Month: March 2018

“ABILITY Network gives us expanded reach” with Dr. Keith Dunleavy, Chairman and CEO of Inovalon

Episode #3

Podcast with Dr. Keith Dunleavy, Chairman and CEO of Inovalon

"ABILITY Network gives us dramatically expanded reach, and helps us improve efficiencies and scale"

paddy Hosted by Paddy Padmanabhan

In this episode, Dr. Keith Dunleavy, Chairman and CEO of Inovalon, talks to us about their recent acquisition, data and analytics, and Inovalon’s growth strategy in 2018 and beyond.

Welcome to the big unlock where we discuss data analytics and emerging technologies in healthcare. Here’s some of the most innovative thinkers in health care information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Hello everyone and welcome to the podcast it is my honor and privilege to have as my special guest today Dr. Keith Dunleavy, Chairman and CEO of Inovalon. Dr. Dunleavy welcome.

Thank You Paddy thank you very much it’s a pleasure good to be talking to you again.

Thank you very much. For the benefit of our listeners maybe you could start by telling us a little bit about who Inovalon is and what kind of problems you’re solving today for the healthcare industry.

Sure Paddy thank you. Inovalon is a company that is entirely focused on how data can help to improve the understanding and the clinical and economic outcome improvement of healthcare. Data is at the center of all decision-making and all efforts to improve healthcare and in order to bring that data together to analyze it to inform a more intelligent and informed decision in the healthcare community you need a number of technological capabilities and it’s these technological capabilities that Inovalon is focused on. Those capabilities are the ability to connect into an aggregate massive amounts of data. Number two to be able to analyze that data in a petabyte volumes in incredibly high speeds. Number three is to be able to then take the analysis from that computer and be able to drive meaningful impact in the marketplace in the point of care where the patients are actually serviced and taken care of. And then number four the ability to take all of that impact and summarize it into data visualization and reporting and processes that are necessary for the backend of healthcare to operate and be strategically directions. So it’s these four capabilities that enable what is referred to often in healthcare as the transformation from a volume driven health care market to a value driven healthcare market that Inovalon is focused on. So it’s really a technology layer, a cloud-based technology layer that is enabling and empowering the improvement of healthcare.

Right right and I will come back to the major themes that you highlighted data-driven healthcare, the transition from fee-for-service to value-based care and cloud. These are very important emerging themes in healthcare today. I will come to that in a minute but first you made a big exciting announcement last week, your acquisition of ability network first of all congratulations!

Thank you.

And would you like to tell us a little bit about the rationale for the acquisition and the synergies that you expect to drive from the transaction.

Sure so historically Inovalon have focused on aggregating information, analyzing it and driving impact on behalf of the major health plans, pharmaceutical companies, medical device manufacturers and diagnostic companies around the country. Now these are large corporations that service tens and hundreds of millions of patients and we have spent our time developing the analytical capabilities connection pipes and cloud computing environment necessary to do that. Ultimately getting to the point where we today have over 241 million patients in our system and trans-covering the vast amount of the United States in our work. What combining with ability network allows us to now do is to dramatically expand the reach of that analytical capability that connectivity capability and the ability to drive impact all the way down to the point of care at 44,000 provider sites around the country combining what we have historically achieved at Inovalon together. With the SAS software as-a-service cloud-based platform of ability network allows us to achieve a market-leading vertical integration of data driven healthcare all the way from the health plan, the pharmaceutical company, the medical device manufacturer, the diagnostic company, the employer all the way down to where the patient gets their care at the point of care where the provider is. So this achieves enormous expansion of capability and reach but also achieves a significant improvement in the operational efficiencies of the company and the scale of the company allowing us to really deliver end to end value-based care enablement through a cloud-based platform across the entire breadth of the ecosystem. It’s very exciting for us there is enormous expansion of channel for the company and also a very significant expansion of total data set size and connectivity reach. So we’re very excited about it a lot of positives for the healthcare marketplace as well as the technology marketplace and our shareholders as well.

Right right and definitely exciting it’s a worth of a billion dollars or so in transaction size so it’s not a small transaction by any means and definitely sounds like you are expanding your coverage and reach significantly especially on the provider side and even more specifically on the ambulatory side of the continuum. Would that be a fair statement?

Paddy you’re spot on they cover approximately 44,000 what are called provider sites and as you appropriately point out what that means in the healthcare world is acute care providers like hospitals and walk-in clinics. Post acute providers like homecare, nursing homes, and hospice and ambulatory providers like the doctors offices that you and I would go to on a routine basis or or when we get sick. So across the board they have that connectivity into those provider environments and very importantly they do it in a way that’s in the workflow of how those organizations practice medicine. So unlike a connectivity that might be in what we call the back end of the IT systems of facilities ability network is part of the front end and the operational day-to-day flow of operations at these centers. They actually have what is called the my ability software platform which is a workspace or a desktop of seven different applications that their customer base uses every day to execute on the critical needs that they have administratively clinical quality wise, regulatory compliance wise, financial processing wise. All of the matters that a physician and care giving facility needs to deal with in order to ultimately operate so by having that front of mind presence in the provider environment connected in real-time with the Inovalon one platform. Cloud allows us to do tremendous things. You know have access to information and data in a real-time manner be able to put analytical results and insights in front of the provider site also in real-time allow us to help them operate more efficiently, achieve better quality insights and outcomes have a better financial and economic performance ultimately improve the patient experience as well as the overall economics of the whole ecosystem. So it is quite exciting and it is truly industry-leading there’s no other solution that vertically integrates all the away from the major players in the health plan Pharma device Diagnostics world all the way down to the patient’s point of care in real time in a cloud-based format like we will now have. So it is a very exciting process for us.

