Health Care Reinvented

Discover conversations around the many ways Highmark and Allegheny Health Network (AHN) are reinventing health care. From community expansion and partnerships and bringing care closer to patients to deploying the latest and most advanced technologies, Highmark and AHN are bringing the future of health care to members and patients right now. L

Highmark Creates a Digital Front Door to Access Care 04/28/2025

Highmark Creates a Digital Front Door to Access Care In an era where technology seamlessly integrates into every aspect of our lives, the intersection of healthcare and technology has given rise to innovative solutions that are transforming how we manage and interact with our health. Highmark's Digital Front Door is a prime example of such innovation, and it’s reshaping the way millions access health services. * Jonathan Kersting, of the Pittsburgh Technology Council, welcomes Stacy Byers, Senior Vice President of Experience Design at Highmark to delve into the groundbreaking work being done to revolutionize healthcare access through Highmark's Digital Front Door app. Imagine an app that acts as a personalized health companion, one that simplifies scheduling appointments, unearths hidden benefits, and provides secure data handling. Byers details how Highmark's Digital Front Door does just that, merging healthcare with cutting-edge technology to create a comprehensive health ecosystem. This innovation connects members to mental health services, virtual care solutions, wellness programs, and personalized recommendations, all within a seamless digital interface. By emphasizing user-centric design, Highmark has managed to onboard 1.2 million users within just a year. This rapid adoption highlights the pressing need for simplicity in healthcare access and underscores the app’s ability to cater to a diverse user base, from tech-savvy professionals to seniors needing extra support. Byers reveals the challenges of modernizing healthcare experiences, which often involve different apps, login credentials, and fragmented experiences. By leveraging their living health strategy initiated in 2020, Highmark decided to create a comprehensive digital solution that combines these disparate elements under a single digital front door. Highmark aims to streamline experiences, from discovering medical benefits to accessing virtual care, reducing administrative headaches, and empowering users to take control of their health journey. It's about making healthcare less burdensome and more accessible, enabling members to focus on wellness rather than paperwork. /episode/index/show/healthcarereinvented/id/36339215

How Artificial Intelligence and Data Analytics Are Transforming the Patient Experience 02/17/2025

Breaking Barriers in Mental Health Care: Highmark Leads the Way 01/17/2025

Addressing Substance Use Disorders with Technology and a Unique Collaboration 06/17/2024

Health Care Reinvented: Streamlining Billing, Increasing Customer Satisfaction 02/07/2024

