Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
FHIR Catching Fire, A Conversation with Joe Gagnon, CEO of 1upHealth
139 Plays2 years ago
Interoperability has been a major topic in Digital Health for over a decade, but initial progress was slow and enabling technologies have only taken off in the last few years.
Joe Gagnon, CEO of 1upHealth, a fast-growing data interoperability vendor, joins Alantra for a discussion on its evolution, namely the FHIR standard, how payers and ACOs are acting as agents of change, the potential for collaboration among Digital Health vendors, and how interoperability platforms could evolve over time into ecosystems.
Recommended
Transcript
Introduction to Joe Gagnon and Data Interoperability
00:00:06
Speaker
Welcome all to the most recent installment of Crossroads by Elantra. Our guest today is Joe Gagnon. Joe is currently CEO of OneUp Health, a fast-growing data interoperability vendor for healthcare organizations of all sizes, both payers and providers. So we've asked Joe to share his perspectives on the state of data interoperability
00:00:31
Speaker
in healthcare today and his assessment on where things are going or edit towards. Before we jump to the thick of things, I did have a quick look at your LinkedIn profile.
Joe's Career Journey and Insights
00:00:42
Speaker
I must admit you are a multifaceted individual. You've worked at both large and smaller tech vendors. Yes, that's true. The largest.
00:00:53
Speaker
One at one point IBM, right? A hundred billion dollar company. And ENY, if I'm not mistaken. I did that as well from 10 to a billion we went. Yeah. And now one up as about what in terms of employees, a hundred and fifty employees here. Aside from having a varied work experience, you have somewhat of a creative flair. You host your own podcast. You've written a book recently, right? On performance and wellness. Yep. Lastly, you run every day. I do. Even in the rain today. It's fun to be out there.
00:01:21
Speaker
And I've been blogging for 10 years. So I'm coming up on my 10 year anniversary of every day of blogging. Wow. Good. Which is probably harder than running every day. Must be. I got Bob Cronin to help me out today. Bob Leiser, Data Management and Analytics Practice at Elantra. Joe, good to see you again.
The Evolution of Healthcare Data Interoperability
00:01:40
Speaker
Good to talk with you. I'm Bob Cronin, Managing Director with Elantra Tech and I
00:01:45
Speaker
focus on B2B enterprise software companies exclusively on those that are focused on data management, data analytics, and all things related to artificial intelligence and machine learning.
00:01:57
Speaker
It'll probably bring more of a technological perspective than I could. So I thought I would invite into the discussion. First question to you, what we have seen in our practice at Alantra, our digital health practice, is that interoperability is a common theme. 10 years ago, it was also on a very much ever recurring theme as well. What in your opinion has changed the most? What I have seen is 10 years ago is totally walled off. And now,
00:02:25
Speaker
we're kind of starting to see the light at the end of the tunnel. People are opening up a little bit and making it more accessible. Can you share your thoughts around what you see in terms of data openness, if I can use that term? Yeah. And I think that the context for why now is always a good question. I think we all, anyone in sort of our current era of technology companies,
00:02:49
Speaker
know the technology, whether it was the railroad having a standard track or highway interstate system or when AT&T rolled out a national phone system, that creating connectivity changed the dynamic of how we lived and operated and worked.
00:03:06
Speaker
interstate commerce happened because of both the rail system as well as the highway system. But that was all driven by standards. And we always knew that right in health care, we knew that that was ultimately going to be the moment when we could start to operate as an integrated industry. The problem was, in the beginning, there weren't standards that we could agree upon. And we made some somewhat failed attempts at doing it.
00:03:31
Speaker
But finally, with the introduction and acceptance that the web was really going to drive the standards in the industry is when interoperability became truly possible.
00:03:40
Speaker
And that's when we say FHIR as a data standard really is based on JavaScript object notation as a data standard, and then the rest of the web technologies, RESTful APIs. And then we have on the government side, you know, the largest payer in the world, CMS, Center for Medicaid and Medicare Services, saying, by the way, we feel like we need better data when we spend $750 billion a year to understand if we're getting a value return for that.
00:04:09
Speaker
because even 1% really means a lot of money. And so they started down a path saying, oh, now there's these data standards, we can use them, we can get a better return on our investment, ultimately driving to better care, lower risk, higher quality, better equity, and it starts and ends with data.
00:04:29
Speaker
What about the commercial payers?
