works here in a little bit detail, 76 00:02:40,324 --> 00:02:42,084 but you mentioned something very important, which is 77 00:02:42,084 --> 00:02:42,745 high velocity. 78 00:02:44,099 --> 00:02:46,259 It's it's a high velocity market. Certainly, when 79 00:02:46,259 --> 00:02:48,759 we talk about, again, that rapidly evolving landscape, 80 00:02:49,299 --> 00:02:50,580 I'd love to touch on this a little 81 00:02:50,580 --> 00:02:52,580 bit more because, again, we know that health 82 00:02:52,580 --> 00:02:54,519 plans are dealing with a lot of pressure, 83 00:02:54,580 --> 00:02:57,784 right, growing membership, complex care models, and then 84 00:02:57,784 --> 00:03:00,104 you add regulatory demands onto that, I I 85 00:03:00,104 --> 00:03:01,324 think it's really crucial. 86 00:03:02,104 --> 00:03:04,125 From where you're sitting right now, 87 00:03:04,425 --> 00:03:06,745 what does it actually look like when a 88 00:03:06,745 --> 00:03:08,604 health plan's claims processing infrastructure 89 00:03:09,639 --> 00:03:10,139 starts 90 00:03:10,439 --> 00:03:13,000 to buckle under all of this weight that 91 00:03:13,000 --> 00:03:15,480 we're experiencing right now? I mean, you look 92 00:03:15,480 --> 00:03:17,319 at at any health plan right now, you 93 00:03:17,319 --> 00:03:19,639 know, medical loss ratio shooting through the roof 94 00:03:19,639 --> 00:03:20,939 either through, you know, 95 00:03:21,719 --> 00:03:23,900 very expensive drugs, more utilization, 96 00:03:24,465 --> 00:03:27,044 you know, people just getting, an aging population 97 00:03:27,264 --> 00:03:28,864 or even people getting smarter about their health 98 00:03:28,864 --> 00:03:30,305 care. I mean, the the impact of AI 99 00:03:30,305 --> 00:03:32,064 and chat GPT has meant that people are 100 00:03:32,064 --> 00:03:34,324 actually now going and sort of self diagnosing 101 00:03:34,465 --> 00:03:36,064 and seeing doctors where they where they wouldn't 102 00:03:36,064 --> 00:03:38,569 have seen before. So utilization is increasing. You 103 00:03:38,569 --> 00:03:40,889 know, cost of drugs is increasing. And then 104 00:03:40,889 --> 00:03:43,689 you have this interesting dynamic where on the 105 00:03:43,689 --> 00:03:45,530 revenue cycle management side of things, 106 00:03:46,169 --> 00:03:48,430 providers are using AI to code, 107 00:03:49,384 --> 00:03:51,705 their claims more effectively, and that's causing an 108 00:03:51,705 --> 00:03:53,784 increase in the in the the medical loss 109 00:03:53,784 --> 00:03:56,664 ratio. So you you think about that bucket 110 00:03:56,664 --> 00:03:58,205 of, you know, cost. 111 00:03:58,584 --> 00:03:59,965 There's really increasing 112 00:04:00,264 --> 00:04:02,905 in in terms of, the the MLR for 113 00:04:02,905 --> 00:04:04,239 our for our payers. And And then the 114 00:04:04,239 --> 00:04:06,080 other bucket of cost is the administrative loss 115 00:04:06,080 --> 00:04:07,199 ratio, which is like, how much does it 116 00:04:07,199 --> 00:04:08,560 just cost to own and operate the plan, 117 00:04:08,560 --> 00:04:09,939 process claims, do everything? 118 00:04:10,319 --> 00:04:10,819 And 119 00:04:11,120 --> 00:04:13,840 that bucket, I think, is just absolutely ripe 120 00:04:13,840 --> 00:04:16,419 for for disruption from AI tools, from automation, 121 00:04:16,479 --> 00:04:18,019 from scalable modern platforms. 