Health Care Reinvented: Streamlining Billing, Increasing Customer Satisfaction For Allegheny Health Network (AHN) and Highmark, the goal isn’t just to reinvent health care, but to also provide a seamless and supportive patient experience right down to the details of patient billing. After all, patients can get overwhelmed by the disconnected bills and explanations of benefits piling up in their mailboxes. Not only can it compound stress patients already have about their health, but it can also lead to missed payments and costly customer service inquiries. In this episode of Health Care Reinvented, we explore how ANH and Highmark leveraged technology and a leading-edge health care IT company, Cedar, to deploy a solution that not only increases payments but reduces patient stress around the billing process. Listen in to Neil Kulkarni, Vice President of Customer and Clinician Experience Solutions at Highmark Health; Kimberly Wilkinson, Director, Central Business Office, AHN; and Shanti Krishnan, Vice President of Sales at Cedar, detail their journey to radically simplify their customer financial experience by implementing Cedar Pay. With the Payer Intelligence Layer, Highmark members who receive care at AHN have access to uniquely integrated billing information and insurance data. In less than one year with Cedar Pay, AHN added $17 million in patient payments, thanks in part to the integration with Highmark. But the clearest signal that payer-provider partnership was working came from patients themselves, who gave the integrated experience a 90% satisfaction rating. Listen and learn how embracing technology can create so much positive impact and how more projects are in store for the future. Transcription: You're listening to the healthcare reinvented podcast series. And I'm your host, Jonathan Kersting. With the Pittsburgh Technology Council. This podcast is all about the intersection of technology and healthcare. And we talk about it at every single level, whether it's in the operating room, whether it's about virtual visits, and everything in between. It's where technology is making a positive impact. And today, it's all about how technology is simplifying the payer provider system. Simplifying just makes it sound, dare I say too simple, because it is super complex. But you want a streamlined system, you want a sensible system, you want an easy system and understandable system, so the customers don't have to be stressed out when it comes to paying and understanding their bills. And joining us on the podcast today is Neil Kulkarni, who's the vice president of customer and coalition experience solutions at Highmark Health. We have Kimberly Wilkinson, who is Director of Central Business Office at Allegheny Health Network. And we have Shanti Krishnan, who is vice president of sales at Cedar. Thank you so much for hanging out with me today. I'm excited to explore this conversation. And I always love starting with introduction. So our listener knows who is who. So why don't we just start down the list and I went through Neil, let's start with you your background real fast, and what you do, how you do it off the ball, Jonathan, thank you so much for having us and really excited to be able to kind of talk about this with the group today. I've been at Highmark, for a little under five years. And really what my role is all about is how do we transform our delivery system? And how do we make things easier for our customers? How do we make it easier for our clinicians? How do we think about simplification experiences being more practice personalized, and then working with our provider partners to really deliver a seamless and blended experience for people and so we say customer because it doesn't really matter if it's a insurance member or a provider system patient than today, it's a person. And healthcare is really complicated. And so I'm excited and unfortunate that I get to spend kind of my day thinking about how we think make things easier from a system perspective. And you make it sound easy. And that's very complicated, because it's like, like I said, In the beginning, it's one of those deals where it's like, you're dealing with people here, we need simplicity from a very complex system. And that's when you get to work on every day. And that's just improving the quality of people's lives. I love that is so cool, Neil. So Kim, how about yourself and what you do at Allegheny Health Network? Hello, everybody. I'm Kim. I'm the director of the Central Business Office for Allegheny Health Network. And my team is compromised of our Customer Care Center, which is our call center where patients are calling in inquiring about their bills, our Single Billing Office cash management, enrollment and credit balance. So as you can imagine, my areas are very involved with the patients and answering their questions as healthcare is very complicated. And we're, as Neil said, trying to make it uncomplicated for our patients and it easier for them to navigate and understand their bill. And not make it so stressful, because they're stressed enough. That's what I was gonna say. I mean, you're often talking to customers that are at an inflection point in their life where they're dealing with maybe a medical crisis or something and you're just stressed out like crazy. And all of a sudden, they you're getting some, some bills, or some get some questions, and you can't figure it out. So it's just increasing that stress. And you don't want your folks to be stressed out. So that's why I love what you're doing, because let's bring the stress down and help people heal. Right. Right, and make it easier for them make it easy. That's what I'm talking about. And of course, we couldn't have this conversation without our friends from cedars. So Sean cheap. Tell us about yourself and really like what cedar is all about, because I love the fact that like Highmark comes in and uses these tech partners like this to make these things happen to make that simplicity happen based on a technology platform. I'm Shanti Krishna and vice president of sales at Cedar I've been with the company for almost four years now. So we've evolved quite a bit over that time. But really thrilled to be here today. And of course, just so excited to have such wonderful partners in Miele Kim and the rest of the Highmark and AHN teams. What cedar does is that we have a platform that really aims to make it easier and more intuitive for patients to navigate and ultimately fulfill their financial and administrative obligations in health care. We know this is a real pain point for patients and as Kim just alluded to, it's often coming at a moment that is already stressful because of some sort of healthcare incident. And so our view is if we can take the stress out of what is already a pretty stressful situation, you know, we're doing our job. And so, we aim to do this in two kind of key related ways. One is just bringing the best of other consumer industries to this known pain point in the patient healthcare experience, making it more personalized, more intuitive, really leaning on data and design science to help inform the experience And the second is really bringing disparate parties such as payer and provider together on one platform because we know that patients don't see these things as being entirely separate. They're actually very related, yet our system treats them as totally separate. So, again, an area where agent and Highmark have just been such fantastic partners and really helps us to realize this vision. Yeah, I was looking at your website. And you have, I mean, you have the biggest clients out there. And of course, Allegheny Health Network. Highmark, they're right there with you guys. So you're, you're helping lots of lots of big organizations solve these very tough problems. So that's, that's cool stuff. Certainly a privilege. Most definitely. So let's get the conversation rolling. I guess maybe starting off with talking with with Neil Kim about maybe some of the problems that were that Highmark was looking at knowing that you needed to find a solution around this. Can you guys set the stage for us? Yeah. So happy to kind of chat through that. So I think the last couple of years, as we've been looking at how do we drive a better experience for our customers, I really started to break that down into a bunch of buckets of things that we want to focus on. But one of the major ones is around kind of the end and healthcare financial experience to say, hey, people struggled to understand financial costs, they struggled, they don't get treatment at times, because they really don't understand that as well. So that relates is often delayed care, when they actually get then care, then there's really complicated payment processes, we don't do a good job of connecting people to financial services and advocacy programs that they might have access to. So that entire ecosystem is really, really complicated. Everything from kind of understanding what costs are known, giving, comparing cost options, making it easy for people to kind of pay their bills, helping them understand the benefits that they have, as well. And so once we started kind of looking at the space, we said, hey, this is an area that we really need to kind of dig in and and tackle, and we're not doing a good enough job today. And so about three years ago, we really started kind of looking into, Hey, what are the set of partners because this is it's complicated, like it's talked about, it isn't something that we're going to solve completely on our own. And we know that there are other organizations and kind of other companies that are really partnering to drive this experience. And so we started looking at who are the center partners that are doing that. And so through that process, we identified initially, a company called boot up as a place that we wanted to start and that transition into cedar. And so I think one of the interesting parts, which I think we'll talk