The Role of Commercial Payers and CMS Mandates
00:04:30
Speaker
You did mention CMS, but again, they do have the resources versus provider organizations, not as familiar with CMS, the way they're structured, but definitely payers do have pretty large budgets. They aggregate probably the majority of the data. What's their role in all of this? Do you feel they can be an actor for change, a catalyst for change? I think so. So where the leverage point happened was when Medicare Advantage got introduced, which was to use
00:04:58
Speaker
commercial payers to execute on Medicare, they now got sort of intertwined in a way with the same needs that CMS is going to have because now they're getting a lot of their money from the federal government, not just from employers and patients. And so then the data requirements that CMS is going to have, you're going to have to think about how you do that for your commercial business because you're not going to want to sort of run
00:05:26
Speaker
this in a bifurcated way, just having insights on Medicare Advantage patients and no insights on commercial patients. So the drive to create one standard repository across all of that at the claims level, and then adding the clinical data to that, starts to position this third-party payer world in a very different place. Where the payer really before was an administrative entity, it's now becoming a bit of a care entity, helping guide care, authorize payment,
00:05:55
Speaker
decide what's on a formulary, really figure out how we can, across someone's lifetime, provide them better care. And that's where the payer is ending up. To do that best, you're going to need data and interoperate with that data. You mentioned one tell when being fired, right? What about the kind of the mandate given by CMS to ACOs by 2030 cover all Medicare?
00:06:25
Speaker
beneficiaries and most Medicaid beneficiaries? Yeah. Is that in your opinion, a second tailwind? Is it a bigger tailwind? I think the good thing for us who want interoperability to happen is that there are actually multiple tailwinds coming. Another one dropped yesterday when CMS said that pair-to-pair is going to be required, they'll move data. That prior auth, which went through, Congress has to use FHIR data, not just patient access, but bulk access.
00:06:55
Speaker
Really all of the infrastructure is going to use this common infrastructure. The ACO side of the world, the pay vider side of the world where we're starting to collapse the payer and the delivery model around risk.
00:07:10
Speaker
is a theme that we're not going to be able to get away from. It's just no way because really at the end of the day, you know, when you think about how our system works and insurance works generally, right, there's a very high expensive customers and then there's the people who pay for all of them. And the risk-bearing entities who own the highest risk
00:07:29
Speaker
have to figure out a way to manage that business because you can't really pay for the risk if you just own the most sick customers. And so I believe what we're starting to see is that they're saying you need to manage the risk at a more aggregate level to be able to deliver on care appropriately at the appropriate cost.
00:07:52
Speaker
And that tailwind goes back to the same thing. Well, how would you figure that out? You need data. You need currency on that data. You need completeness on that data. You need it to interoperate between business partners. Because really, the ACO is a bit of a shell, right? It's an organizing construct to deal with the root cause issue. And so therefore, how would it operate better?
00:08:15
Speaker
You think that has prevented ACOs from really taking ground? Because you know, it's a pretty old concept by now. I think that they are in a way, they have good intention.
00:08:30
Speaker
But the execution hasn't been where we would like it to be. And so I think many of the intentions, whether they be around quality care or risk are the right direction, but the execution hasn't been where it needs to be. And I think that's why they haven't been able to achieve the objectives. It'd sort of be, if we went into the retail trading space and financial services, you know, if you were trading on 90 day old data, how well would your stock portfolio perform? Pretty poorly.
00:08:59
Speaker
And so when you're trying to manage risk on a 90 day old set of data, at best, I think that until the data and interoperability catch up to these good structures, we're going to struggle. And I think that's why we're seeing the need to do this happen now.
00:09:16
Speaker
And Joe, jumping in on the interoperability issue, I tend to look at data management from a horizontal perspective and when it comes to healthcare work with Fred and his team. But as you know, as well as anyone, there are myriad different vendors out there who are talking about helping healthcare entities unlock the potential of their data, but many of them are not standards-based, many of them not fire-based. Do you see these ecosystems living side by side or do you see an accelerating move toward
00:09:46
Speaker
the fire mandate at this point? I think that we all believe that we're over sort of the debate. And it's a matter of time, because there isn't really any advantage. I mean, there are some proprietary technology players who are going to try and protect themselves for as long as they can.
