Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Efficiently Breaking Barriers Between Payers and Providers with Dan Wilson, CEO at Moxe Health
75 Plays1 year ago
Collaboration between payers and providers has not only technological but also behavioral roadblocks. Dan Wilson, Founder & CEO of Moxe Health, joins Frederic Laurier at Alantra to discuss overcoming historical trust issues between the two, how he has built a purely digital business in a historically services-oriented Release of Information (ROI) subsector, the Datavant / Ciox merger, his provider subsidization model, and the importance of fast implementations in healthcare IT.
Recommended
Transcript
Introduction to Crossroads Podcast and Guests
00:00:05
Speaker
Welcome to Crossroads by Elantra. I'm Fred Laurier and I head up the firm's digital health investment banking practice. In today's episode, we welcome Dan Wilson. Dan is the founder and CEO of Moxi Health, a leading infrastructure solution vendor that has created a network that exchanges information in a logical and contextually aware manner across a variety of EHR systems.
Insights on Payer-Provider Relationships
00:00:28
Speaker
Dan has been immersed in healthcare IT systems since 2007 and today he shares invaluable insights on building a business that manages the competing interests of payers and providers who need to collaborate with each other more than ever. We'll also discuss his experience in finding high value use cases with clear returns on investment in a broad interoperability market around a solution that requires little to know OCR, QA or other processes that are common in medical record or retrieval and abstraction.
Impact of Merger on Healthcare Interoperability
00:00:55
Speaker
Furthermore, Dan shares his thoughts on the merger between Psyox and DataVet, a pivotal transaction in healthcare interoperability, as well as the benefits of using a provider subsidization model to maximize deployment in a competitive provider tech landscape.
Dan Wilson's Journey in Healthcare IT
00:01:10
Speaker
Dan, I believe that you got your start in industry at Epic as a project coordinator. Is that right first and foremost? It is, yeah. I was working primarily with their implementing clients across a number of different geographies, but yep, it was on the implementation side.
00:01:27
Speaker
You then founded Moxie in 2012, and I'll get to Mox in a minute, but in a nutshell, Moxie is a clinical data exchange provider connecting payers and provider systems to improve the record retrieval process. Is that the best way of summarizing what Moxie is all about? Yeah. No, I think that's a good summary. There's obviously
00:01:47
Speaker
A few things we do on top of the ultimate data exchange process to try to continue to add value to our clients, but that is the punchline.
00:01:58
Speaker
Good.
Moxie's Role in Medical Data Exchange
00:01:59
Speaker
For our listeners, for their benefit, can you provide us an order of magnitude of the amount of data processed by your platform? We think about it in terms of medical records, which is, depending on where you sit in the industry, maybe means something or doesn't mean something, but somewhere in the order of 20 million or so medical records a year, we'll move through the system.
00:02:19
Speaker
And medical record is really gonna be the kind of more or less complete medical history on an individual from a specific location they received care we are working with clients on the pair and the provider side probably cover about seventy million people.
Promoting Affordable Care and Safety Net Providers
00:02:38
Speaker
And switching gears for a minute and maybe going back to your personal background, it sounds like you're extremely active in the community. You help promote access to affordable care in the Madison region, if I'm not mistaken. Can you tell us what that work has meant for you and also in shaping Moxie and what it is today?
00:02:59
Speaker
Actually, the origin of Moxie was more on the affordable care side than in the clinical data side. But in Madison, I've had an opportunity to be fairly involved with the United Way. So really looking at how we do more to promote a delivery system in the Dane County, which is the county that Madison is based out of, but what we can do locally to improve outcomes, particularly within the BIPOC community.
00:03:25
Speaker
So looking at different providers who specialize or have programs specifically centered around black and other minority populations that have had historically worse outcomes from the white population in madison so there's a big concerted effort on what we can do to get more dollars into different community providers so that has been an unbelievably rewarding opportunity to see the great work that so many people are doing.
00:03:53
Speaker
that is still just an unbelievable critical area to focus that actually kind of dovetails with when we originally getting started with the company the goal was to build software for fqhc so federally qualified helping centers and other safety net providers.
Challenges in Payer-Provider Collaboration
00:04:09
Speaker
The initial idea was really looking at the expansion of Medicaid and trying to figure out how we could help these providers operate their clinics more efficiently. And I wanted to make sure that they didn't have to pay for the software. I thought ultimately if we could get to manage Medicaid or we could get to the county and have them help cover the cost of this software, it would be kind of a net benefit to the community.
