Podcast Transcript for Joni Pidcock

My name is Joni Pidcock. I am the director of Payer Services at Orion Health. Orion Health is a global technology company that provides solutions which enable health care to more than one million patients globally.

Orion's goal is to be the custodian of the World Healthcare Record at Orion Health, a leading provider of population and health management, and precision heath solutions.

Here at Orion I'm primarily responsible for the payer services, product strategy, and the overall payer line of business in my career. My background is in health IT. I also have some background in finance IT. In health IT I work mainly with products that affect the US payer market specifically.

Within that career, I've naturally been drawn to innovation, interoperability, issues with data that data platforms can solve.

In the last about five or so years, I've worked closely with three of the largest payers in the US. The focus of those specific engagements were always around data acquisition and the issues around data acquisition. Mostly to improve patient outcomes and then, of course, to lower the overall cost of coverage, since it is the payer market.

What is common with each of those large engagements are the paying points, which is trust between entities, trust between the payers, the providers, the IT organizations, technology companies in between, security and HIPAA compliance.

Even though HIPAA has a definition, you can definitely tell in each of the payer organizations, even the provider groups and specialty organizations, that they have their interpretations of HIPPA, compliance and security protocols.

They're all very different. Some of them are strict. Some of them are following the intention of HIPAA, which is to allow patient data sharing. It runs a gambit. There's always a lot of conversation and information that needs to be shared to find a level of comfort between entities for an interoperability engagement.

Then, the last being resources that a provider specialty organization has available to integrate with a payer organization. The payers have deep pockets. They've got the money out there. These provider organizations, this is not something that they specialize in.

They don't generally have teams that have this type of IT background or an understanding of the clinical data from an electronic interoperability perspective. That also ends up being a pain point for that. For me, what's driving data platform needs in the market today is the need to be able to prepare for the future, which seems sort of obvious.

Regardless of your opinion of the Affordable Care Act, that aggressive push to get those health records in an electronic form and to be able to prepare for interoperability has sparked a basic requirement for real-time data as an integral part of the payer strategy from the whole life cycle of patient care.

Now that the fate of the Affordable Care Act in today's political climate is in flux, the health care industry faces challenges of where best to invest for the future. It's somewhat of an unknown of where the industry is going.

I believe in my experience that investing in a flexible, open, robust data platform is the best bet for preparing for that inevitable pivot, that unseen focus, or that change in regulation that may come from left field.

That's an important piece of information for any payer organization who is trying to figure out what the IT strategy is for the future. Among most payer organizations, their core competency, at least in the past, has not been in clinical data operation strategy, interoperability, and there's a lot of nuance to dealing with clinical data.

For example, identifying when clinical data messages are being sent in a standard format or being sent in a standard format using a non-standard way of writing the message.

Understanding the difference between the provider data that may or may not be populating the EMR and the way that EMR being generally a third party, so providers aren't generally building their homegrown systems, or at least that's not the majority of the industry and what that EMR interface is doing to populate the data within those messages, you'd think that the standards would be apples to apples.

Any person who has worked in an implementation team to actually do these integrations will tell you that the nuances are vast. You cannot have an expectation that whatever map was drawn for clinical data is actually going to be what comes out the other side. That's a challenge as well.

Payer organizations do have a deep knowledge of their own payer data, of course. Claims, rosters, basic demographics, that's all data that they've been dealing with for their administrative transactions, historically, and going into the future, utilizing technology to help make those transactions less cumbersome, less resource-heavy, and less expensive.

That has been an area of technology innovation that the payer organizations have been focusing on. Now, being able to overlay clinical data, that's where we're seeing current thought leadership going in for the payer market overall.

Dealing with the breadth and depth of clinical data and data quality for clinical data and mastering clinical data, that's a lot of expertise that you need to have in one place. In my opinion, unless you're going to hire all of those people, you're better off working with a third party that has a platform that has been built and cultivated using experience and understanding of the data.

Any good third-party platform, in my opinion, will have evolved with the clinical standards that we see today. They will have an experienced implementation team that is high touch. This is not a throw-over-the-wall type of engagement.

This team of people, including the technologists, will have executed integrations not just with the interfaces that are out there today, the Epic, Cerner, but also the custom data interfaces and have a working knowledge of what is required for a successful engagement.

Anyone that tells you that they can simply, and affordably, and quickly integrate with a wide swath of EMRs is surely not exposing the whole story, given my experience with actually trying to be successful in that way.

What is the right data platform? The right data platform to bring payers into the future must have integration strength. It has to be flexible and open and robust, as I was saying before.

It's got to scale because the amount of data, the explosion of big data in the last 10, 15 years is really difficult to wrestle with. Also, there is a lot of data that is continuously being created today. That will be the future.