a little bit further about, and kind of our discussion is, one the place to start might not be completely the place that yet. And so if this was a one where hey, everyone solve it in healthcare, it's easy, go do it, just go implement a solution, and we're good that it would be easy to go saw. And so we started experimenting and working with the senior team on Hey, initial concept, here's what we think, how would you scale it? How would you deploy that? And so we iterated on that with them. And with hm, team over time on how do you start making these things really easy? How do you bring the best of kind of other experiences that as a person, you've gotten used to whether it's financial services, whether it is retail, other things in your life that you're doing, and we really worked collaboratively to go through that with them. But that was been a three year journey to say where we started and the product that the solution that we started with right now is very different than what we actually have live. But I think that's a good part of this partnership to say, hey, continue to iterate, change, really meet the customers understand what they need, and deliver a set of capabilities or experience to a customer that really makes it easy for them to understand on the provider side, what they need to pay on a payer side, does that match what their payer has paid their EOB and really bring all that together in a really seamless way. So that's, that's really kind of what brought us to Cedar in the partnership between cedar age and a hybrid on ours. That's super interesting. And you bring up the point of fact that like, it's not like this is one of these places where you go, you buy the software, you plug it in, and though your problem solved, but know that this has been an iterative process, you don't end up where you think you're gonna end up. Because as you're discovering things along the way, it changes and of course, time changes, the industry changes, and that you got to, I guess, continually be addressing this as an issue as it goes along. Because you never fully get to like, let that's the one solution. We're done. So, Kim, I'm curious. From your side, obviously, you're much on the front lines, when you're hearing from the customers and so forth. What were some of the key things that they were kind of bringing up realizing like we got to keep improving? Like, how can we make sure that our customers are number one, and that we can we can do right by them all times. The one thing that we were lacking was the ability to provide an electronic communication, ie the text messages, the emails, or QR codes, things like that. So that partnering with theater has given us the ability to do that and evolve. And as you said, healthcare is ever changing. So as soon as we're getting one thing implemented, there's another section that you need to work on. And adding that payer intelligence for our Highmark members, has been a game changer for us, letting them know What their HSA and FSA balances are, and having that EOB comparison so that they can see. And again, helping them understand, as Neil was saying, with the payer and the provider, and linking that to that they can see that they are matching, you know, and helping eliminate that confusion. And just giving them access to some self serve options that they did not have before that we're now able to do has been a game changer for us as well. It's very empowering for the customer as well. I mean, I love that. But to get it makes, it seems like it's so easy, but you need a partner like cedar here. So I'm curious to hear from Shanti. And he obviously you come together with a client like this, and you know, this is a big project, right? And then it's going to evolve it. And it's what was it like kind of kicking this project off and kind of walking through this journey, as you're able to, you know, go through each step and then see ours as needs change, and then use those cedar products to help solve this problem. Yeah, I mean, I think to Neil's point, when we started out this started on this journey over four years ago, I think it really came from a place of collaboration. And, you know, at the time, Gouda really wanted to solve this problem of payer and provider collaboration, payer and provider coordination for the benefit of patients, but obviously not wanting to do that in a vacuum wanting to do it with a partner that could really inform us of the key pain points, and really what was most feasible out of the gates. And so that's kind of how this journey started. And so where we are today is that the cedar platform is live on the post visit billing side at Allegheny Health Network. And we've incorporated additional functionality known as the payer intelligence layer, which is both Neil and Kim alluded to, enables patients to see elements of their benefits information alongside their bills, so they can see it, their EOB and Bill have been reconciled, they can see their deductible status, and they actually have the ability to pay their bills out of their HSA. So this is available for Highmark members presenting at h n, we're continuing on this journey. This is really just the start. I was gonna say found, yeah, we found that even just this this what seems like a very small kind of tweak and an otherwise typical billing experience has led to really, really, really positive impacts for both a financial perspective for both payer and provider as well as the patient and member experience perspective. So I would say throughout the entire journey, the entire the, the approach has been extremely collaborative. And we've really leaned on both these teams to kind of help direct us and where we can have the most impact. Without a doubt, as I mentioned before, I was sneaking around on the cedar website, and I did come across that case study based on what we're talking about today. And the results have been pretty, pretty, pretty substantial. So far from these initial, you know, first steps of the rollout. Can you talk a little bit about some of the the results for lack of a better term so far? Sure. So we've definitely increased our pace patient satisfaction, we put several initiatives in place to contribute to that we have flexible payment plans, allowing for Apple Pay as a source of payment or the QR code. Again, as we mentioned, the payer intelligence for Highmark members, the ability to do your cell service options, we've updated our statement format, enhanced our payment plans to allow patients to consolidate their many visits into one payment plan so that they're not making multiple payments. And cedar has also assisted us with our customer service area. And this has helped us tremendously with reducing our abandonment rates. So when patients are calling in, you know, we are under the industry, industry standards for our abandonment rate now, which is that the standard is 3%. And we are well under that at an average of 1.3%. Our POST call surveys. And the results were first call resolution are up a percentage of 82%. And again, our satisfaction scores tend to increase as well. So I feel like we're servicing the patients in a better fashion, answering their questions. And again, giving them that ability to self serve as they feel need. Yeah, I think some of the other things, at least kind of but also more broadly, I think we've seen a big impact on collections. So I think it's over 17 million in income, incremental patient payments. That's not even accounting for it. We have a huge influx of people that are out on payment plans that didn't have payment plan options before. And so I think even from a customer experience perspective, hey, cost of healthcare is high and it has an impact on affordability that has an impact on the rest of your life to say Hey, can you pay your mortgage, can you pay your phone bill, you need to make a trade off decision on on some of that type of stuff. So really that payment plan functionality and things that we've done have been really impactful. I think the two other really big ones for us that we've seen is really a 33% lift in HSA FSA. So health spending accounts, utilization. And so to me, that's a big thing to say people in identical plans, they have these things, but I know what happens for me, I forget my car, I forget that you have that available. And then actually, right by reading my mind, Neal, you're reading my mind. If I remember, I was like, where's my HSA card and said, I don't keep it in my wallet with me at all times. And so one nudging and reminding people that they have these funds available to use for a payment has been really, really big. And so we've seen a big effect of that. Also on the Highmark side, we look at it in terms of what is our net promoter score or customer experience holistically in a segment and industry in a market right now. And so we've seen really good improvements overall in western Pennsylvania, with our net promoter score with the types of solutions that we're implementing in the space. So I think it's been a win win all round to say, a big impact for HN, but also a really big benefit for Highmark, in terms of making it easy for our customers to access care and pay for Kevin, you get to have so much fun doing what you're doing, because you're actually seeing a positive impact. It's only got us invigorate you more and more on both sides on the theater side on the high marks actually, like basically, we came together we're going through this journey, we're actually seeing the results we wanted. And we realized there's still more opportunity to do more. So you must be pretty stoked. We are really excited, we have a big roadmap and backlog of things that we want to tackle. So I think some of the things that we're we're really starting to lean into. So Shanti alluded to something that we call the payer intelligence layer. And so that is the component that is a Highmark insurance oriented to say, how... /episode/index/show/healthcarereinvented/id/29847098