00:04:32
Speaker
Our understanding is that providers in payer, to some extent, are being pushed to work closer together. A lot of that is driven by value-based care initiatives. The intent is better patient outcomes, but at the same time, what we're seeing is it does push some administrative strains onto providers by having to fulfill more requests for medical records, be it for EDIS scoring or risk adjustment purposes. At the same time, providers do need fuller information about a patient to provide them with better care.
00:04:59
Speaker
What, in your opinion, are the key collaboration challenges between providers and payers to make this work?
00:05:06
Speaker
I think there are so many years of payers and providers trying to find ways to get an edge in their work together, that when we sit and talk about a shift to value-based care or a shift to any more collaborative model, overcoming the historic lack of trust is always going to be the most challenging place to make progress. I think it really comes down to, can you get the economic incentives aligned well enough between these two groups that they can kind of overcome the lack of trust
00:05:35
Speaker
and start making progress. When you start to get deeper into the actual kind of act of sharing more information, a lot of it comes down to how is the data going to be used.
00:05:45
Speaker
The health plan needs data for HEDIS and risk, as you mentioned. The provider is concerned that data may go to the plan for those programs, but then may end up being used to help the plan negotiate different contracts, or may be used to look on the payment or program integrity side for areas where payments should be clawed back.
00:06:08
Speaker
And so there's this kind of desire perhaps to help run more efficient operational programs but a reticence around sharing data for payment and so really working through what are the use cases for data which use cases is your good alignment. Make sure that both sides are very comfortable with how data is ultimately going to be used is all key to the upfront conversation.
00:06:32
Speaker
recognizing that once you start to get piano line once you start to demonstrate that you're going to use data for purposes that have been agreed to you can start now repairing the trust you start to see a more holistic more natural kind of sharing of information back and forth which is the objective we're all working towards we view a huge part of our role as we don't be yourself as a payer business or provider business.
Automation and Efficiency in ROI Processes
00:06:55
Speaker
We're simply trying to make our little corner of health care as efficient as it can be and that means we're going to try to balance what health plans and what providers are looking for and we're going to figure out how you can keep the scale balance in terms of benefit receive we have dedicated teams that work with pairs and with providers.
00:07:15
Speaker
we made a very concerned effort we don't have people who are only payer or only provider customer success representatives gonna fall into the trap of inadvertently treating one side as good and one side as bad. I believe that release of information or i the acronym is one thing you enable that one of the primary use cases for your solution.
00:07:39
Speaker
Absolutely primary. Yep. So historically, it was mostly done by fax or mail very costly and efficient. Can you explain what parts or if you automate it entirely? Can you explain what your solution does to make streamline this to make this as automated as possible?
00:07:55
Speaker
So part of this is we didn't come at the problem to solve ROI. We were thinking more about just how do you build software to help the provider operate as efficiently as possible. And we were kind of taken into the ROI space. Historically, we understood from a health plan that they were having trouble getting access to medical records. And when we dug in with them to understand what data they were actually looking for, realized we could get everything they were looking for electronically.
00:08:21
Speaker
So, it was a little bit of dumb luck perhaps, but the legacy ROI industry was so focused on the fact that a kind of legal medical record does not just exist in the EHR. It may span not just the EHR, but other systems. And so, if you're thinking in that framing, then this is a very, very hard problem to solve electronically.
00:08:44
Speaker
But that's not how we came at it. We came at it from a health plan saying I need this subset of data elements that we would view as a record that will hold up to an audit for risk adjustment. And when we looked at that scope of data elements, we
00:08:59
Speaker
We knew that those are, for the most part, going to be in one core system that makes up the legal medical record, which is the EHR. And we knew the EHR quite well. So we went and built connectivity into all the different APIs that the EHRs make available. And we work with it now at this point, a handful of the leading EHR systems.
00:09:19
Speaker
our first client was running epic and our second with Cerner so those are two different systems they have two different sets of APIs but ultimately permutations on the same thing we were able to get set up with that set of APIs we needed so rather than coming out like a typically had been done in the interoperability space of really trying to say i'm gonna be a platform and i'm gonna do everything and you tell me your problem and i can fix it. We approach it as a product business where we said we want to solve the highest value use case that we can find.
00:09:49
Speaker
And we're going to identify within the health plans we decided was the client we wanted to try to serve initially what are going to be the highest value use cases for them which took us to risk and quality. For some of those legacy our vendors malpractice lawsuits were defending malpractice lawsuits was a big revenue generator a big use case.
