All right. Here we are from 5 20 22 and we're with a show . Data and insights officer, w w why are we adding insights officer to chief data officer? It used to be just CDO.
And now you have insights insights about,
so the key that is we have massive amounts of data in almost 200 million members. Uh, so how do you turn all these a hundred million members? Yeah. Of, um, rich data sets, which include health plan data, but also a combination of medical records and labs and pharmacy, you know, like, uh, genomics, et cetera.
So. Yeah, we can brag about the data we have, but how do you turn it into insights and how that those insights generate outcomes?
Because you're focused on health. Yeah. You want people to be healthy. Yes. Um, so what who's demanding the insights and where do the insights go in order to drive health in the communities?
I would say it's a multi-facets, uh, like when it comes to know who the key consumers are, one is our care provider partners, you know, the. And the key there is making sure you get these insights into their workflow. So they take action on them and some actions may yield outcomes, but then it's a, it's a closed loop process.
We have a framework called dial D I a L. So it's data insights actions and learn the data insights, action and learn, learn, right? Because it's a closed loop, right? You, you, you have the data, you generate the insights and those insights leads to. And those actions leads to some outcomes. And you learn through that and repeat the same process again, pivoting like from what you learned.
Yeah. So, uh, and, and so providers are, okay. Providers are key partners, but also our care managers, because sometimes, you know, care is delivered by multiple physician partners and our care managers can coordinate care across the spectrum of, you know, And, and with virtual health taking, you know, like it's digital, virtual, and in-person all these different modalities of care.
How do you coordinate across the whole value stream? So care providers are care managers and also consumer direct. We have an app called Sydney that has 20 million users, you know, so how do we give them like gaps in care or, you know, like, uh, know colorectal screening, appointment reminders, you know, wellness visits.
So that's another direct consumer engagement. And then we have a lot of our call center, service operations folks, where when members call us in a, how do you provide them additional support? In addition to answering the question they have. So you're focused on the whole person
health. They, we are, we clearly have all that technology that pulls up and says, oh, I'm talking to a show for right now or whatnot, but you also see the appointments.
And if they miss, uh, if they're calling, uh, calling us about a, a, an EOB explanation of. Or wanting to know if a provider is in the network, we could remind them that, Hey, by the way, you know, like you have a colorectal appointment, you know, meeting, or, you know, you missed a medication refill, you know, are, you know, you're coming up for your annual wellness visit, you know, and even help them with, uh, like, uh, setting that appointment
200 million patients to gnomic data.
When we've talked about w when I first came into healthcare, 20 12, 20 13, And we had this concept of whole person profile. How are we getting closer
to that whole person profile? Yeah. Great question. Um, uh, VR, like, so when we, you know yeah, because
everyone says, oh, it was knows so much about you, but yeah.
But I go to the health system and they treat me like, they've never met me before and I was here yesterday. Yeah,
absolutely. There is, uh, the openness to that. That's really the poor framework of profitability, the payers and providers being ready to share this information and the journey has started. So what, what, and, and, and some of our members, our metrics are we have 45 million members as part of our health plan.
Okay. But we serve over 115 million members, you know, outside our health plan business, like for example, in a behavioral health, like. Uh, radiology benefits. So our reach is 115 and, uh, because of historical information, we have captured on members who have left, uh, left us, you know, like, uh, that poll data walls down to 200 million members.
Right? So imagine the opportunities we have with such a, you know, it is the largest integrated dataset in the industry. Now, the kind of possibilities we can with that data. Right. So, and, and, and to specifically answer your question. Now the power of the data for us is being able to generate meaningful insights and share that with all the ecosystem partners, which are our care providers, our consumers, and our internal care management associates and service operations people.
So everybody's acting on the same insights and providing the whole person care like,
so you're, you're working on interoperability. Yeah. In a big way. It is the government framework helping the of framework, fire
fight API. Yeah, absolutely. Uh, so, um, so in the past we used to look at all these mandates coming from CMSs, or we need to do the bare minimum to check the box.