122 00:04:18,384 --> 00:04:19,824 And that's really what we wanna bring to 123 00:04:19,824 --> 00:04:21,745 health care plans is a is a platform 124 00:04:21,745 --> 00:04:24,064 for scalability and a platform for innovation. And 125 00:04:24,064 --> 00:04:25,904 one where we can innovate on behalf of 126 00:04:25,904 --> 00:04:27,925 our customers and invent things using, 127 00:04:28,305 --> 00:04:29,745 all of the tools that are available us 128 00:04:29,745 --> 00:04:31,904 today to us today from an automation perspective, 129 00:04:31,904 --> 00:04:34,110 from an AI perspective, and just continually drive 130 00:04:34,110 --> 00:04:36,269 that ALR cost down so that our our 131 00:04:36,269 --> 00:04:37,649 plans, our customers 132 00:04:38,029 --> 00:04:40,189 can, you know, redivert some of those savings 133 00:04:40,189 --> 00:04:42,189 back to, you know, better health care outcomes, 134 00:04:42,189 --> 00:04:44,769 better customer, better, you know, patient experience, 135 00:04:45,375 --> 00:04:47,694 and really maintain their business and maintain their 136 00:04:47,694 --> 00:04:49,295 margins in the face of increasing it a 137 00:04:49,295 --> 00:04:49,795 lot. 138 00:04:50,175 --> 00:04:52,654 You mentioned innovation, which is certainly really crucial 139 00:04:52,654 --> 00:04:54,735 work from where you're sitting. You're innovating every 140 00:04:54,735 --> 00:04:56,595 single day. That's part of your job. 141 00:04:57,134 --> 00:04:59,055 You at HealthEdge and you certainly your team 142 00:04:59,055 --> 00:05:01,960 as well, you've reached an incredible milestone specifically 143 00:05:01,960 --> 00:05:04,360 with AWS, which most of our listeners are 144 00:05:04,360 --> 00:05:05,879 obviously familiar with, a big player in the 145 00:05:05,879 --> 00:05:06,379 space, 146 00:05:06,840 --> 00:05:08,759 in a single instance handling the equivalent of 147 00:05:08,759 --> 00:05:11,660 40,000,000 members. And, again, you cut that latency 148 00:05:12,324 --> 00:05:14,165 by more than half at that same time 149 00:05:14,165 --> 00:05:16,665 while also going through that process. Can you 150 00:05:16,725 --> 00:05:19,285 just walk us through what this meant for 151 00:05:19,285 --> 00:05:19,785 you? 152 00:05:20,165 --> 00:05:23,205 And, again, because you improved scale and speed 153 00:05:23,205 --> 00:05:24,425 at the same time, 154 00:05:24,805 --> 00:05:26,824 which is really, really hard to do. 155 00:05:27,199 --> 00:05:29,120 Yeah. And, you know, we made a decision 156 00:05:29,120 --> 00:05:30,660 to go all in with AWS, 157 00:05:31,439 --> 00:05:33,520 about eighteen months ago now. We said, hey. 158 00:05:33,520 --> 00:05:35,060 There's no point I was pursuing 159 00:05:35,680 --> 00:05:38,160 a multi cloud strategy. It's just diluting not 160 00:05:38,160 --> 00:05:40,160 only our purchasing power, but also the partnership 161 00:05:40,160 --> 00:05:42,415 opportunity we have with our cloud provider. And 162 00:05:42,415 --> 00:05:44,514 part of that was an acknowledgment that 163 00:05:45,615 --> 00:05:47,775 going all in with a with a single 164 00:05:47,775 --> 00:05:50,254 provider would also enable us to get really, 165 00:05:50,254 --> 00:05:50,754 really 166 00:05:52,014 --> 00:05:54,574 familiar with everything that would that provide that, 167 00:05:55,069 --> 00:05:57,069 cloud provider was able to offer us and 168 00:05:57,069 --> 00:05:59,870 really develop deep expertise and partnership with them 169 00:05:59,870 --> 00:06:01,470 in order