00:10:13
Speaker
It's not the case for you. It's not, no. We are very focused on the payers, those kind of adjacent, if you will, use cases that make up ROI. We've kind of taken the approach of going to our clients and saying, look, the volume of requests that are coming in from these payers is really the volume that you are struggling to staff and manage. And that's why you went and worked with an outsourced vendor in the first place.
00:10:38
Speaker
But if we take all of that volume off your plate and we automate it, you're left with a volume that is much easier to manage. It's consistent, more or less. And candidly on the legal side, if somebody's suing you for malpractice, probably you should have your staff as the ones who are reviewing the records that are going to go out and help make that case.
00:11:00
Speaker
What we've seen is that some number of our clients do that they bring it back in house and some number say you know what i still don't want to manage all those other pieces myself will continue to use a vendor for that and they just design a contract where there may be some division of labor so we work alongside a number of like c roi vendors at a wide range of our clients and have as good of a relationship as you might expect.
00:11:23
Speaker
And maybe one last question on ROI. I cannot talk about ROI without asking you about the Data Event Psyox merger,
Impact of Merger on ROI Industry
00:11:31
Speaker
right? It was a watershed moment, in my opinion. It's a massive merger. Can you share your thoughts? How disruptive has this been? Did it open the market for folks like you? Did it make it harder?
00:11:44
Speaker
So the ROI industry has been around for a long time and throughout its history, very, very manual. And what Psyox did very well is they rolled up that industry progressively through health port, doing a lot of rollups pre Psyox. You have this lineage of rolling up the ROI industry.
00:12:05
Speaker
And then I think the real kind of very compelling part of SIACs was the, we're not just going to do the ROI side, we'll also do the request side and we're going to take both sides of the problem and serve out both groups. I think the DataVant merger is a recognition of two things. One is that the ROI industry is changing and that continuing to service it out with the same unit economics and the same approaches is not going to work for much longer.
00:12:33
Speaker
And so there needs to be kind of some digitization that is happening. And I think we demonstrated that very acutely, but there's a lot of trends kind of pushing that. So CyX decided to go into the pharma space and has been successful selling contracts. And I think they have investment from some different pharmaceutical businesses. And then you take DataVant, which is by all accounts, industry leading technology group, really strong culture, great team.
00:13:00
Speaker
And is building tooling for the pharmaceutical industry and they're dealing with the identify data, where is dealing very much with identifiable data and you look at the two of them coming together and you can kind of see how this becomes.
00:13:15
Speaker
really a growth opportunity. No doubt, huge merger, very interesting to kind of watch how that plays out. And CyX was on the path of trying to digitize a lot of their kind of core business even prior to the merger. So they've been working on this for now a number of years and we've seen that out in the market, but it hasn't been much impact to our business at this point.
00:13:38
Speaker
And maybe focusing on Moxie for a second, exchanging medical records is core to
Moxie's Partnership and Data Abstraction Approach
00:13:44
Speaker
your mission. You can do it for a number of reasons you've mentioned it, right? It can be care management, risk adjustment, prior art, claims denial management, we just discussed ROI. At the core of it, you need a strong abstraction process. Historically, it's been done through OCR, NLP technologies, whenever the data was unstructured or not hard to get to, if I'm not mistaken.
00:14:05
Speaker
How do you handle abstraction so we're very partner centric business we work with a lot of the people you're talking about and maybe compete in some ways as well. The biggest challenges i see in traditional abstraction that ocr is very finicky and there's a lot of time and energy that goes into then queuing what's been ocr and working with it and we don't have any of those problems we have zero sharing that happens within our system because we're getting everything directly out of the h r.
00:14:33
Speaker
and it has all of the metadata attached to it. So whenever it is discrete data, so thinking problems, allergies, meds, things like that, where you may need to use that discrete information to pull out specific data that somebody is looking for.
00:14:49
Speaker
That is extraordinarily clear cut for us we can basically produce the data in whatever format our client is looking for we do a lot of abstraction if you will into files that can be submitted into their engines and things like that.
00:15:05
Speaker
So I want to draw the distinction between the discrete data, which is straightforward, and the unstructured data, which is where you need that NLP that you're referencing, which is significantly more complex. We don't do NLP. We will work with our client and whatever vendors they work with in order to perform the NLP that is required around the abstraction. Or if it's going to be a human-driven model, we will put the information directly into whatever abstraction tool is in place.
00:15:33
Speaker
So we work with companies like Astrada, who's doing NLP for HEDIS, with AmeriHealth, who has kind of pulled us all together. We work with companies like EdFX, where you're going to have a couple of different NLP tools, and UPMC, who's an investor of ours, that came about through some work we were doing with Health Fidelity, who was doing NLP for risk adjustment.