Health Care Reinvented: Big Data Provides Big Outcomes for Patients 05/08/2023

Health Care Reinvented: Big Data Provides Big Outcomes for Patients On this episode of Highmark’s Health Care Reinvented, learn how Highmark uses massive data sets to improve patient experience and outcomes while simultaneously managing data bias and the utmost security. We welcome Ian Blunt, VP of Advanced Analytics at Highmark Health, where his group form a center of expertise for all things data science and sophisticated analytical techniques. Leading a team of 100-plus data scientists, researchers and engineers, Blunt and his team are at the forefront of developing new capabilities for novel use cases, building predictive analytics and machine learning models, next best action selection, behavioral engineering, evaluation of interventions, analytics enablement, natural language processing, coordinating Highmark’s analytic product portfolio and transitioning analytics to the cloud. At the end of the day, Blunt says all of the work comes down to directly improving the patient experience and proving health outcomes. Listen and learn how the human experience is expressed through the data! Transcription: All right, Audrey, we're gonna get just a little geeky today on healthcare reinvented because we have someone who is no stranger to the healthcare reinvented podcast rodeo, we have Ian Blunt hanging out with us today. Very excited because this guy, when it comes to all things, analytics, we want to talk to you. Because he always I think last time we talked to moderate our brains were like, ooh, like this. And now it's great to do a deep dive. So we're really excited. So do you want to? So Ian, why don't you just tell people a little bit about your background, and why you're such an expert on the topic that we're going to be talking about? Sure. I'm very excited to be here talking to you guys about it. So my name is Ian Blunt. I'm Vice President of advanced analytics for Highmark Health. So we form a center of expertise for all things data science and sophisticated analytic techniques within the organization, Highmark Health integrated health care organization. So we've got a health insurance arm, we've got a provider arm in the form of Allegheny Health Network, and we've got a few diversified businesses as well and my team kind of sit at the parent company and help each of the business units with the various use cases they've got to apply. And that's that I think techniques that every now and again, we did get to this really interesting thing, or blended health, where we're using information from both sides in a regulated way to improve the experience for all of our members and patients make it sound so simple, but healthcare is really complicated. That's one of the things that I think makes it such a rich territory for analytics. It's also been an industry that's kind of slow to adopt some of the analytic techniques, often for good reason, because of the magnitude of the decisions being made and security concerns around the data privacy, and what have you. But I think when you look at how high marks really trying to transform healthcare, it all comes down to I live in health strategy, which really is about making healthcare simple, making it personalized, and making it more proactive. And there's advanced analytics applications throughout that kind of mission statement. So what are the big things that you're working on? So like, what keeps you up at night, so that, you know, sort of set the table for us so we can understand because sometimes people are listening to this? And they're like, huh, how does that, you know, how does that really translate into meaningful experience and meaningful outcomes? There's so much going on. It's really exciting, again, kind of a factor of healthcare having been traditionally slow to adopt these techniques, and also the huge range of use cases that Highmark Health covers. So some really good examples, I think about how we can improve the efficiency but certain services work with so got a really nice technique that's operational within chemotherapy infusion facilities with within Allegheny Health Network. So traditionally, if you have cancer, new on chemotherapy drugs, you'll go to the infusion center, you'll sit in an infusion chair for variable length of time. And you'll do that several times over the course of your treatment. And traditionally about was just booked based on where the local administrators thought they could see a slot, what we are able to do is, first of all, build a model that predicts how long each infusion is actually going to take. So personalize it around the patient and the treatment that they're having. And then apply some optimization techniques. So we can optimize for schedule. That means we can fit each potential appointment in where there's a good slot for it. And one of the things we found is we were able to increase the utilization of each chair from about 55% of its time being occupied to bet 90% of its time being occupied, which is great, because these are saving for the provider, which means we can lower the cost of health care overall. And also, these are really valuable resources, potentially life saving. So we want to maximize the access to it as much as we can. There's also other fringe benefits. So when you're not, don't have that schedule optimized, some sessions over run, they just take longer than expected, which means the next patient, you know, getting frustrated there, whoever's, you know, often people using the service need a ride, so whoever's come to pick them up, is now hanging around, no need to be there and no idea what's going on. And also, when the whole system kind of comes a regular, you put a lot of pressure on your pharmacy that mix in these chemotherapy drugs, which of course, if they're under pressure, that increases the likelihood someone could make a mistake. So there's some potentially very serious outcomes there. So by smoothing that all out with providing a much more efficient use of the service which is lower cost with providing better outcomes, better experience for patients and providers, as well. So it's it's a real win for that kind of application of advanced analytic techniques. That's an interesting use case and thinking. I mean, it seems like so niche, you look at all the things that goes into healthcare, but how important is that, I mean, the idea that you can get more people into the chairs, so that way, they're able to get the treatment in a faster way. And then the ripple effects, not like the safety of like a pharmacist mixing something and not being rushed to mix up things so that you're making sure they're getting the right, the right treatments. That to me is is amazing having problems come to you to say we need to solve this, obviously, there were some issues around that. So they came to your team. And they're like, Wow, we need to solve this. How can we do it? So how does that process work? Yeah, so I'd say it's about 7030, the business coming to us with things they'd like to do, and 30% of us heading out with ideas solved. So I think also, the cool thing about the way we've implemented that chemotherapy infusion example is even though chemotherapy infusions niche, and we're going to scale to all of the infusion centers, and then that's kind of a limit there, you see that pattern repeated many times. So for example, operating rooms, again, variable length, important resource problems, if it was schedules, that's the sort of clog up and then dialysis appointments, even MRI. So there's lots of places where those same basic principles can be repeated, to achieve similar even better outcomes. And then, of course, the challenge we've got is well, how do we manage it all, there's far more demand for these services for analytic techniques than we can meet. So it's about a process of running backlogs of requests, prioritizing them based on value. Again, one of the things I really enjoy about working in healthcare is we talked about value in terms of stakeholder quintuple aim. So it's not just dollars and cents, although lowering costs is an important part of the going to play. But you've got how can we bet get better outcomes for the population, and you've got the clinical and patient experience very important factors. And just recently, the IHI who defined quintuple aim added increase in health equity to that as well. So that kind of changes nicely with a lot of the sort of community based organizations that Highmark works about works with, and how we think about equity and social needs alongside traditional healthcare needs. What about the issues like around security? Right? Like, can you talk about that, there's so much data, people get so worried and intimidated. And yet they really don't have all the facts in terms of, of how that data lives and how that data is protected? Yeah. Healthcare data, medical industry data is I think, most fiercely protected by the public. I've seen literature out there where people do surveys, and they are more interested in protecting privacy around health care than they are, for example, criminal records, or their tax records. So critically, critically important that we treat those data securely. And with respect, it's a huge privilege to get to work with this information. And part of executing on that privilege really is concepts within healthcare industry, we call minimum necessary. So we should only be sharing the minimum necessary data that we need to go and execute. And in my line of work, that typically means we don't need to see names and addresses, we need to see some of the demographic factors, we need to see the health history, but I don't need to know who that piece of information is associated with, I can do my job just as well, without knowing that. So that's another way that we keep it secure. And then the other challenge we've got is thinking about exchanging information within healthcare. So it's actually relatively a security people shout at me, it's relatively simple