to bring these outcomes to our 170 00:06:01,470 --> 00:06:05,389 customers. And we very early on realized that, 171 00:06:05,389 --> 00:06:07,229 you know, we've been pushing the boundaries of 172 00:06:07,229 --> 00:06:07,729 scalability 173 00:06:08,714 --> 00:06:10,415 using a physical hardware 174 00:06:10,795 --> 00:06:12,714 mindset. Right? And then we can we were 175 00:06:12,714 --> 00:06:14,395 previously in a private cloud and a data 176 00:06:14,395 --> 00:06:17,035 center virtualized there. And whenever we thought about 177 00:06:17,035 --> 00:06:18,795 scalability, it was like, you know, let's buy 178 00:06:18,795 --> 00:06:21,194 some more machines, long lead time, larger machines, 179 00:06:21,194 --> 00:06:23,610 whatever. Right? We we we would scale to 180 00:06:23,610 --> 00:06:26,350 the point where we could afford the infrastructure 181 00:06:26,810 --> 00:06:28,810 and and, you know, it's expensive infrastructure when 182 00:06:28,810 --> 00:06:30,730 it's in in a data center. So we 183 00:06:30,730 --> 00:06:32,090 would so we're thinking about it in a 184 00:06:32,090 --> 00:06:34,810 in a very non high performance compute way 185 00:06:34,810 --> 00:06:36,435 and then more of a sort of, like, 186 00:06:36,595 --> 00:06:39,555 horizontally scaling traditional data center way. When we 187 00:06:39,555 --> 00:06:41,235 moved to the cloud, all of a sudden 188 00:06:41,235 --> 00:06:43,074 we were able to take advantage of some 189 00:06:43,074 --> 00:06:45,875 new, you know, AWS silicon, the Graviton chips, 190 00:06:45,875 --> 00:06:48,435 the high performance compute instances, and we're able 191 00:06:48,435 --> 00:06:51,209 to dynamically scale them to meet the demands 192 00:06:51,209 --> 00:06:53,529 of our application and drive where we were 193 00:06:53,529 --> 00:06:56,089 able to scale to way beyond where we 194 00:06:56,089 --> 00:06:58,089 had previously been able to. And I think 195 00:06:58,089 --> 00:06:58,990 that's just a 196 00:06:59,529 --> 00:07:02,009 a a a a great indication of how 197 00:07:02,009 --> 00:07:04,089 deeply partnered we are with AWS and then 198 00:07:04,089 --> 00:07:06,384 also the the ability for that partnership to 199 00:07:06,384 --> 00:07:09,185 bring true scalability and and true outcomes for 200 00:07:09,185 --> 00:07:11,345 us from a technology perspective. And you mentioned 201 00:07:11,345 --> 00:07:12,805 the latency there. I mean, really, 202 00:07:13,264 --> 00:07:14,645 you know, AWS 203 00:07:15,504 --> 00:07:16,485 is a a 204 00:07:16,944 --> 00:07:18,245 has deep expertise 205 00:07:18,970 --> 00:07:21,370 in how to get their infrastructure to talk 206 00:07:21,370 --> 00:07:23,310 to each other and how to, you know, 207 00:07:24,089 --> 00:07:26,430 continuously fight against the speed of light 208 00:07:26,730 --> 00:07:29,449 to to to bring latency down between their 209 00:07:29,449 --> 00:07:32,095 their applications and between their services. And that 210 00:07:32,095 --> 00:07:33,455 really shows when you look at things like 211 00:07:33,455 --> 00:07:35,795 the network IO, the latency, the disk. 212 00:07:36,175 --> 00:07:37,774 You know, we had our our database administered 213 00:07:37,935 --> 00:07:39,134 getting a bit technical, but we had our 214 00:07:39,134 --> 00:07:40,115 database administered 215 00:07:40,574 --> 00:07:41,074 administrator, 216 00:07:41,774 --> 00:07:43,074 incredible lady called Manu. 217 