Absolutely it does sound like all the best on the transaction I know it’s yet to close but all the best with the transaction flows and I’m sure you are going to have your hands full in the foreseeable future. So switching topics Inovalon believes in a data-driven future for healthcare so can you talk to us a little bit about the emerging data sources now it’s you know we’ve gone well past electronic health records that’s kind of table stakes now everybody’s supposed to have access to it and claims data which has been around a long time this is all the traditional data sources for one of a better word now you’ve got new data sources coming together right. You’ve got the IOT data, the social determinants data, genomics data soon you’re going to have speech data from your Alex among other things. What’s your view on how all of these new data sources can be integrated into transforming care delivery as we know it and what role do you see for those types of data sources in your own services and products to your customers.

Well Paddy, this is an enormously important topic as you aptly point out. Let’s walk through there’s a lot in there in your question let’s kind of tease out the different parts and pieces of it that allow for a holistic data strategy. So first and foremost as you point out there are lots of different types of data that are involved in healthcare. There are the most traditional element that people would refer to as claims data, there is obviously what some people call as clinical data. We’ll come back and talk about that in a moment. There’s also a patient reported data, there is a data that gets reflected in what’s called activities of daily living data, there is behavioral data reflecting whether or not a patient is actually doing what they are recommended to do from as basic as are they getting their prescriptions filled too are they actually doing the physical therapy that they’re recommended to have done and and are they managing their salt intake or other aspects of their care. So this is a type of data that’s important. There is significant amounts of additional data from activities and devices so you have your health care trackers that come from your mobile phone, that come from your Fitbit, that come from your electronically connected scale there is data that comes from medical devices such as implantable defibrillators and pacemakers and insulin pumps there’s data that comes from as you point out genetic components and genetic is an entire world of its own where you range from genetic marker data which is whether a patient has or does not have a particular sequence that is identified as a genetic marker versus having actual sequence data which is a more granular level of genetic data. We can come back and talk about that as well but then also is the very important aspect that you point out about these these walled gardens and the aspect that data for a particular patient resides in so many different locations and platforms it’s not just that there are numerous different types of data it’s also that there are numerous different locations of data and also stages of data. The process of a patient’s healthcare experience actually has various different linear stuffs that alter the data things like what are called adjudication steps where the information that reflects the patient’s care actually gets edited and expanded on or actually removed from the data set from a financial point of view or a authorized point of view so you have this a multi-dimensional set of information that is variant in the nature of it, the location of it, the timing of it, the staging of it all of which needs to be tracked. And they are this data resides in a highly disparate set of sophistication levels of management in the marketplace meaning some of it is in very basic diagnostic laboratory machine level repositories and some of it is in very advanced cloud-based architectures. So the task of bringing this together in comprehensive fashion is rather significant in its scale and this is something that Inovalon has spent tremendous amount of time, investment energy, focus, subject matter expertise in developing so I’ll give you a few statistics that you might find Interesting. In 2016 the numbers for 2017 I don’t have in my head yet but for 2016 the average Medicare Advantage member in the United States saw 6.2 different locations, each one of those locations more than one location two or more locations often on different EHR platforms or connected through different HIE systems so that the average patient typically had data residing in a minimum of twelve different systems around the country around their eco system and beyond that of course they might travel somewhere on vacation and get sick there or fill a prescription there or have a visit to an emergency room there and of course patients change their name their name gets incorrectly entered into systems the multi additional identifiers of those patients vary by accident or on purpose on purpose meaning when they get married or not and so proper alignment of it with the right patient is incredibly important at Inovalon. What we’ve done is we have developed a system of intelligent data integration we call the front end of this the I port system and the I port system which has multiple different types meaning there’s Enterprise ID port and there’s cloud-based I port which we call I port HD. This undertakes a process of allowing the 37 billion medical events that we have in our platform to teach the system what to expect as far as data inflows because you can’t possibly use human data mapping on those kinds of massive data influx when you’re receiving data that ultimately sourced from thousands of different hospitals, tens of thousands of different clinical facilities, hundreds of thousands of different laboratory sources across millions of patients that is streaming in at a velocity that requires you to have a very intelligent data integration platform. Ours conducts more than 1100 data integrity analyses on the data that comes in so that it can identify errors and omissions in the data and get smarter and smarter at identifying where an error might be. So Inovalon data comes to it in identified what’s called primary source fashion which means we have a proper identifiers on all of our data and can longitudinally match up the genetic data with the claims data, with the laboratory data, with the patient reported data, with the physician entered data, with the electronic health care record data and so forth before then undertaking and encrypted at the identification process on that data so then to come back to what are we doing in a going-forward way it has also to do with how do you structure that data. So one of the things we have been very mindful over the years is how do you make sure that the data structure in our database architecture strategy is laid out in a way that allows for super high speed analysis. Because actually the way that you store your data significantly impacts the speed at which you can undertake a multivariate compute process. So we had to also anticipate the expansion of data types over time in structuring the architecture you know how might genetic data look as we get further and further into the granularity of that information, how might patient reported devices look. So all this is a huge focus of ours we are we have a whole team that focuses on data architecture strategy and it’s a significant differentiator of the size and volumes of data that we deal with.