to create a completely walled garden where just nothing can get in, nothing can get out. And one of the things we need to do as a modern healthcare companies share information. So share with provider partners share with vendors provide healthcare solutions shared with all sorts of people. So it really is about being able to have those systems that facilitate rapid ability to move information to where it needs to be but also keep everything secure, to make sure that that information isn't going to go anywhere that it shouldn't be going and we've got a well matured data governance infrastructure that supports us in doing that and it comes all the more important is interoperability. Rose is a trend within the healthcare industry. We're not Talk in file transfers anymore. Now we've got people accessing through API's and other means we need to be able to adapt quickly, as needed. But also make sure we're doing it in a very measured, controlled and secure way. I was really curious to talk more about like how you're able to eliminate bias. And this as well, too, that's a lot that I've been hearing is obviously keeping it secure. But then, as you're gathering this data to make sure that you're not getting bias out of this, you can actually make decisions and things based upon real clean data, I guess, for lack of a better term. Yeah. So that's a fascinating subject. And I think one that in general, is going to come into the sort of AI and analytics industry, it's already come in. So if we think about data security is what we can and can't do. There's a lot of law there. And then there's also the question of what we should and shouldn't do. And that's where I think data ethics really comes into play. Highmark really wants to establish itself as a thought leader on within the industry, it's very important to us personally, that the Insight we're generating is being used in an ethical way. And that covers lots of different applications, particularly around model bias, which has been a very hot topic for the last couple of years. And we've put a number of systems and processes in place to help guide our thinking around that, and also working with a number of partners as well to inform what we do. So to be very kind of like, high level on it, when we're ever we're considering sort of an AI based use case. The first thing we do is we think about the use case itself. So what before we do any modeling tall, even thinking about the data? What are the business asking us to do? You know, how might the data or how might that action, introduce some sort of bias? Is that even the right thing to be doing, and we can drive a conversation within the business on that? Then the next one, once we've accepted the use case, and we're working on it typically involves some level of predictive model. Within a predictive model, you can find a list of influential features, basically, what data elements drive in the model outputs? And depending on which algorithm you're using, sometimes you have to use simple explainers to get at that, but it gives us a really good sense of what's going on there. And then we check that back with our business colleagues. So we literally go down the list, is there anything problematic in that, that we're worried about? Is there anything that's proxy and something that might be problematic, and then the next step is really important. So it's not the sense that if it's in there, and problematic, we automatically take it out, we need to think about the impact it's having. There are some times when actually it's really important. For example, prevalence of diabetes is different depending on people's ethnicity. So there's a really good argument for having ethnicity based information within a diabetes model. And again, it's about the actual output, what happens differently in the real world because of what the models say. And so we think through those various use cases, take information out rebuild the model if we feel we need to. And then we do a series before it's elevated to production, we do assess what's called back tests. So essentially, we look at model performance over a range of different categories and get a good sense of, you know, is it performing particularly well on one category, but particularly poorly on another, and we use scores in that as well. So it's kind of typical check on what the model is performing. And then the last thing we do is we monitor the model's performance over time. So we're checking for drift so we can understand and be alerted to if anything, when we launched it production was unbiased, has now seems to become biased, for whatever reason, and we can dig in to that. So that's, that's our system, we go through that. We're very proud of it. I've got to say, we've not had too many cases where anyone's had to raise their hand and say, I think something's not quite right here, which is great. But I think it's important that we're always vigilant and always developing around some of this stuff as well. And I think one of the important things come in, just in general, like the trends in the latest legislation around AI ethics, and what have you, I think are going in a really good direction. We used to train people used to try to regulate specific use cases. And I think AI is going to become so pervasive, that doesn't really make any sense. What we need to think about is harms. So what's the harm of something being biased if I'm Netflix recommending a movie, versus what's the harm of saying biased if I'm offering a health care solution, but it is going to have a demonstrable impact on people's lives and the degree of scrutiny that you're applying to each application needs to flex based on Basically the risks that you're incurring by operating in that space. I know what I'm thinking. I'm wondering, what advice would you give to people who are in college or thinking about trying to have an impact, right? A lot of everyone's looking for? How do they have an impact? How do they make a difference? And, you know, people might not understand that, that this is another opportunity right there in terms of the work that you're doing, what guidance, what advice would you give people if they want to follow that kind of trajectory of career opportunities and in analytics. Oh, I would definitely say pick something you're passionate about. Because that, that kind of gives you that whole side. So I was talking a little bit about the data ethics piece, I mean, a lot of being able to spot what what might be problematic in the use case, or in inferential variable comes from having data scientists that are really engaged in healthcare. They're interested in the policy, their strategy, as well as the technical solutions. And there's kind of two models in general of doing data science. So one is, you kind of keep all your data scientists locked up in a dark room somewhere. And you've got this analytic consultant figure that goes between them and the business gathering requirements. It's fine, it's very transactional. But what we think is one that's not very satisfying for the data scientists. And two, it doesn't really give the optimal solution. So the data scientist will excellently solve the problem that set them, but we really miss them being in the room, around the table with the business, so they can actually help the business iterate on what the real problem we're trying to solve here is, and at Highmark, we definitely practice that partnership model, seeing our data scientists at the table, understanding the strategy helps the business understand the data in the analytics as well. So they trust it more. And ultimately, I think gets us much better solutions. And, I think, really phenomenal implementation rates. So one thing you see quoted quite a lot is data science projects, only like 30 to 40% of them make it to production. At Highmark, that number is much closer to 80, or 90. So we're really getting value out of this stuff. And to me, it's all about that partnership model. Now, that does create some challenges for us, because now we're looking out for not only data scientists with top notch technical skills, but we also need people that are interested in healthcare and strategy and can do the communication piece as well. But I'm proud to say like we've hired that throughout. And we've got a really fantastic team here, data scientists and research that physicians and analysts and data engineers and software engineers, strategy analysts, and product owners, who can all operate in that way. And I think that's one of the reasons we're so successful in just bringing this huge number of use cases to bear to transform healthcare. How many are in the team? Seems like you kind of quite the cruel obviously, that makes this happen. It's kind of exciting to lead a team like this. Yeah, we do. So we sit within the larger enterprise and data organized hate enterprise and data analytics organization. We specialize, as I say, in the sort of advanced analytics enter the market. So your data science sophisticated techniques, there's about 100 of us within the advanced analytics group. And that covers everything from big data analytics, machine learning and AI and natural language processing, but also out into what we in healthcare called core ideas, more commonly in industry, next best action, basically working out what someone's needs are, and then what the best way to meet that need is and then pushing that message into a workflow system so it can be actioned straightaway. We also do think about how we package that call to action as well. So using nudge techniques, a be testing to make sure when that call to action is out there for the next best action, it's more likely to be acted upon. And then we also do analytic evaluation analytics. So one of the things really important to us, is once we've triggered an action, we understand the benefit that both Highmark and the member and patient got out of that interaction. And we create this learning system so that... /episode/index/show/healthcarereinvented/id/26775381

