Ingram Micro Ep#13 Why Being Behind on Health IT Might Be Rural Health's Biggest Advantage

John Meyer: Welcome to Health Reimagined. I'm John Meyer from Meyer Media, powered by Ingram Micro. While major health systems have spent years and billions modernize their technology, Royal health organizations often watch from the sidelines, unable to keep pace. But here's the twist. The gap might actually be an advantage. Today's topic, why being behind on health. It might actually be Royal Health's biggest advantage. Please join me in WELCOMING Dan from InfoCAP to the show. Thank you so much for joining me.

Dan: Hey John, good to see you again.

John Meyer: Dan. Before we kick things off on our topic, how about you tell us a little bit about infocap? Sure.

Dan: Yeah. So, uh, uh, infocap AI is where to find out more about us. And we do intelligent document processing and what we call human centric automation. So it's basically we help to bridge the gaps on. Even companies that spend billions of dollars on technology, they're automating pieces. And then there's always. Well, here in Massachusetts, we could call them potholes, gigantic potholes in your automation. And what goes in there, you throw people at the problem, you do things manually. And that's where all of your other planning kind of fell apart. So we help to bridge that gap so that you make your overall automation just sing like it should have been in the first place. But the nature of the way that procurement of big tech stuff happens, you just end up with these gaps. That's sort of unavoidable.

John Meyer: Now we're talking about approvals, whether it's automation, whether it's using a manual process. Why don't you talk us through how a typical approval process works within the healthcare industry?

Dan: Yeah, so there's definitely some, uh, some extremes here. It can be very streamlined, very integrated. Uh, it could be. In the case of Metro Health, you know, there are billing teams that handle doing the entire process of submitting the, the approval request, uh, uh, prior approval request to get some kind of treatment or be, uh, a drug or whatever. And they could have 500 people that do that. Which seems slightly insane when you're saying it's really. How do I get this machine to talk to this machine? So, uh, a doctor, a fish pharmacist, whatever, submitting that I need to, you know, the patient needs this. It goes over to this side. That should be, it seems like it should be a thing that could be automated because it's. This healthcare industry is not new. So it's been around, uh, automation has been applied, but there's some gaps on the rural health side, uh, when they get a response back, it's uh, you know, it says denied. It's not the final word. You can appeal that. And that's a whole process too. So uh, the, the denial might, might come literally back into a fax machine on a desk. And I thought for sure that uh, when I first accidentally got in this industry, uh, for uh, document processing that I, the faxes would be dead long before now, but they still exist. And whether it's actually printing out a piece of paper in front of you or comes into an electronic inbox as a fax, it, it piles up and it's one of five jobs that somebody's doing is to continuously check for these uh, denials and then react to them. And that is, uh, it's, you know, for, for me, I got into tech because it's supposed to make our lives easier and let us focus on the things that actually matter, which is in this case the health care. Let's get people healthy, keep them healthy, get them out of the hospital, get them on the way to recovery and not have a bunch of people having to act essentially like they're human robots. Because that's. Some people maybe are better at doing it than others, but so they really have to do it.

John Meyer: Dan, when you talk about it, that's. While it has some automated and some technology involved in a process, there's still manual process to be in prior denied when you're trying to get those authorizations.

Dan: Yeah, yeah, yeah. So it's um. And one of the things that's fascinating to me is that it doesn't require. So doing an appeal does not require like a law degree or you don't have to be a doctor necessarily to do the appeal process. That can be handled by staff. But when you're under equipped to even keep track of these things, there's a timer on every denial that if you don't respond and file an appeal in time, you can't get that money back. And the money comes then out of the pocket of the rural high health system itself. And this, it's, you know, it's a vicious cycle where they're already underfunded, they're getting dinged, they're essentially kind of bleeding out on their budget because they have not been able to do the appeal process. And maybe they already went ahead and did a procedure or prescribed some medicine or whatever it was. And now the money has to come from somewhere. So it comes out of their bottom line. And that's um, to me that seems tragically bad and we should try to avoid that. So again, people can avoid you Know, they can focus on get people healthy, get them well, get them back to whatever it is that they wanted to do and were doing just fine before they set foot into a health, uh, care system.