00:10:04
Speaker
But really at the end of the day, if we're here for one reason, which is to take care of people at the right cost, at the right equity, then we have to sort of get over ourselves and start to operate better in a more integrated fashion. It's going to take time. This is a $3.8 trillion or $4 trillion industry that has so many components to it that
00:10:26
Speaker
It won't happen in a couple of years, but if we're here in 10 years doing this podcast again, I think we'll have seen massive improvements start to happen. Because you see the signs when an organization operates off of data, they operate better. The customer has a better experience. And there are some digital health companies who are using data to improve that. Nothing against legacy providers. They are doing the best they can with what was there. And so they had to build
00:10:55
Speaker
alternative proprietary data models to be able to satisfy the information needs of these entities, but you don't need to do that anymore. And I think that back to this CMS announcement yesterday, which was, I think, December 6th,
00:11:09
Speaker
It portends the fact that fire will be the data standard for the industry. If you think there's enough old people listening to this podcast, in 1994, when the web browser came out, there was a debate about this thing called a URL and www and the standards for how we would do commerce. There's no one who uses the web today who knows those things exist. Like you said to someone with a URL, they wouldn't even know what you were talking about. But it was a big debate.
00:11:38
Speaker
Then we got over it and then commerce flourished. And I think we're sort of seeing the same moment now. Along the same lines, interoperability in the data world across many different verticals, you'll hear this concept of data liquidity, which is this
00:11:55
Speaker
the vendor's effort to deliver data, ideally on a real-time basis, but that can be used to populate and power downstream systems. And then you can think of data warehouses, data lakes, analytic systems, automation, RPA, workflow automation, and even data science machine learning.
Future Vision of OneUp Health and Data Ecosystem
00:12:17
Speaker
If your vision comes true about one of health and fire,
00:12:22
Speaker
It seems to me you could be positioned to be the snowflake for the healthcare market, right? And I'm curious as to how you see the platform evolving over time. I know you have, you introduced SQL on fire this spring, but there's so many different options I think for you in the future. Is that something you envision developing further as you move ahead? Yeah. So it's just a good question. And I think that.
00:12:50
Speaker
What we see a world is that there is, by our customers, at a federated data that's shared across an industry. Each customer building what's core to them. Their integrated set of claims and clinical data could be therapeutic data. It could be device data over time that they use to operate their business. That's what they need, to do their business the best they possibly can. No one wants to share their customer data. And so that's fair.
00:13:20
Speaker
What we believe is that you need an open infrastructure to enable that to happen so that what you start to move towards is this ecosystem concept that leverages the cloud to provide this data as the core, the heart of the solution that has other capabilities that surround it. So we build containerized application capability to run application knowledge against this data. So bring the app to the data, not the other way around.
00:13:49
Speaker
We build an analytics framework so you can use whatever analytics you want against this data. It becomes your source of data where you invest. You have an event model that helps drive member experience or patient experience because it's triggered off a set of events that's in the data that we learn from. Then you also have a set of APIs for access individually or through an entity. And you articulate an open architecture.
00:14:16
Speaker
that says that the core of what you want to invest in is the best, most complete current data that you can use to connect and compute off of, but that all the other capabilities that you want, and that could be a prior auth or a quality measure.
00:14:31
Speaker
all relies on that data. So it does become the source. This is a very different, more dynamic kind of data model that evolves into the future that one day also powers some AI insights because I have a more complete data set than I would have other had. And so you would see, you know, the OneUp Health team thinking in an open ecosystem world where the benefit to you as our customer is that your data that you've invested in
00:15:01
Speaker
is used broadly in the execution of your business. That should, every day we remind ourselves, better care, lower risk, lower cost, more equity, a better experience. And we make this little joke, which is, the sun keeps you alive, but data makes your life better. Hey, Joe, it was a real pleasure. Thank you so much for sharing your insights today. I learned a
00:15:24
Speaker
a ton. I'm sure you did as well. We appreciate your care and attention to this topic and we'll be out there fighting a good fight. Good. Thank you so much. Thank you. Hopefully you enjoyed as much as we did our discussion with Joe. I personally learned a lot from it. I thought it was particularly interesting to hear his perspectives on a central standard finally being agreed upon. How bears have been at the forefront of its adoption in the direct role it should play in the provision of new care models.
00:15:54
Speaker
Platforms like OneOps may evolve to become truly open ecosystems that not only help their customers access data, but more tangibly help deliver better care from it. If you'd like to hear more about Alantra's thought on the space, please feel free to reach out to us.