Connecting to Your Doc is Just a Secure Text Away 04/10/2023

Connecting to Your Doc is Just a Secure Text Away Did you know that connecting to your doctor is literally just a text away? On this episode of the Highmark Health Care Reinvented Podcast Series, Benjamin Edelshain, MD , Vice President, Clinical Engagement & Digital Innovation at Highmark Health, gives us the whole story on how a secure mobile text messaging platform is building better patient-doctor connections for healthier outcomes. The platform was deployed at the height of COVID-19, immediately proving its effectiveness in a world where people could not easily meet with health care providers. Ben shares some encouraging and surprising stats on how many patients are using the platform and how text messaging has improved customer engagement. Discover how a simple text message is part of an ever-growing ecosystem of engagement tools to ensure access to care. Transcription: Welcome to Healthcare reinvented, exploring the intersection of healthcare and technology brought to you by Highmark, here are your hosts, the Pittsburgh technology Council's Audrey Russo and Jonathan Kersting. This is Jonathan Kersting. With the Pittsburgh Technology Council. This is the next episode of healthcare Reinvented, where we explore the intersections of technology and healthcare. Today's interview will be a lot of fun. It's a follow up from our previous season and today we are going to be talking to Dr. Ben Edelshain, and he's with Highmark Health. And I love the fact that that Highmark is finding ways for its patients and doctors to better connect and using technology where it makes sense. And in our first interview that we had was, I can't believe it's, I think, more than 18 months ago, and I'm so excited to follow up on this. It's all about just using the simple concept of using texting to talk back and forth with your doctor. And it sounds easier than you think, especially in the medical setting. So I'm excited to learn a the progress of it and some new things they might be working on and get some numbers around this as well, too, just to see how effective it's been. So Ben, welcome to the show today. We're so glad to have you. And it's great to reconnect. Yeah, Jonathan, thank you very much for having me. I'm honestly super excited to share some updates. And it's always great talking to you. And just coming back again, is a privilege and an honor. very humbled. Yeah. Looking forward to sharing some exciting stuff. And you know, following up from where we left off,. A year and a half ago, just flown by and you had a child. Congratulations. Thank you so much. Yes, we we had our second little Clara, and she's turning one soon. So very cool. Very cool. You got to be stoked about that. Absolutely. Very cool. So before we get things kids, I'm just refreshing our listeners, maybe are they forgotten or there's the first time listening, could you give us your background and what you do with Highmark Health. Very happy to do so. So I am Ben Edelshain. I've been with Highmark, for about four years now, I'm a vice president in our enterprise clinical organization. I'm originally from the UK, hence the accent and used to be a national health service doctor back in London, but been stateside for about 10 years. And so my responsibilities at Highmark Health include kind of trying to push us to be more tech driven, more consumer focused. And then operationally I run a department to telephonic nurses who support our customers, as well as care navigate navigation as well, helping members find the best possible care. That is interesting, that's gonna be a very rewarding job, because you're actually seeing the work that you do improves the quality of patients lives. It just, I think that's going to be so much fun. I say this without any sort of sarcasm, and I love working. And I see a lot of similar missions to, you know, socialized care where I came from our country, slightly different by country and in the US. And but I think in Pennsylvania and Pittsburgh, we're doing something special to try and change the paradigm. And I'm very excited to be part of that journey. So that's why I love having these conversations, because I think you said the right word. I think Highmark is doing so much to change the paradigm. I mean, the idea is using technology to empower people. And it's not just about the technology, because there's technology all over the place. But how you can apply it in a way that people can actually use it, and use it to actually make the experience better make their health better. That's why I thought it was so much fun when we first talked to you know, just detailing how using something as simple as text messaging, as a really effective way of being able to keep that connection going between doctor and patient, which is just so vital. Tell us more about how that kind of started up. And then really how this has been now it's up and running for more than a year and a half now. Yeah, so just if we rewind the clock, you know, even beyond, gosh, that year and a half ago, and you know, when COVID first broke out, right, and patients were rightly scared to go and see their doctors to engage in person with that health care. You know, what we discussed last time was we we challenged ourselves and said, Hey, look, we have this texting capability that traditionally use, you know, primarily for marketing purposes, right? We have adoption, why don't we try to juice it up and and use that one way messaging system and flip it to two way and then as people respond to us at Highmark, you know, let's have a nurse on the other end who's part of the benefit structure that I have or receives, and let's enable that nurse who's on the Highmark side, but to also be kind of that augmentative support for the doctor's practice. And, you know, for us that's, you know, really supporting our colleagues a lot to get Allegheny Health Network. But it's not it's not just a job. So that's, that's like I didn't think about is the whole point that this is actually a way to kind of help the doctor out as well too. Because if you have a nurse that's helping out, they're able to, you know, it frees up their time to put it where it's more important, and being able to then you but still give the care to the patient at the same time. So that to me, I think is really interesting. So the docs are probably saying, Okay, this is great, it's like a little relief valve that we can talk, we can learn about something going on before it becomes a serious problem that would require someone to come in to the doctor or something like that. I agree. And I think part of the strategy moving forward is, you know, as a former physician myself, I empathize with, you know, those still in practice where they're forced to have really short consultation time. Right, right. I'm sure as patients, we experienced that, where it feels like, you know, you have 15 minutes, and that's it. And so, you know, perhaps this evolves into what those other topics that you maybe can't fit into 15 minutes, and then, you know, take it offline, or actually take it online, right, and have it in a more digitally enabled manner, and at the convenience of the customer, right at the convenience when they want to talk about it. And so, I mean, we've so a year and a half has passed, we have had, you know, specific to these, what I would call like health conversations or clinical conversations, say, a nurse or other kind of professional, like a pharmacist or behavioral health specialist. Since going live, we've had 30,000 interactions. Wow. Yeah, that's, that's a lot. That's awesome. Wow. You know, and to put that into context, that's just one year that was lost. And, you know, we use texting for other purposes, primarily, one way, we send about 4 million texts. You know, it's starting to become a decent chunk of Yeah. So, you know, again, changing the paradigm so that the conversation you have with your healthcare insurer, but you know, really, we're an integrated system, but the conversation you're having is more about your health and wellness, and less about your benefits and your right cetera. Exactly. Just the fact that it just keeps you in closer touch with your caregivers, I think is just so important. And you can do it in a way that's not eating into the system and just wasting people's time. But it's like, no, this is a great way that you know, something's not right, you're concerned about something you're able to easily address it before becomes that bigger problem. It just makes me sick, more convenient. And it just, I'm curious, I think this is going to keep growing. Because I mean, the first year, I mean, 30,000 interactions. That's, that's pretty amazing. To me, I'm thinking this is gonna continue to keep building, and you'll probably find more use cases for it as well. I hope so. And we certainly have plans. And you know what? I like the elegance of the simplicity. Yeah, definitely. Text is essentially free. Right? And, you know, maybe your conversation starts with a text then goes into a secure channel where you're drinking bidirectionally. And maybe you decide, hey, I do want to talk to you, and then you set up a mutually convenient time. Exactly. My dream, my aspiration by the end of next year, is to eliminate any cold calling, that's not expected. That comes from a nurse for my health plan to okay, just like there is no reason why we can't achieve that. So, you know, part of where we're headed is okay. We think texting works. Well, we know texting works, right? I'll throw you out of fun facts. So you're familiar, obviously, as a technologist, kind of the click through rate terminology, right? industry average for texting, click throughs, about 15%, one, five. But when you start due to doing two way and having a healthcare professional on the other side, and picking the moments that matter to the customer, we're at about 30% click rate. Wow, you're doubling