John Meyer: Dan, actually you touched on it right away is that they've already done the process, the procedure, or they've subscribed some, uh, prescription out there. It's already in the hands of the customer, the consumer or the company. And now what happens is that they got to go back and appeal the denial that came through. But that person needs that or they needed to do that medical procedure. So now it's a vicious cycle of going back and forth and focusing on trying to do, process that claim and try to get that authorization when they're already done with it.

Dan: Yeah, yeah. And it's tricky. I mean, you know, as, as health professionals, you do no harm. You're supposed to be, you know, your whole reason to exist is to make people healthy. And um, are you going to take a chance that it's going to go through eventually? I mean, it tends to often, but, um, you know, you can get stuck in a bit of a loop there. And there's actually a case in West Virginia and I'm just going to look up the, the name because I'm, I'm terrible at remembering names. Uh, Eric Tennant in West Virginia. Uh, he, he died. Uh, and it's because of, uh, uh, cancer treatment that was sort of experimental, um, and certainly not mainstream, but it was well within the medically, um, sufficient, uh, sort of, uh, world. And um, the insurer kept denying the, the appeal. Deny, deny, deny. Eventually it went through. Uh, there was a big push from the state. It got to the right people to make it happen. But he died about a month afterwards after he was finally, uh, able to have the procedure, uh, done and have the medication done. And he actually couldn't at that point. The cancer had advanced enough that he couldn't, he couldn't actually use that medication, that treatment. So there was actually a state law passed that was unanimously passed, uh, to do reform of prior authorization so that these, what was seen like abuse is not actually allowed anymore, at least in West Virginia. And hopefully that's going to spread around the country.

John Meyer: Well, Dan, this wouldn't be a conversation. We didn't talk a little bit about AI and we know that payers are using AI to deny claims faster. What's happening on the provider side?

Dan: Yeah, so it's uh. So we could call it David and Goliath. We could call it, um. For those of us who Are uh, Gen X. And remember Crocodile Dundee. There's the famous scene where Crocodile Dundee, somebody's trying to stick him up with a, with a relatively small knife and he pulls out his gigantic Aussie knife and says that's not a knife, this is a knife. You know, it's not an even playing field. So uh, you know, large uh, large uh, payers, uh, insurance companies uh, are well entrenched in automation because they have to be. And you know, is it on purpose that they're using automation and AI to deny. That's an open question. Uh, certainly lots of opinions on that. But realistically they are better equipped to deal with high volume things that are going on as part of the whole healthcare insurance process. So their ability to you know, they have staff, they have technology, their ability to basically pummel, um, rural health providers especially, they're already underfunded, they're understaffed. There's lots that they're trying to do including just keep the lights on and make sure they're. There is an emergency room that's within 30 to 60 minutes of most of the population that they're serving and those are much more serious deals. So this um, they're kind of getting machine gunned by the ability of just technology to pound on them, to deny appropriately or not and then chew up their time in responding which takes about 38 minutes on average statistically. Uh, and the worst part of this to me is that uh, denials are uh, if they are, if they have the time and the ability to do it within the time frame of the, the uh, deadline about 80, slightly over 80% of those appeals are successful. So it's not a matter of, it's not like this isn't abuse on the side of the providers. They're not, they're not, they're not doing unnecessary surgery. They're not like going to town trying to over prescribe things or you know, produce different kinds of um. They're not doing it just to get practice on a certain kind of surgery. Right. So how do you, how do you keep them focused? And um, a lot of them have given up because they, they feel like it's been, this is the same thing. It gets denied every time and they have other things they need to do that's you know, more emergency driven and then the time just expires. So it's really to uh, us, you know, what gets measured gets worked on. If you don't have a system that lets you make sure you're at the least on top of these and can Respond in time and do the actual response. That's step one. And then we can go another step beyond that to actually use AI on the provider side in rural health so that they can also be equipped with the stuff that's, you know, it's essentially, it's the administrative burden is usually the term that it's called. And that's not what they should be focusing, you know, their hours in the system doing.