Thank you for that detailed overview yeah it sounds to me like if I boil it down there’s a couple things. One is the ability of an enterprise such as Inovalon to take all the data that’s coming in standardized it, normalize it, and make it usable to put it very simply. There’s also an external factor which you referred to earlier on in your comments which are the wall gardens you have to have the you know having the internal ability to integrate aggregate and standardize and normalize the data is one thing but having the ability to get the data is another thing and there’s some external factors there which I think you refer to as walled gardens and we know we all talk about the I word interoperability and just a quick comment on that. Do you think we’re getting any closer to solving that through fire for instance what do you think it’s going to be left of individual enterprises such as Inovalon to find and build solutions and try to gain acceptance across the industry where do you where do you think we are in that journey.

I think we’re making good progress Paddy, so I think that the you know we’re in a refreshed cycle in the healthcare technology landscape in our view you know you had first generational electronic health care record systems for instance you then with the financial stimulus of a few years back went through a second cycle an enormous expansion of the brands and formats of EHRs which dramatically expanded coverage of various different technology platforms. But also unfortunately at the same time expanded than the number of variants of data structures that introduced a new challenge of interoperability ironically. We’re now on arguably the third cycle and this is now driven more intensely by financial scrutiny of how do I as a hospital or a health plan or an integrated health care delivery system invest my hard-earned dollars into technology as opposed to a scramble to put something in place for meaningful use or collection of stimulus dollars. So the marketplace is being more scrutinizing of platforms today and the technological function now on the interoperability provided by those different platforms is now getting a lot more attention than arguably it did four or five years ago. So that is playing well to the market now increasingly coming up with standards you’re getting this book politically technologically and economically which I think is heading us in the right direction.

Thank you thank you Dr. Dunleavy. Switching to another topic cloud you know Inovalon platform is a cloud-based platform and you pointed to that in your earlier comments how do you see cloud adoption rates in general today in healthcare and is there anything holding it back from an accelerated adoption curve.

So we have seen a significant inflection in the adoption of cloud we at Inovalon began our cloud journey approximately three years ago and started aggressively investing into cloud in 2015 and all new development or the vast majority of new development was being done in native cloud format and then in 2017 last year we brought together approximately 80 different components in our platform into one cloud-based platform called the Inovalon one platform and we undertook an aggressive migration of clients to that platform because it enabled far more modular approach to solutioning for our clients benefit, it allowed for a much more efficient application of technology dollars and elimination of inefficiency a human being a time and overall delivered a higher ROI for for our clients as well as greater flexibility for for the company. So by the end of 2017 we had 94 million patients migrated onto our cloud-based platform which is up about 450 percent year-over-year and that included four of the nation’s five largest healthcare systems. So that is literally within a 12-month period so an enormously rapid transition of marketplaces willingness to be utilizing the cloud and I think that that’s for a number of different reasons it’s because of the economic pressures on healthcare it’s because of the functionality differentiator able to be delivered in cloud is overcoming the subjective concern around things like security of the data and of the computer environment. So as that has the value able to be delivered through cloud and the economic benefit of being able to be delivered through cloud has accelerated so dramatically over the last 2 or so years that has overcome the subjective concerns of this new thing and we’re seeing strong positive response to the cloud.

That’s that’s really encouraging to hear Dr. Dunleavy and I’m sure that it’s going to play out well for you know all the other technology companies and healthcare enterprises who are adopting a kind of a cloud for strategies if you world for new solutions. Especially in analytics where data is coming in from different sources and eventually the data leaks and data warehouses are now sitting on cloud somewhere as opposed to an enterprise environment. So that’s really encouraging to hear now you also touched upon economic pressures in your in your comments just now so we are seeing a shift from fee-for-service to value-based care and the value-based care train has left the station as everybody acknowledges that I’m curious know your views on how far ahead the industry is in terms of adopting value based care initiatives you know alternate payment models and the like and not just because of regulatory pressure but also market pressures and just as a way of doing business for the future and related to that you know how are other forces such as rising consumerism, the growing influence of Millennials and their way of consuming healthcare and their way of engaging in general with smart phones and stuff like that. What does all that mean for your business and for the healthcare market? Would you care to comment on that?