00:07:43,535 --> 00:07:44,750 And she was, like, having a little bit 218 00:07:44,750 --> 00:07:46,350 concerned about the IO. And then after we 219 00:07:46,350 --> 00:07:48,829 routed, the the ability to write information to 220 00:07:48,829 --> 00:07:49,990 the disk, and then after we moved to 221 00:07:49,990 --> 00:07:51,229 the cloud, she was like, oh, wow. We're 222 00:07:51,229 --> 00:07:53,629 gonna be fine. This is amazing. It's it's 223 00:07:53,629 --> 00:07:55,470 much better than we're able to achieve. So 224 00:07:55,470 --> 00:07:57,705 I I think, you know, maintaining your own 225 00:07:57,705 --> 00:07:58,205 infrastructure, 226 00:07:58,824 --> 00:08:01,564 you can do well. I think moving to 227 00:08:01,865 --> 00:08:04,585 a a cloud hyperscaler and really leaning into 228 00:08:04,585 --> 00:08:06,985 one cloud hyperscaler, you can do amazing and 229 00:08:06,985 --> 00:08:09,064 great things with them because they will also 230 00:08:09,064 --> 00:08:10,665 invest in you, and you can invest in 231 00:08:10,665 --> 00:08:11,805 that partnership together. 232 00:08:12,759 --> 00:08:14,220 Applying this to 233 00:08:14,600 --> 00:08:16,040 the use case in and of itself, just 234 00:08:16,040 --> 00:08:18,060 as a quick follow-up here. Right? 235 00:08:18,439 --> 00:08:20,680 Why does the single instance that you just 236 00:08:20,680 --> 00:08:22,540 described make such a difference 237 00:08:23,080 --> 00:08:25,879 from a day to day operations perspective? What 238 00:08:25,879 --> 00:08:28,574 difference does it make for day to day 239 00:08:28,574 --> 00:08:29,074 operations? 240 00:08:29,774 --> 00:08:30,514 So traditionally, 241 00:08:30,894 --> 00:08:33,134 for a health plan, you would have different 242 00:08:33,134 --> 00:08:36,174 lines of businesses, maybe different regions on multiple 243 00:08:36,174 --> 00:08:37,634 different core admin platforms. 244 00:08:38,335 --> 00:08:40,019 So you have the the 245 00:08:40,340 --> 00:08:42,980 the same system, sometimes a different system, sometimes 246 00:08:42,980 --> 00:08:44,580 the same system, but a different version of 247 00:08:44,580 --> 00:08:45,320 the same system 248 00:08:45,779 --> 00:08:48,759 running in multiple places across across the organization. 249 00:08:49,220 --> 00:08:50,660 And for us, when we're trying to bring 250 00:08:50,660 --> 00:08:52,420 down the cost of operations and we're trying 251 00:08:52,420 --> 00:08:54,500 to commoditize claims processing and really sort of 252 00:08:54,500 --> 00:08:57,584 continue to lower the cost of operations, 253 00:08:58,444 --> 00:09:01,345 having multiple different systems and multiple different tools 254 00:09:01,565 --> 00:09:02,865 and multiple different instances 255 00:09:03,324 --> 00:09:05,084 really means that you can't get economies of 256 00:09:05,084 --> 00:09:07,245 scale or leverage from the investment that you 257 00:09:07,245 --> 00:09:08,909 have in that technology. And the same is 258 00:09:08,909 --> 00:09:10,589 true for for any plan. You know, if 259 00:09:10,589 --> 00:09:12,509 you look at a plan that, has been 260 00:09:12,509 --> 00:09:14,110 around for any length of time, there's gonna 261 00:09:14,110 --> 00:09:15,789 be many, many different systems, and they're gonna 262 00:09:15,789 --> 00:09:18,049 be thinking about this consolidation into one. 263 00:09:18,429 --> 00:09:19,490 When you can consolidate 264 00:09:20,589 --> 00:09:22,429 all