that. That's impressive. I mean, yeah, he's looking at a 30% engagement rate like that, click and through that you're having real conversations that I mean, this is something that people are in there. And the cool thing is when they have this good experience with it, they're gonna continue to rely on it, they're gonna see it as something that they can they can use. And I just think it builds a better relationship with your caregiver and makes you sometimes like less afraid. There's always that little bit that fear factor, the more you kind of start talking about something and the more you have to get the back and forth. I know for me, like just personally, I remember like, I've never liked going to the doctor, I remember being like, oh, I can do my virtual visits. And as I started virtual visits, I wasn't so free to actually go in and see the doctor. So I think it's it's a great way to kind of step things up as well to to get those of us who maybe have a little bit of the white coat phobia, I guess. You need an actual person that professional and, you know, maybe that comes into the a little nudge that says, you should really go see your doc. And, you know, the other added beauty over time is that, you know, with the customer, the patient's consent, like maybe we can prep the doctor right for the visit. So we know what's going to be top of mind. And what's the point? Yeah, that makes so much sense. Because like, yeah, if you're working with a nurse, and you had a, say, like a couple days of back and forth, and like, hey, why don't you come in next week, then that nurse can then provide that conversation, there's probably some detail in there that the Doc can look into, and really informs what he or she is able to, you know, do when it comes to treat the patient, and they're gonna, you're gonna get all that better care, when you're there seeing the doctor have a better experience? Well, and then, you know, as a blue plan that has a hospital system, right? So that interaction with the nurse can be transitioned into, okay. Why can't I just book you in right now? Because I have access to a very cool, true one call resolution, right? True, nice. This is all based on a very simple technology, which I think is just so awesome. Like, it's something that we're all very familiar with at this point. So Ben, tell me more about the engagement rate on this. I mean, especially across different age groups. I'm wondering, is there a difference between like younger people and older people using texting to talk with their doctors and nurses? Jonathan, that's a great question. You might actually be surprised on this. I think, you know, in our society, we have this somewhat unfair perspective, sometimes that older folks don't use technology. And what we found actually, is that when you have a healthcare professional on the other end of the phone, and you're doing two way texting, the highest engagement rate we're seeing is amongst the senior population. Interesting. I'm so happy to hear that. I think that we shouldn't underestimate kind of smartphone adoption amongst those 65 and older. And look, if you make the tech simple. And it works, and it drives again, drives value to the customer, we're seeing that senior, customers are engaging nearly double the rates that from folks who are under 65. Well, that is just fascinating. I'm curious, are there any extra security concerns around this being being that there's probably HIPAA stuff at some point, depending upon what the conversation is? Yeah, that's an excellent question, Jonathan. And I do want to make sure that it is clear to your listeners. So for us the text message, what you would see in like, iOS is the initial primer. And so it says, hey, you've got a message waiting for you. This is why it's also elegant, no download needed, it just opens up a secure browser. Gotcha. Which is like all sort of safe for the patient or the member opts in to say, Yep, I'm happy to keep going. And then, you know, we have very little security concerns at that point. Very cool. And he had the idea that like, yeah, you're not downloading something, or it's like, I can't do that right now. It just opens up the secure browser. And there you go, and you know that everything is safe. And there's there's nothing to worry about. Very cool. I mean, makes it sound simple. I'm sure it's very hard to implement. But obviously, the user experience is easy. And that's what it's all about using technology to make things easy, not complicated. We have a great partner, the company we work with is called Relay, and they have made our life very easy. I mean, I might have mentioned this before, but we went from one way texting to fully implementing two way and 12 weeks, which for any kind of tech project is like a backup. That's just 12 weeks. Oh, my goodness. Yeah, that's, that's very cool. Very cool. And also some added benefits. I think that, you know, we I think about a lot, maybe consumers don't is, you know, the amount of satisfaction this brings to the health care professionals as well, that are being more efficient with their time, it's more meaningful, you know, they can have, you know, multiple chats open, if that's the way they want to work, and then, but then kind of, again, not be cold calling necessarily and actively engaging folks, and just the scale at which you can help people kind of grows exponentially in a very low fidelity manner. I did. I didn't want to share one interesting thing with you. We did. This is a exclusive for your podcast. I like exclusive that's what it's all about. Come on, man. Lay it on me. So once we had the sort of texting apparatus if he would. We started thinking a bit about like, the words we use in that initial text, and we how we approach our customers, as well. Actually in in a world where unfortunately, you know people who scam innocent customers yes are doing more texting right and phishing, etc. So we decided it was it was after we last spoke it was kind of in the works, but we decided just after we spoke last time to partner with CMU, CMU. Sorry, Carnegie Mellon University. Absolutely, yeah. In our backyard. We partnered with Professor George Lowenstein, as well as Samantha Hall and Sammy, who's a PhD candidate. And they are both world renowned experts in behavioral economics. So as applied to healthcare, so the field being, you know, what are the words? What are what are the words, what are the kind of nudge tactics that you can use in a healthcare setting, to really empower an individual to be more engaged in their self care? Okay, you know, nudge tactics, for example, being kind of things like loss aversion, like, you know, you're missing out on benefits that are at no cost to you, people like you are taking advantage of this, why not engage with us? So we partnered on a project to start kind of seeing how we could tailor the words in our messages. And in two months, we increased our initial phone pickup rate by 16%. Just yeah, just by saying, hey, the nurse is going to call this customer this member, patient. Let's send a text an hour ahead of time, saying hello. says Hi, Mark. I'm calling from your healthcare team. I'm going to call you in an hour. Very interesting, huh? Okay. Alone, the telephonic pick up rate by 16%. That makes perfect sense. You're giving that little bit that warning. So And plus if you feel like you know that someone's caring for you, right, yeah, I mean, you know, that, like you're, you're being looked after, and then you got the warning that like there will be a call coming. And it's a legit call. It's not gonna it's not a telemarketer trying to like, upgrade you on something, and it's just never heard of. Yeah, that's awesome. So we've, I mean, again, like you send the text set an hour ahead of time, maybe the person that's the beauty of a two way system is they text back saying, Hey, I'm busy in an hour. Can you do 6pm This evening and say, Yeah, sure. But we're very excited about this collaboration with CMU. We're sort of working on some other plans. And with a view to publish in the academic literature. We think this is a joint partnership between Highmark and CMU. And we think, you know, again, it makes me sound silly to say groundbreaking and texting in the same sentence. But I think we might be onto something. No, I would call it groundbreaking because you're using a very simple and established and safe technology and using it to empower people to better take care of themselves. That's awesome. To me, I think that's something that the team should be super proud of. And that's why it's so much fun having these conversations, because, you know, over the years, we've been doing these with Highmark, looking at how Highmark works with the Carnegie Mellon with outside vendors that are taught that their games, taking that technology, and focusing it down to where it actually helps the patient. That's just tremendous. And that's why it's so much fun to explore these conversations. That's why I'm so glad I got to have an update with you, Ben about what you guys are up to because it's like, wow, you're getting people there actually 30,000 people using this, your great open rates, click through rates and people picking up the phone because they got a text message an hour before the call was going to help it. Let me leave you with three kinds of additional teasers. Definitely. You know, one is we're working, in fact, the technology is live, we're just piloting that, to take it one step further, which is kind of the texting, that leads to a conversation that leads to a scheduling module, schedule the time just like you would with a doctor, just like with Open Table, right, like, but with your nurse. Right. So that's going live this year. The second is, you know, this, we're seeing good kind of engagement with employers, right people who provide health insurance and sort of, you know, they see the value,... /episode/index/show/healthcarereinvented/id/26495547