No Paddy, we’re the technology platform that enables it to happen so let me try and give you an example so let’s take the pharmaceutical marketplace for instance. Very well known in in healthcare that new drugs are coming on to the market that are very expensive they’re very expensive but they can deliver a tremendous benefit to the right patient so a health plan or an employer who is being asked to pay for these medications is obviously sensitive to making sure that it is being given to the right patient, the patient that really needs it and uniquely benefits from it and that the value argued for the medication is in fact being realized so herein is a great place for our technology platform. A technology platform that is able to be connected into the ecosystem the laboratories, the hospitals, the health plans, the pharmaceutical data streams can help to identify the right patients that fulfil the criteria for being appropriate and eligible for a particular medication, an expensive medication. Then can identify that patient to the right physicians and then can track and report on the impact and benefit and performance of that drug on that patient so that a pharmaceutical company can go to a health plan and say we have a great drug it’s expensive but the value delivered is way in excess of the expense and we will stand behind that we have a technology partner by the name of Inovalon who we’ll put in place this platform you will be able to monitor and see the patients that are on these medications you’ll be able to monitor and see the value that you are receiving and in exchange the health plan gets comfortable with the high cost medication because they can see the high value benefit and they’re able to see that in near real-time using our software so that all parties are benefited the pharmaceutical company gets a larger distribution of its drug to an expanded market, the health plan or the employer gets visibility into the value that they are receiving in exchange for what they are paying out and of course the patient is getting a new medication that is highly beneficial to whatever condition they’re suffering from and its software and connectivity and intervention and reporting capabilities on the Inovalon one platform that empowers that entire exchange of value and benefit and cost.

Interesting very interesting Dr. Dunleavy let’s talk about quest Diagnostics this is one of your strategic partnerships and this is this is this is something that you and I have discussed before and I also saw that lately you won some awards for the products that you launched collaboratively with Quest. Firstly, congratulations on that in fact I featured some of that work in my book as well you want to give us an update on where you are with the partnership you know any key milestones you want to touch upon.

Thanks Paddy, our company that obviously is highly highly penetrated into the marketplace and is looking for lots of ways that not only the laboratory work that they do but the platform and presence that they have with physicians is leveraged to the greatest degree possible. So as you know what we put in place in partnership with Quest is the ability to have a request by a physician not only be for a blood laboratory for instance but for an analytical test data diagnostic which they can request in the same way that they would request a blood test. But instead of the blood test taking one two or three or however many days to be complete the analytical test is complete within a couple seconds and reports back to them on a number of different enquiries they can have so that they can help change how they would practice medicine for the benefit of the patient in real-time so that that obviously required significant efforts on quest side to enable that in their platform. And we at Inovalon designed the real-time capability in an active active active cloud from native environment format which was first of its kind and allowed for responses back within two or three seconds anywhere in the country despite the massive size of data moving that was necessary in compute process that was necessary and formulation of format response that was necessary. So both organizations did some really impressive development and achievement on that and we are really pleased with aware that moved this capability in the marketplace and how many other applications that now obviously has with on demand a real-time analytics so we continue to move that into a different Quest opportunities meaning clients of theirs, ACO’s of theirs, hospital systems of theirs neither organization reports out on the volumes under that process but it is a very exciting and ongoing positive progression of our technologies together so it I very recently met with several of their senior people and we’re excited about next chapters on that as well.

Right and it’s award-winning – so congratulations on that.

Thank you, thank You Paddy.

Well we are done to a last couple minutes here I thought maybe you could round out this discussion by talking to us about what your top two priorities are for 2018.

Well great I appreciate it Paddy I’d love to tell you about some of the new technologies that we’ve been working on and undertaking in the marketplace and are extremely exciting. So obviously one of the main focus is we spent a lot of time, energy and resources in ‘016 and ‘017 building out our cloud environment. We run a private cloud environment in multiple tier 4 data centers and also burst into and utilize commercial clouds such as AWS and Azure and others that large investment we’re now converting into strong harvesting of value for our clients and for us but we’re also using that a very large compute environment that we now have to do some very exciting new capabilities. One of them is natural language processing as a service or NLP as a service in 2016 we developed natural language processing capability here at Inovalon to decrease the amount of human intervention we needed to convert unstructured data into structured data. We rolled that out across the company in 2017 and it dramatically decreased our personnel requirements and therefore obviously cost and dramatically increased our speed. You combine NLP together with Direct Connect EHRs and you get a capability that allows you to aggregate clinical data in real time from millions of different patient data sources and then apply natural language processing on it in near real-time and provide back a compute on what was previously thought of as an ____(transcript missing) 39:48

So we have started rolling out a service called NLP as a service where organizations can literally just license and use that software capability in large scale. We have made great progress on that we’re excited about that and that requires the enormous computer environment that we’ve developed and the connectivity that we’ve developed so bringing together investments that we have done to bring truly market-leading capabilities out into healthcare. So it’s just one of the examples of things we were working on here in 2018 and we’re excited about it.

Yeah yeah and unstructured data is of course the vast unexplored frontier of health care data which by some estimates constitutes 80 percent of all healthcare data out there. So that should be exciting too so you’re opening up the new frontier there.

No it is truly exciting and as an engineer and a physician. You know I was an electrical engineer before I went off to medical school to sit in a conference room and watch on the screen cases in real time be aggregated and analyzed from all their different EHR locations and identified as whether or not this patient’s cancer is progressing, is stable, needs a change in therapeutic approach it is truly amazing absolutely amazing.

Unbelievable that’s great so Dr. Dunleavy we are at the end of our a lot of time for this and greatly greatly appreciate your taking the time it’s a real pleasure speaking with you as always and all the way best for for the rest of the year and beyond.

Paddy always a pleasure and I appreciate your time great to talk to you again.