these different things into one, it brings 265 00:09:22,429 --> 00:09:23,889 a tremendous amount of efficiency, 266 00:09:24,384 --> 00:09:26,784 and it brings a, you know, it it 267 00:09:26,784 --> 00:09:28,944 brings lower cost in the long run because 268 00:09:28,944 --> 00:09:31,105 you're not maintaining multiple different systems. You're not 269 00:09:31,105 --> 00:09:33,584 maintaining multiple different workforces that have to integrate 270 00:09:33,584 --> 00:09:35,345 with these different systems. You can get a 271 00:09:35,345 --> 00:09:37,110 single view of your data. You can start 272 00:09:37,110 --> 00:09:39,509 to talk about events across these, diff, you 273 00:09:39,509 --> 00:09:42,230 know, the different customer life cycles that are 274 00:09:42,230 --> 00:09:44,230 triggering things on your data platform. You don't 275 00:09:44,230 --> 00:09:46,870 have to worry about integrations. Like, each of 276 00:09:46,870 --> 00:09:48,389 these systems has to be integrated with up 277 00:09:48,389 --> 00:09:49,429 to 120 278 00:09:49,429 --> 00:09:51,945 different inside internal tools. Right? So now all 279 00:09:51,945 --> 00:09:53,304 of a sudden, if you have 10 systems, 280 00:09:53,304 --> 00:09:54,504 you have 1,200 281 00:09:54,504 --> 00:09:56,665 integrations that you have to maintain. You're shuffling 282 00:09:56,665 --> 00:09:59,144 data everywhere from different things. So it's really 283 00:09:59,144 --> 00:10:01,085 a a a grand simplification 284 00:10:01,625 --> 00:10:02,845 of the internal architecture 285 00:10:03,545 --> 00:10:04,605 of the health plan 286 00:10:04,929 --> 00:10:06,230 and the and the claims, 287 00:10:07,170 --> 00:10:09,570 operating system. And that enables you to do 288 00:10:09,570 --> 00:10:12,710 much more interesting things with AI, with data, 289 00:10:12,769 --> 00:10:15,410 with your visibility into, you know, how your 290 00:10:15,410 --> 00:10:17,730 business is performing with the latest BI tools 291 00:10:17,730 --> 00:10:19,815 that you can query with natural language. And 292 00:10:19,815 --> 00:10:22,154 it removes this sort of diaspora of systems 293 00:10:22,695 --> 00:10:24,375 that are very hard to integrate and and 294 00:10:24,375 --> 00:10:26,955 gather intelligence out of and and provides you 295 00:10:27,014 --> 00:10:29,894 really with an edge to continuously optimize your 296 00:10:29,894 --> 00:10:30,875 business and continuously, 297 00:10:31,415 --> 00:10:33,115 you know, reduce the cost of outcomes. 298 00:10:34,110 --> 00:10:36,129 A lot of leaders are pointing to 299 00:10:36,750 --> 00:10:38,850 that piece specifically, the integration 300 00:10:39,230 --> 00:10:41,809 part and the infrastructure piece as a crucial 301 00:10:41,870 --> 00:10:43,710 enabler for health care as we move into 302 00:10:43,710 --> 00:10:44,590 2027 303 00:10:44,590 --> 00:10:46,450 and beyond. If that's not the case, 304 00:10:46,934 --> 00:10:49,254 then organizations are going to have an issue 305 00:10:49,254 --> 00:10:50,855 moving forward. And I wanna stick with that 306 00:10:50,855 --> 00:10:52,934 theme a little bit because, again, I feel 307 00:10:52,934 --> 00:10:55,335 like especially with AI, and you've talked about 308 00:10:55,335 --> 00:10:57,914 the AI native enterprise, so to speak. Right? 