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Health Care Reinvented: Telehealth Expands Care If there's one silver lining to the COVID-19 pandemic, it is the accelerated adoption of Telehealth. In the next AHN/Highmark Health Care Reinvented Podcast, get to know Highmark Health’s Laura Messineo, RN MHA, Vice President, Enterprise Virtual Health, as she discusses the key uses and trends with Telehealth. Under her leadership, Highmark is growing its virtual health capabilities to not only keep members and patients connected to their doctor, but ensure that quality health care is available to more people. You will be amazed at the technologies that bring a doctor's office right to a patient through virtual appointments. Even more exciting is how fast the technology is evolving to put ever more tools and capabilities in doctors' hands to treat patients remotely. If there's one silver lining to the COVID-19 pandemic, it is the accelerated adoption of Telehealth. In the next AHN/Highmark Health Care Reinvented Podcast, get to know Highmark Health’s Laura Messineo, RN MHA, Vice President, Enterprise Virtual Health, as she discusses the key uses and trends with Telehealth. Under her leadership, Highmark is growing its virtual health capabilities to not only keep members and patients connected to their doctor, but ensure that quality health care is available to more people. You will be amazed at the technologies that bring a doctor's office right to a patient through virtual appointments. Even more exciting is how fast the technology is evolving to put ever more tools and capabilities in doctors' hands to treat patients remotely. Laura Messineo is a dynamic nursing leader in the healthcare industry. Her innovative nursing leadership skills enable her to successfully align corporate strategic goals to operationalize clinical and financial targets. With over a decade of experience within the telemedicine industry, Laura has proven successes implementing telehealth solutions to drive performance and financial metrics. Laura speaks nationally on a variety of topics and sits on various professional boards. Listen to this fascinating conversation and peer into the future of health care today. /episode/index/show/healthcarereinvented/id/18692372

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Health Care Reinvented

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