Thank you so much and have a great day. It was really good talking to you. Thank you Keith and thank you ____(transcript missing)

Thank you, have a great weekend.

We hope you enjoyed this podcast subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

About our guest

Dr. Dunleavy has served as Inovalon’s Chief Executive Officer since his organization of the company’s predecessor companies in 1998, as Chairman of the board of directors since the creation of the board in 2006, and as President from the Company’s foundation until May of 2014. Dr. Dunleavy is responsible for the overall execution of the company’s business plan, strategic relationships, and the identification and realization of company product strategy and vision.

During his tenure at Inovalon, Dr. Dunleavy has worked extensively with a wide array and number of healthcare organizations, regulatory and oversight bodies, and technology companies examining the growing role of data within healthcare, and its ability to drive meaningful insight and improvement for its constituents. Driven by a vision of data’s ability to drive insight and improvement in healthcare, Dr. Dunleavy has led Inovalon from its origins to its current industry-leading position leveraging advanced, cloud-based platforms which are informed by data pertaining to more than 932,000 physicians, 455,000 clinical facilities, and 240 million Americans, and more than 37 billion medical events providing a powerful platform that enables high-value impact, improving quality and economics for health plans, ACOs, hospitals, physicians, consumers and pharma/life-sciences researchers.

Dr. Dunleavy received a bachelor’s degree in Biology modified with Engineering with High Honors from Dartmouth College where his studies and work focused upon the neurosciences, computer sciences and electrical engineering with his honors thesis focused on the computer simulation of artificial human cerebellar functional units. Dr. Dunleavy earned his doctorate in medicine from Harvard Medical School, completed his medical residency at The Johns Hopkins Hospital in Baltimore, Maryland, practiced and was Board Certified in Internal Medicine. He serves as a Director on the Dartmouth Medical School Board of Overseers, has authored or co-authored several scientific journal articles, abstracts, and proprietary research papers, and has presented his work and materials at multiple national and international conferences.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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“No Regrets Strategy : the Road to Value-based Care” with Neal Singh, CEO of Caradigm

Episode #2

Podcast with Neal Singh, CEO at Caradigm

“No Regrets Strategy : the Road to Value-based Care” with Neal Singh, CEO of Caradigm

paddy Hosted by Paddy Padmanabhan

In this episode, Neal Singh, CEO at Caradigm discusses population health management, AI and emerging data sources, especially social determinants of health.

Welcome to The Big Unlock where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers and health care information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Hello, everyone this is Paddy, it’s my real pleasure to have on this podcast my very special guest Neal Singh, CEO of Caradigm. Neil, welcome!

Thank You Paddy, I appreciate the honour to attend your podcast and happy to answer any questions today.

Wonderful wonderful let’s start with this for the benefit of our listeners. Tell us a bit about Caradigm and what problem Caradigm solves for healthcare today.

Sure, so the Caradigm Paddy, was set up in 2012 as a joint venture between Microsoft and GE and from day one you know we’ve been set up as a population health software company and that continues to be our strategy and focus. Our key differentiator is that we provide a tightly end-to-end highly integrated enterprise population health portfolio of applications both with handling data analytics as well as care coordination. Specifically, in the context of data we offer real-time data analytics and in terms of you know getting data in from multiple systems in a real-time basis and taking action on it versus just doing traditional ETL mechanisms to get data once a month or once a quarter. And other differentiator that we have is we actually get data across multiple spectrums of healthcare so be it clinical claims, financial and now we have even extended deeper into social determinants of health. And what we have found historically is many vendors just focus on just clinical or just claims and I think having the super set really allows our customers to get a significant leg up and in terms of being able to help our patients move towards the population health goals. Specifically, in the context of social determinants of health you know we recognize the importance and value in the context of social economic and environmental factors which determine about 50% of the overall health of the patient. And at least 25 cents of every healthcare dollar is being now spent in treatment of conditions resulting from potentially changeable behaviours. For example zip code has a strong predictor on a person health than even the genetic code in some cases and the National Quality forum CDC and who all acknowledge the importance of social determinants of health.

Right, right, I’m going to come back to the different data types and the emerging data types in a minute but you know you defined Caradigm as a population health management company. How has the definition of population health management changed over the last couple years or has it changed at all.

Yeah, absolutely I think you know in fact I will say it’s not changed but it’s solidified. It’s probably the word to use what we’ve seen specifically is that you know we work very closely in conjunction with class research and class research has defined a definition of population health management which is the process of proactively monitoring and caring for defined patient groups. I think furthermore drawing on healthcare organizations and their leading top health vendors that we have participated with them as well and that they have assembled a framework. And this framework really has seven core aspects of capabilities which is aggregation, analysis, care coordination and health improvement, administrative and financial patient engagement and clinician engagement. So these are the core seven areas they’re defined on a framework. I think we’ve even tried to simplify it down to kind of I would say three core capabilities which is if you want an effective population management you really got to focus on data control, on the healthcare analytics and care coordination and engagement to deliver solutions in this category of applications in the population health space.