309 00:10:58,134 --> 00:11:00,535 How does that infrastructure work then lay the 310 00:11:00,535 --> 00:11:01,035 groundwork 311 00:11:01,569 --> 00:11:02,309 for organizations 312 00:11:03,009 --> 00:11:03,750 to have 313 00:11:04,209 --> 00:11:06,230 AI driven automation in place? 314 00:11:06,690 --> 00:11:08,610 And, again, just touching back on on what 315 00:11:08,610 --> 00:11:10,850 we've just talked about, what's the risk of 316 00:11:10,850 --> 00:11:14,610 Healthfence that just try to bolt on, and 317 00:11:14,610 --> 00:11:17,325 they're not establishing that infrastructure that we've just 318 00:11:17,325 --> 00:11:17,985 talked about. 319 00:11:18,605 --> 00:11:20,924 Yeah. There's a lot of really great demos 320 00:11:20,924 --> 00:11:23,165 out there for, you know, AI startups that 321 00:11:23,165 --> 00:11:25,085 will bolt something on top of the system 322 00:11:25,085 --> 00:11:26,684 of record. You know? And they'll they'll get 323 00:11:26,684 --> 00:11:29,105 to a really good, yeah, you know, demo 324 00:11:30,129 --> 00:11:31,649 maybe in a couple of weeks, and they'll 325 00:11:31,649 --> 00:11:32,610 show you it. And I'll be like, this 326 00:11:32,610 --> 00:11:34,129 is proof concept, and you'll get really excited 327 00:11:34,129 --> 00:11:35,329 about the fact that that that this could 328 00:11:35,329 --> 00:11:37,809 actually scale out across, you know, the entire 329 00:11:38,049 --> 00:11:40,529 the the entire set of use cases that 330 00:11:40,529 --> 00:11:42,370 you want to deploy this tool in. And 331 00:11:42,370 --> 00:11:43,429 the reality is 332 00:11:43,975 --> 00:11:45,654 it that it's not gonna it's not gonna 333 00:11:45,654 --> 00:11:47,975 scale out because, ultimately, you have the system 334 00:11:47,975 --> 00:11:49,495 of record. And in order for you to 335 00:11:49,495 --> 00:11:51,174 expand all the use cases, you would have 336 00:11:51,174 --> 00:11:53,095 to, you know, take the data that's in 337 00:11:53,095 --> 00:11:54,695 the system of record and march out. And 338 00:11:54,695 --> 00:11:56,375 it's like it it becomes it becomes a 339 00:11:56,375 --> 00:11:58,215 nightmare anything beyond the first one or two 340 00:11:58,215 --> 00:12:00,679 use cases. And, you know, we believe that 341 00:12:00,980 --> 00:12:03,459 by deeply integrating AI into our platform and 342 00:12:03,459 --> 00:12:05,480 by providing a platform that is 343 00:12:06,100 --> 00:12:08,819 equipping AI tooling on top of the system 344 00:12:08,819 --> 00:12:10,980 record and inside the system record, you can 345 00:12:10,980 --> 00:12:11,625 get much 346 00:12:11,945 --> 00:12:13,865 more efficiency out of that, and you can 347 00:12:13,865 --> 00:12:15,865 get a much higher return on your investment 348 00:12:15,865 --> 00:12:16,985 from AI. And you can do it a 349 00:12:16,985 --> 00:12:19,304 lot faster than if you're just still marshaling 350 00:12:19,304 --> 00:12:21,404 all these different tools and you're trying to, 351 00:12:21,705 --> 00:12:23,144 you know, add bolt ons on top of 352 00:12:23,144 --> 00:12:25,070 the system of record. So our belief is 353 00:12:25,070 --> 00:12:27,230 that we can move incredibly quickly to your 354 00:12:27,230 --> 00:12:28,529 point earlier on about velocity 355 00:12:29,149 --> 00:12:30,690 in deploying AI capabilities 356 00:12:31,790 --> 00:12:34,290 to, you know, reduce the amount of dependence 357 00:12:34,350 --> 00:12:36,910 we have on on humans and human effort 358 00:12:36,910 --> 00:12:39,695 clicking through UIs and and moving information left 359 