Right now, we are looking at interoperability as a competitive advantage, which can help us grow the business, right? Because if you can tie this interoperability of data sharing to help the country. You know, in terms of doing a better outreach in terms of learning more about them, or being able to collaborate better with the provider, it's really helping us to differentiate ourselves.
So when you tie it to growth, the, the focus and the investments are there to make it happen. And then number two is whether it is CAFCA or whether it is now DaVinci, which is another big initiative, or even easing prior auth, you know, because when you look at easing prior-auth. So it is an admin burden for the provider.
It's a consumer operation and for payers to it for anybody. Yeah. Right. So we started, we have almost 10 large health systems where we have automated pirate and current. Right. And when you have discussions, automated
priorities. So the prior authorization is being touched by humans.
No mean like from the provider EMR workflow, they click on.
And the response comes to us and we compare it with our clinical policy and send them a response back instantaneously. Right. Obviously we are expanding it more and more and to additional use cases. Right? So huge opportunity for us from a collaboration because
significant, I mean, as a, as a physician, they used to have to handle follow-up phone calls and all that other stuff.
Now they're essentially pressing a button coming back and going, okay. You're authorized,
authorized, and then we are also making a data-driven where, you know, if our history has shown, we have authorized it after an appeal 99% of the time. Why even compared it with certain medical evidence, when we know the, you know, we are analyzing all the historical data on past approvals.
Right? Right. So we are kind of making a data driven and continuously improving on the process. And that's where our partnership with epic know, we have a big partnership because as. Top 80, 180 hospitals in the out of a hundred have epic. So we are partnering with epic in on that. And it brings a credibility too, because all the big systems have made massive investments.
And then, you know, and then our discussions, you know, even talking to the epic folks, You know, when the health system CEOs call them. And when they say we are partnering with the payers, you know, like, especially with Anthem, that discussion pivots from, you know, why didn't you guys pay claims on time, two more?
How can we use the admin? Got
You know, we talked about experience a lot in healthcare. We talked about experience. We talked about the administrative burden, um, clinical staffing, shortages, and data has so many. We have so many opportunities. Uh, we tend to get stuck in certain areas. Getting it back in the workflow is a
Um, clean data just in general, we have. And we also, still, still to this day have data silos, all these places over. Um, are we seeing progress in any or all of those areas?
Yeah. All of the areas, you know, in some areas it's a little bit slow and I would say, I think fire adoption has been a little bit slower.
Like the EHR is, are required.
it will bleed into 23, you know, but that's still fairly aggressive in our, our, my fear is I hope they don't delay it any further and put a heart. Um,
you know what, they, they actually have been pretty good. I feel like they've been pretty good lately. They say, Hey, we've given you a pretty big
Yeah. And, and, and I think that's also when. Do the data sharing based on a use case that benefits both the payer and the provider, then it really helps, you know, so the other opportunity from a clinical standpoint, where we see is precision medicine, because when you have 200 million lives, you could find patients like me, where we have seen the disease progression, you know, based on these drugs and share that information, you know, to the provider for an active diabetic saying, Hey, by the way, if you're 50 years old, have all these conditions here is what treatment works for patients like.
And share that information to them at the point of care, you know? So, so now you're pivoting the discussion around the patient centric versus focused on the payment aspect of it.
Alright. So our, our listeners are providers predominantly, what's the message to providers. Let's turn a little bit, but didn't mean we're sort of, we're, we're engaging each other, but we're not engaging the camera.
So give me an idea. What's what's the message for providers.
Yeah, I would say interoperability is real, you know, data sharing is something that we are taking it very seriously as a national payer. And our focus is simplifying the administrative burden for the providers and consumers and putting members at the center of everything.
And the way we are looking at. At whole person health with focused on proactive, predictive, and personalized care.
So you guys are ready to partner. Fantastic. 📍 The show. I want to thank you for your time.
I appreciate your time.