Right, right, so so it sounds like Population health management as you define it or as you stated it the definition has solidified so people have a better understanding and there is some common framework that people are applying to define population health management and so there’s a common language in the marketplace that is emerging it which was not the case a couple of years ago. You know people may you know they meant different things when they said population of management. So you know obviously the data sources you refer to some of them and it’s key to population health management to develop a holistic view of patients and you rightly mentioned social determinants of health zip code as an example as one of the strongest predictors of health and wellness on populations. So you know the data sources are emerging they are kind of in structured and unstructured formats and they’re they look a lot different from your standard structured electronic health records you know you’re talking about social determinants, you’re talking about IOT data, you’re talking about genomics data, all kinds of data sources. What do you see are the biggest challenges the industry is going to have to overcome in being able to harness all of this data to generate the kind of insights you need to effectively be a published in health management company or effectively manage population health if you’re a health system.

I think this is an excellent question, I think there are a few pieces. Number one is you need to have systems infrastructure and capability to be able to aggregate you know the growing set of data pieces right whether it is you know like I mentioned earlier and there’s the clinical claims financial expanding to social determinants of health, you mentioned genomics and IOT. I think we will continue to see data sources increase or even a much faster accelerating pace. So you need a system that can scale and take in different data types and that I think is one key aspect of what you need in any platform to be able to move forward and provide population health management. The second piece is as these different data sources keep coming in how do you start not just aggregating the data but how do you pull that data in and make that available throughout your entire application set so that you can start reaping the benefits in a very seamless manner. So I think those two pieces are combined at the Meta level important aspects of how you basically deal with data. Then getting to the next part of the question which is you know how do you how do we think about these different sources of data for example you mentioned genomics I think genomics is early on it’s a key part of precision health in terms of imposition health will end up with and I see basically more of population health you know morphing into basic aspects of precision health over a longer period of time but I think right now genomics is it’s commercially not viable, it’s the basic, it’s still a very expensive tool and I think as that as the prices come down as the applicability comes up becomes more widely usable I think it will become a key part of data just as what we’re talking about today in the case of social determinants of health you know beyond the few data points and mention earlier around social determinants of health what we’re doing is you know we have taken a much more broader approach to social determinants. For example you know like many application providers what they do is they take they ask a few questions and they display the answers of social determinants of health. I think that’s very much at the periphery level it’s a good marketing message but it doesn’t really add any value. So what we’re doing is really upping the game in terms of taking these large data sets and pulling them into our system normalizing them and then morphing them in terms of different application scenarios. So for example when we do stratification of risk meaning we’re trying to figure out, out of these you know millions of patients which one stuff, the provide should focus on we basically we build our algorithms which are driven with AI now as a mix to really drive towards you know patients who have a higher socio-economic risk profile we use social determinants of health to help drive a risk stratification you know before we start making actions in terms of clinical side of the equation. In care management we are trying to understand the socioeconomic profile of a patient before engaging with them. We are dealing we are tailoring the goals and intervention for the care of plans based on data that drives through the social determinants of health. In quality improvement we identify potential barriers to closing gaps example transportation gaps you know somebody doesn’t have transportation access how do you how will they be able to close the gap in care and of course knowledge have basically providing insight to providers about the patient through the gathering of this data. So I think there are many aspects even some other aspects that come into play like identifying communities who need a particular resource for or basically community health worker who wants to provide home visits to care managers and and and in location and dialysis facilities as to where the availability is so there are lots of things that we can do with social data but the main point is how do we make that available seamlessly in the applications as part of the workflow versus the care manager of care coordinator has coordinated having to figure out a hey here some social data let me try to figure out how to integrate that into my day-to-day life.

All right when we talk about all these new and emerging data sources we have to talk about two things one is the I-word interoperability right. How are we gonna solve that so that’s one and then the other thing you already touched upon this whole notion of you know marketing message versus real substance to what you’re doing and in that context you know AI, everybody is talking AI. I know these are slightly unrelated but I would like to do you know touch upon the you know are we going to are we going to see an interoperability solution I mean is fire going to be the solution what is the solution and and how are you approaching it and then tell me a little bit about what do you think of AI you know is it hype is it real you know what is it you guys doing?

No sure I think that’s an excellent question especially given the conversations happening today in the market and both these topics. So I think from a Caradigm perspective we welcome advances and improving interoperability amongst different systems you know we know that certain EMR vendors have been hesitant in sharing data and new protocols like fire and I helped break down those barriers I think that should lead towards more comprehensive patient records, improved communication ultimately improve patient outcomes. Now one file can provide benefit it is better utilized towards what I would quantify as low to medium volume transactions. And so when it comes to high volume bulk transfers of you know megabytes of data which we do very regularly for large population of our providers I think you still have to resort today to the traditional web services and ETL mechanisms to drive larger volume and I think the other portion is I think I love the fact that Apple has now you know made fire an interface for individual patient records and I think that’s a first example of how companies like Apple are going to help try the echo system forward and interoperability now and that portion of course still focuses on an individual patient getting access to the record from a set of providers who basically agreed to partner with Apple. I hope that that ecosystem continues to grow because I think it’s super important for healthcare transparency and even wellness that patients have access to all the records seamlessly and I think that that would be a great outcome for patients.