00:15:57
Speaker
Our approach has been to try to enable as many people as possible play this role of we want to be your partner in getting the highest quality, lowest cost data, and we want to help make that data operational.
00:16:11
Speaker
any plans of adding an analytics layer of sorts to provide clinicians with some additional decision support tools since you already have the data. Our view is that we want to be the highest quality, lowest cost source of data. We want to get the industry to use clinical data as widespread as possible. We think it's a better source of information than administrative data for running kind of the business of healthcare and we want to help make that happen.
00:16:37
Speaker
And then we wanna help operationalize and activate the insights that are being generated from that data. So we do have another part of our business, which is an area of growth for us where we take insights that are coming out of analytical tools that we've put data into. And we help those insights get driven back to the point of care, put into the EMR, put into workflow and ultimately acted upon.
00:17:01
Speaker
We think it's really important to decouple the activation and addressing of the insights from the actual generation of the insight, because I don't think there's any kind of generalized analytics player who's going to win across all of the different domains where we're trying to solve problems. We are doing more from an infrastructure perspective to make data usable for more things.
00:17:23
Speaker
So we are investing in tools and capabilities to make data enriched better prepared for use. Make sure that we're getting maximum yield. Our approach is we can kind of modularize this a bit. We can allow the analytics businesses to really focus in on what they do best. And given, frankly, all the advancements that are taking place in machine learning and AI right now,
00:17:48
Speaker
if you're in the analytics space you really need all of your energy focused on how to deploy those technical breakthroughs into what it is that you're working on.
Efficient Onboarding and Provider Subsidization
00:17:58
Speaker
In some sense, payers are subsidizing the access to your software for providers. Last year was the worst year on record for health systems, just from kind of a bottom line standpoint. What's your sales pitch to payers? How are they seeing the tangible benefits of, again, paying for providers to use your solutions?
00:18:19
Speaker
I do think about it as subsidizing. I think providers have a lot of financial strain that they're under. They've made a lot of big investments in their EHRs. A very early goal for us was to make it easier for a clinic to operate efficiently and not need to cover the cost of that because I think a more efficient clinic
00:18:42
Speaker
ultimately is a benefit to the consumer to the individual to the member and so we kind of looked at the insurer as the group who ultimately was going to get the most benefit out of these types of programs so we look for them to help subsidize the program.
00:18:57
Speaker
This was part of why it was so important for us to go and identify what are those very specific use cases of maximum benefit so that we could frame it up in a way that really did speak to the financial ROI. So when we're speaking with a health plan, we're typically going to be talking about how they can use clinical data to more effectively run their risk adjustment and their quality programs.
00:19:19
Speaker
And the idea is that risk adjustment has a very clear financial ROI associated with it. We have a classic better, faster, cheaper pitch. You know, you're going to spend less, you're going to get more data with the money that you have allocated and you're going to get it faster and in a format that you want it in. That was pretty straightforward. The value is so clear and obvious once you start working with electronic data versus more paper analog data.
00:19:43
Speaker
And one thing that really cut my eye is on average to onboard a new practice, it takes less than 20 hours. First question is, is this a recent improvement or has it always been like this? Cause I mean, it's astonishing 20 hours. It's almost unheard of.
00:20:01
Speaker
Yeah, and it actually is per system. That can mean 20, 25 facilities, 40 facilities, 20 hours. You want to be very disciplined about the data that is being released and make sure, as you would expect, that it's exactly what everyone expects to be released. And so that's all included in that figure.
00:20:18
Speaker
And it's been that way pretty much since the beginning. My background is on the implementation side. I think I've always appreciated the benefit of a really clean, well-run implementation. I've seen how, particularly in healthcare, word of mouth is the best marketing engine you can have. And if I can make the implementation an extension of demonstrating my value to you, I'm going to do that.
Conclusion and Engagement Invitation
00:20:48
Speaker
This was truly a fascinating discussion, Dan. I can't thank you enough for having taken the time and certainly look forward to catching up with you soon in Madison, one of my favorite cities in the US. I think there's a lot to learn from you on staying focused on very tailored niches in a broad space and particularly on how you are handling some of the most behavioral frictions and getting providers and payer to work closer together.
00:21:09
Speaker
Dan, thank you again for your time. If you'd like to hear more about Alentra's perspectives on other digital health topics, please subscribe to the podcast and feel free to reach out to us. Wonderful. Yeah, great seeing you as well. Have a good one.