00:12:39,695 --> 00:12:42,674 and right, then we can very, very rapidly 360 00:12:42,735 --> 00:12:44,595 bring a truly integrated 361 00:12:44,975 --> 00:12:47,855 AI toolkit that is deeply connected to the 362 00:12:47,855 --> 00:12:50,514 system of record. And again, that that single, 363 00:12:51,190 --> 00:12:53,269 platform and single instance enables us to do 364 00:12:53,269 --> 00:12:55,350 that. We can build, you know, these these 365 00:12:55,350 --> 00:12:58,070 tools that enable AIs to consume information, enable 366 00:12:58,070 --> 00:13:00,070 AI agents to act within the within the 367 00:13:00,070 --> 00:13:03,190 system of record, and work in in concert 368 00:13:03,190 --> 00:13:05,029 with each other and with all of the 369 00:13:05,029 --> 00:13:06,329 other systems in the ecosystem 370 00:13:06,845 --> 00:13:08,285 rather than being something that's sort of bolted 371 00:13:08,285 --> 00:13:09,345 on from the outside. 372 00:13:10,605 --> 00:13:11,105 Realistically, 373 00:13:13,245 --> 00:13:16,445 how much time do we have then to 374 00:13:16,445 --> 00:13:19,345 rethink these legacy payer platforms before 375 00:13:20,279 --> 00:13:23,399 we hit that hard ceiling. Right? And from 376 00:13:23,399 --> 00:13:25,879 your perspective, from the conversations you were having 377 00:13:25,879 --> 00:13:27,980 with health system leaders across the country, 378 00:13:28,440 --> 00:13:29,500 what are the questions 379 00:13:29,879 --> 00:13:31,500 that leaders need to ask 380 00:13:31,879 --> 00:13:34,004 right now that they need to ask their 381 00:13:34,164 --> 00:13:36,325 technology partners to avoid running into some of 382 00:13:36,325 --> 00:13:37,625 the issues that we've highlighted? 383 00:13:38,725 --> 00:13:40,245 You know, I might I tie it back 384 00:13:40,245 --> 00:13:42,164 to the the performance of the company. Right? 385 00:13:42,164 --> 00:13:43,924 Like, when you think about and if everything 386 00:13:43,924 --> 00:13:44,985 that we do in technology, 387 00:13:45,445 --> 00:13:46,184 it's really 388 00:13:46,519 --> 00:13:48,679 about reducing the cost of operations. Right? Like, 389 00:13:48,679 --> 00:13:51,159 it's how we continually driving down the operating 390 00:13:51,159 --> 00:13:53,639 costs. And if I was a, you know, 391 00:13:53,639 --> 00:13:55,659 a business leader at a plan, 392 00:13:56,039 --> 00:13:58,220 the real question I would be asking is, 393 00:13:58,875 --> 00:14:01,054 are we going to be able to accelerate 394 00:14:01,514 --> 00:14:04,335 the savings that we want to realize 395 00:14:04,794 --> 00:14:05,615 in our administrative 396 00:14:05,995 --> 00:14:06,654 loss ratio 397 00:14:07,915 --> 00:14:08,735 fast enough 398 00:14:09,115 --> 00:14:10,335 to keep up with the competition? 399 00:14:11,115 --> 00:14:13,134 And are we gonna be able to invest 400 00:14:13,195 --> 00:14:14,159 enough in it 401 00:14:14,559 --> 00:14:17,120 to be able to deliver true outcomes and 402 00:14:17,120 --> 00:14:17,860 true value, 403 00:14:18,240 --> 00:14:20,319 or should we partner with someone who's gonna 404 00:14:20,319 --> 00:14:22,159 do that and who's gonna guarantee that that 405 00:14:22,159 --> 00:14:24,000 cost is gonna come back and who's gonna 406 00:14:24,000 --> 00:14:26,399 continue to invest with the best and brightest 407 00:14:26,399 --> 00:14:28,254 and get, you know, huge leverage out of 408 00:14:28,254 --> 00:14:31,134 partnerships with