Now getting into the AI piece you know it’s a very good question in terms if it is hype or reality. I think you know AI is one of the next key advances in healthcare. You know a solution that incorporates machine learning, deep learning we can provide you know better analytics to organizations well I think it’s moving from what I would say being hype to now showing early promise of delivery. What we are doing specifically before I kind of deep dive into that pieces you know what we’re doing specifically we have taken an approach to AI which is different than lot of the you know healthcare startups that are trying to formulate algorithms around AI or or even make statements around AI. I think many AI vendors position themselves as the AI company or deep products that you have to buy or the thing that you have to buy and then figure out how to work with your IT organization to enable within your workflow I think we are taking an approach that you know AI needs to be you know seamlessly infused to our system it needs to be ambiently embedded across our application workflows and customers should not have to do anything special to buy or enable AI in order to beat the benefits or even know the existence of the AI for that matter.

Invisible in another words. Absolutely, absolutely I mean that’s where and really we need to focus on not AI as a technology but in terms of what outcomes and ROI we can reap for our customers I think that that’s really where we’re focusing in terms of our investments and in terms of in terms of our outcomes.

That’s all well said Neal, that is so well said because I think a few years back we had the same thing with big data right as though big data was the solution or you know was the be all and end all but we’ve seen that over time you know it just permeates through an entire analytics infrastructure and it’s no longer visible. It’s invisible to the point of it seamlessly being incorporated into all advanced technology solutions right? Would that be a fair statement?

Yeah I would agree I think you said it articulated extremely well that is exactly what we are we would love to see and so what the thing is you know we have been investing we have got a partnership at Microsoft. We infact doing a pretty big launch around you know intelligent population health as we call it as how do we bring AI into population health so there will be a pretty big launch happening next week at HIMSS around what they’re doing in AI and specifically in terms of what scenarios we are enabling within the work flow so whether it’s bringing intelligence into, how we stratify the population of patients or bringing intelligence into how care coordination assessment workflows becomes smarter and better so you know we have we have we have basically enabled AI in our system we don’t plan to charge customers for AI we plan to basically deliver differentiating value proposition where AI make our systems significantly smarter for our customers and drive significant value for them in these workflows and to be honest we are early on I think the industry’s early on but more importantly what we’re doing is we’ve become very I would say very thoughtful about working with real customers and real data to identify real outcomes I think that’s important because you know sitting in a computer lab building AI is an interesting technology experiment but what we are doing is we are working with real customers and then enabling these as part of the work flow so that the next customer basically gets the benefit of that enable meant without either having to pay for it or you knowing it that it exists.

Awesome, awesome I just love that whole position that you stated I think that is so important for your customers and also your competitors and peers in the industry to understand. Ultimately it is about what it does it’s not about be-all and end-all in itself that’s wonderful. You know for you were you were one of the contributors to my recent book the big unlock and once again I must thank you for taking the time for speaking with me and providing me with the input so the one thing that you had said there that stuck with me. You had said that health systems are going to find it increasingly hard to live by the rule that they will operate within a single EHR system for the benefit of our listeners and for my own benefit I’d like to hear you say it again what should health systems be doing those were locked in yesterday from the EHR what you know what do we have forward for them.

That’s a good question so the concept and motion of a single EHR I think that there are there are certain hospital systems that are locked into a single EHR but you know as even single EHR hospitals you know are now rethinking that strategy because as a lot of M&A activity is happening it’s nearly impossible to keep buying hospital systems and then trying to spend a large chunk of you know IT dollars and just bringing people into a single EHR system. But I think what’s made it even more I would say harder to think about everything sitting in one EHR is this motion around accountable care or around clinically integrated networks and so you know if you’re taking on an accountable care contract and especially as part of the accountable care contract whether it’s a commercial or a federal contract you know you may have to provide care with other organizations and they basically may not be in the same EMR system and they may not even be of your size in terms of you know if you’re a large enterprise player partnering with another enterprise player partnering with smaller clinics right you can’t have the same EMR everywhere or even try to say that look we can’t provide care until all the systems get on 20 MR which can take many many years. So really I think in that world if you want to be successful in this new payment reformed model of value-based care I think you have to really think about how can you operate in a environment with multiple systems. Whether they are EMR, whether they are claim system, they are financial systems, they are social data systems. I think you really have to live within this world so you really need a system that can actually help you across the boundaries of data but also more importantly cross the boundaries of your enterprise organization and be able to scale to that level of carrying data seamlessly so that’s really what you can do is say I can provide care. I’ll give an example you know let’s say you know I’m providing care for a patient and I’m a care manager and you know one of the things I’m trying to basically do is make sure that I can provide the maximum amount of high-quality care for the patient outside the hospital so they can do right things wellness and care and prescription perspective to take care of their care. But then my patient basically shows up in an ER system for some medical situation you know and if that ER system sits outside my HR then basically I would never know that happened but if you’re in this across enterprise data scenario in our systems what we do is we alert the care manager hey your patient showed up in this ER today and no matter what EMR system was there and then what happens is they can follow up with that patient later on during the day to find out what happened why did they have to go to ER. Again this is how you can prevent a lot of unnecessary ER consumption and which is very expensive right so that’s an example of how you really have to think across one EMR and across one data source.