With social media, with everyone's devices, data is constantly being created and will be evaluated and used to power workflows downstream. Being able to real-time stream from a database to an analytics engine, that type of feature and functionality has got to be a part of that data platform.

The platform needs to embed a data integration engine because there is a need to aggregate mass volumes of high-velocity data. These are going to be sourced from disparate and diverse systems.

This engine needs to be able to combine an out-of-box model, as I was talking about, those more customized models, as well as standard data. You never know what you're going to get when the data comes through.

As I said, each engagement is going to be unique. There'll be some learning, some of the process you can move from one integration to the next. Generally, as a rule, you're going to be finding out what new data system, or data model, or data type you're going to be using that you hadn't before.

The system needs to handle a significant integration challenges. Data is messy. It comes out of order. It is incomplete. It needs to be enriched. It is using the localized codes. It needs to be normalized so that the data...We are comparing apples to apples.

Then you need to be able to share those different documents back and forth. These are all important pieces of a data platform. Going through some of the value props, flexible and open, their rate of adoption varies. An open system is the best way to ensure agility.

You need a platform that has full API approach and supports both the standard APIs, fire, REST, but also can that enable information that needs to be available at securely anywhere that's needed even if it's beyond the standard API, so scalable and robust platform as well.

Genomic data is all the rage right now. It's being collected and projected to be commonplace. A genomic file can be up to 75 megabytes per one file. You really need to have a platform that is going to be robust and scalable to be able to adjust that type of information. Then time lags play health care information as well.

The whole reason why all of this data is useful for trying to improve patient outcomes is about timeliness. If you can get in front of a patient or patient care at the time its happening to affect a more positive outcome or a less expensive outcome, then that's the golden ticket. That's what we're going for.

You are never going to be able to accomplish that until you're able to get the right data in a fashion that makes sense to the consumer at the right time. To be able to get to that point, you need to invest in a platform that's going to do that for you.

You can start building all of those ROI valuable workflows on top of that to help achieve those goals up, better patient outcomes, and lower overall cost. The health care market may be excited about the usual buzzwords. I was just using fire and that genomics data.

Blockchain is another one. These are all amazing innovations that have come about, in my opinion, because of all of the health care data that is now accessible in an electronic form. The reality is that if you look at health care across the US, fax machines still loom pretty large in day-to-day business in health care system.

There's a lot of requirements. This is security. This is what I was talking about in terms of trust, and also of resourcing, and the ability to pay for the upgrades in technology.

What ends up happening is the only way to get to the status, to go to that back office of that specialty company, and pull up their EMR, and print out the document, and then bring it back to the payers, and then upload it, and parse the data from there.

That's due to those things, trust, security, and then resources to be able to be interoperable in a way that it's required successfully. While these buzzwords are exciting, platforms will need to be flexible enough to accommodate those fax as well as be ready to start exchanging data via fire or participating in a blockchain.

In the coming year, there will be a focus on apps that benefit the member. You hear more about this employer or provider, services, applications, workflows that are going to benefit the employer or the provider, but the member is going to start being able to make decisions about their health care coverage, health insurance coverage.

There is a movement to have employers offer a pile of money to their employees and say, "Go out there, and look and see which payer, which insurance company has the best insurance plan for you. That's how your insurance is being paid for."

That changes the focus of the competition. Member-driven applications and features will need to be available to attract that business. It's going to be driven by device data. It's going to be driven by behavioral data.

Current data platforms may not inherently support both the massive amounts of real-time data from the different wearables as well as be able to bring in data from those home-grown systems that may not have kept their records in an electronic format that's easy to get to.

These challenges are all right for a robust, flexible data platform to tackle. Once the payer organization has laid a foundation that is as flexible, and robust, and scalable enough, and open, then that allows them to move more quickly into the future of health care needs, both from patient outcomes perspective and to lower those overall costs of ownership.

An insurance company no longer is just there to cover your medical bill. It's going to be important for them to understand the community that they cover. What are the social determinants that affect the community that they cover?

Is it less expensive to ensure that a group of asthmatic patients have a brand new air conditioner every year than it is to pay for acute asthma episodes in the ER? These are all more member-focused features that I know payer organizations are thinking about that are pretty common.

Now, people need to start thinking outside the box, taking a look at social media and maybe getting a sense of whether or not a patient or a member, cohort is at risk for some sort of expensive medical behavior or mental behavior that is both going to make it more expensive to cover them and also is not keeping them healthy.

That, in essence, is where population health management is able to grow and innovate into the future, but not until you can get that foundation of data that is going to be able to get the right data in the right format to the right people at the right time, which is important there.