AWS much broader than individual plans 409 00:14:31,134 --> 00:14:33,375 would be able to and and hitch onto 410 00:14:33,375 --> 00:14:34,735 that wagon. And I think, like, that that's 411 00:14:34,735 --> 00:14:35,934 the way I'd be thinking about it. So 412 00:14:35,934 --> 00:14:38,174 can I internally develop the skill set and 413 00:14:38,174 --> 00:14:40,495 rapidly ship and, you know, put all the 414 00:14:40,495 --> 00:14:41,554 pieces in place 415 00:14:42,190 --> 00:14:44,190 to guarantee that my business is gonna stay 416 00:14:44,190 --> 00:14:46,110 healthy and that my administrative spot for ratio 417 00:14:46,110 --> 00:14:47,330 is gonna continue to decline, 418 00:14:47,790 --> 00:14:48,290 or 419 00:14:48,670 --> 00:14:51,230 why not partner with someone who's gonna guarantee 420 00:14:51,230 --> 00:14:52,830 that? And then I can focus on things 421 00:14:52,830 --> 00:14:53,970 like member engagement, 422 00:14:54,509 --> 00:14:55,570 health care outcomes, 423 00:14:55,870 --> 00:14:56,370 marketing, 424 00:14:56,910 --> 00:14:59,134 you know, taking care of the population. 425 00:14:59,995 --> 00:15:01,754 Because if you do that, then you're not 426 00:15:01,754 --> 00:15:04,475 going to run out of runway in 2026 427 00:15:04,475 --> 00:15:05,914 and 2027. 428 00:15:05,914 --> 00:15:08,075 We're just very crucial, especially in health care. 429 00:15:08,075 --> 00:15:09,514 Rob, it's so great to have you on. 430 00:15:09,595 --> 00:15:10,875 I just wanna give the floor to you 431 00:15:10,875 --> 00:15:12,315 too. Is there anything else that you wanna 432 00:15:12,315 --> 00:15:13,540 touch on? I know we've we've hit on 433 00:15:13,540 --> 00:15:14,759 a lot of numbers here. 434 00:15:15,139 --> 00:15:17,639 Again, I feel like this is about confidence 435 00:15:17,700 --> 00:15:19,940 for health plans, but just wanna hear any 436 00:15:19,940 --> 00:15:21,639 final thoughts that you have for our listeners. 437 00:15:22,500 --> 00:15:24,139 No. I I think, you know, it's always 438 00:15:24,139 --> 00:15:25,379 a pleasure to come on the on the 439 00:15:25,379 --> 00:15:28,014 Beckett's podcast and and talk about the the 440 00:15:28,014 --> 00:15:30,335 future and the future of AI. And it's 441 00:15:30,335 --> 00:15:33,054 a very exciting but also scary time. You 442 00:15:33,054 --> 00:15:35,075 know, there's excitement in the possibility, 443 00:15:35,535 --> 00:15:37,695 but there is the fear of not moving 444 00:15:37,695 --> 00:15:39,774 fast enough. And, you know, what we do 445 00:15:39,774 --> 00:15:41,955 is help our plans and help our customers 446 00:15:42,210 --> 00:15:44,050 feel like they're moving fast enough. And I 447 00:15:44,050 --> 00:15:46,290 think that brings an enormous amount of excitement 448 00:15:46,290 --> 00:15:48,230 and energy to to our customers and ourselves. 449 00:15:49,090 --> 00:15:49,590 Velocity 450 00:15:49,970 --> 00:15:51,889 is the word of the day for us 451 00:15:51,889 --> 00:15:53,330 today. Rob, so great to have you. Thanks 452 00:15:53,330 --> 00:15:55,570 so much for your time. Thank you. Take 453 00:15:55,570 --> 00:15:56,070 care. 454 00:15:56,845 --> 00:15:58,524 We also want to thank our podcast sponsor, 455 00:15:58,524 --> 00:16:00,205 HealthEdge. You can tune in to more podcasts 456 00:16:00,205 --> 00:16:02,605 from Becker's Healthcare by visiting our podcast page 457 00:16:02,605 --> 00:16:05,184 at beckershospitalreview.com.