Very interesting very interesting so you know you mentioned value-based care right so we know the industry’s shifting towards value-based care but maybe it’s not happening as quickly or as rapidly as we would like it still a lot of fee-for-service arrangements are there if you have a little bit about what you see in the current policy environment and especially as it relates to the shift towards value based care what does it mean what are the implications for your business and when you should prepare it?

That’s an excellent question I think you know despite the uncertainty at the federal level I think the shift to value-based care has not stopped I mean it’s continue to move in that direction because ultimately the move towards value-based care is really around basics and principles of economic right.

You have to really kind of you can’t continue in a world where you’re basically not focused on outcomes driven payment systems and continue to increase health care costs along the way you know. I think people are moving past the uncertainty and even with the changes. We have seen two major shifts one is more and emphasis from the private sector side health plans and employers in particular and secondly we are seeing an increase in breadth and diversity of value-based care programs. For example MAAPE in a bundle payments and the likes of that so I think that portion that will continue to become more and more prevalent but then also I think the federal side we are seeing more movement from voluntary from mandatory to voluntary programs. So I think they will continue to be growth and but I think especially in 2018 we have seen the shift you know while 2017 especially the second half seem to have stalled we’re seeing a significant acceleration happening now in 2018 and that and that’s purely based on what we are seeing from a commercial pipeline and a cells of perspective. The other portion I think is that you know I think organization sees an opportunity to become competitive in a market where the competitors may not be moving as fast so so while we see lawmakers continue to battle it out I think we face one fact that value-based scale is here to stay. Providers, so basically you know push forward with what we call is the no regrets strategy which means provide prioritizing efforts to drive more consistent efficient and coordinated care integrating the IT systems to support accurately forecasting patient risk lowering cost structures and building deeper relationships and loyalty with the patients and I think that no regrets strategy will help you no matter whether you’re in people service or value-based care.

No regret strategy, I like that term okay last question for you what are your 2018 priorities for Caradigm.

Yeah we are focusing on several things I think that the main thing that we are trying to do is with trying to focus heavily on what I would say is rapid time to value and what we mean by rapid time to value is how can our customers get, you know time to value very quickly from our system so when we deploy systems how quickly can be have our systems go live but live is just a milestone how quickly can our systems be adopted as more important and then more importantly what is the outcome and ROI our customers achieving so we focus now very heavily on that time to value equation. So it used to be TCO in the old world of total cost of ownership at a company level across the board every single employer the company’s focus around customer outcomes and driving time as a key factor in terms of getting the outcomes for them in a very rapid way and then the second piece in that same notion of time to value is you know we have traditionally focused on enterprise customers with fully integrated systems that have a single platform and we’re able to service application or a single platform to drive time to value for our enterprise customers. We have now you know launched out solutions that are very quickly adoptable with pre-packaged solution that you know smaller, mid to small ACOs can adopt and get rapid time to value. Literally we’re talking about you know goal eyes that can happen within 30 days of signing a contract and then that I think is very significant and very fast which is kind of unheard off in the healthcare industry in terms of how we can write fast value for our customers. The third piece really is around I think we have to continue to focus on innovation. But the way we are thinking about innovation is very rapid so you know we have a deep technology partnership with Microsoft you know. A primarily because often our roots back to the joint venture with Microsoft where half the company came out of but also in terms of really you know taking advantage of the deep talent that Microsoft has. So for example Microsoft has made some very significant investments around a visual analytics so now we’re going to launch what I call as Power BI for healthcare which is basically how can health care organizations get you know fast time to value around self-service analytics without having to know the understanding about how to do plumbing and hosting and then taking care of security and HIPAA compliance in a very seamless manner. So I think that’s where we’ve kind of put together it with Microsoft’s help in building out the Caradigm visual analytic solution. AI is a good example where we’re using Microsoft technology again not a standalone as the thing that you buy versus as a seamlessly integrated capability throughout our entire workflow and then you know the social determinants of health I think we are doing some really cool and interesting stuff and in all these areas while we have done a lot of technology platforms when the enabling use cases that we’re launching at HIMSS many of them as customers I think will the next 12 months you will see us creating a very significant volume especially in these three areas for having customer value oriented solutions delivered to the market.

Awesome so in one short sentence would you say the mantra for this year is customer success?

Absolutely

Oh fantastic Neil it’s been a real pleasure speaking with you as always and thank you for your time and have a wonderful HIMSS. Look forward to seeing you there. Thank you Paddy, you have a good one. I look forward to seeing you there as well.

We hope you enjoyed this podcast subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

About our guest

Neal Singh is the CEO of Caradigm and serves on the company’s Board of Directors.

Mr. Singh has spent more than 25 years working in enterprise business and software leadership roles. Prior to becoming Caradigm’s CEO and President, Mr. Singh served as Chief Technology Officer, where he led the strategic vision and execution of Caradigm’s enterprise portfolio of population health solutions. A member of Caradigm’s executive leadership team since its inception, Singh joined the company after spending over a decade at Microsoft including his last role as general manager of Global Development at Microsoft Dynamics, where he led a global team overseeing business strategy, product management and engineering. Throughout his career, Mr. Singh has held multiple executive leadership roles, and is recognized as a thought leader for healthcare technology.

Mr. Singh has a PDEE in electrical engineering, a Master of Business Administration from Phillips University and executive education from Harvard University.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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