John Meyer: Dan, Royal Hospitals are typically way behind on technology. Is this actually a disadvantage or couldn't it be an opportunity for them?

Dan: Yeah. So, uh, I think it's really interesting. So I, you know, I'm a, I'm an early adopter kind of guy, so I like to see what's coming with technology and get involved way before it's fully baked. For some reason, I have that form of insanity. And a lot of people that I work with are similarly inclined. Right. So you, you know, the newest, used to be the newest iPhone that came out. I had to, I had to get the newest iPhone. Um, you know, the newest wave of enterprise technology, the kind of stuff that we're talking about. I want to be involved in that to see where we're going and figure out how to get people from, from here to there successfully. And, uh, what I found, and actually I called it slingshotting in my book in 20, uh 14, the Gen Z effect. And slingshotting basically says if you wait long enough, then everything will be ironed out. Uh, all the bugs will be gone, it'll be dramatically cheaper. You know, it used to be that, um, you know, if you look at the history of cell phones, for example, it used to be gigantic bricks that were hardwired into, you know, your desk or your car. You didn't stick them in your pocket. You'd have to have the world's biggest pockets. Right? So, you know that, that early. The earlier waves of technology innovations are big and chunky and expensive and complicated, and they're only for the people that are crazy like me. Everybody else should wait until, like, uh, the case study in the book was iPads were, for hundreds of millions of people around the world, the first computer they ever had. Because it finally was to the point where it's in my hand, it's portable, the battery has a long life. It's crystal clear and very sharp. You can use your fingers. You don't have to use a mouse, you know, nothing. You're just using your, your voice, uh, your hands, and, and that's it. And suddenly you've jumped over 30 years of technology to go from programming and, you know, a command line on a green screen to, you know, whatever it is that you want to do on your iPad, you can. You can now do it. So there's all that interim stuff where you spend a lot of time and money trying to figure out how to get very simple stuff working is now totally baked in there. So for rural health, because they don't have all of the legacy stuff that is, in a lot of ways, it's like, um, it's like a blockage essentially within, uh, within the larger healthcare systems, the moment they touch one thing, some ripple effect happens. In these other systems that are usually, you know, 10, 20, 30 years old, and they're. They're kind of creaky, so they want to make a change. It's hideously expensive. It's very complicated. Everything has interconnections with other things. If you're starting from essentially nothing, you can jump straight to, oh, yeah, this is exactly what the big boys, uh, created, but at a price that's radically different, and it just works. And it doesn't require having staff purely to manage those systems.

John Meyer: Dan, originally you talked about the appeal process that 80% actually get approved after they've already been denied. But can't we just eliminate some of the denials to begin with?

Dan: Yeah, yeah. So I think this is, uh, it's a fun exercise, and I keep coming back to it, and it kind of surprises me how powerful. So, um, when we're doing consulting work and, uh, you know, I've been an internal consultant, I've done lots of consulting to outside organizations like we do these days. And usually one of the questions towards the end of, like, living in the situation that you're trying to help improve, you'll ask people, you know, if you could wave a magic wand and make one thing permanently go away or improve so that you never had to worry about it again. In this case, if you can create the prior, uh, approvals in advance when you're asking for, hey, this patient needs to have this surgery, and then there's a laundry list of things that have to be provided in specific detail and from different systems and all sorts of confirming data. Right. And, uh, if you can draft that and write it so that it's essentially perfect, then it should get instantly approved and you don't have to deal with denials anymore. And there's actually. It might be in West Virginia, I don't recall there was one state, as a result of the more recent, um, legislation, uh, that's happened that's driving all this for rural health transformation. It's a gold card program which means if you uh, as the provider, if you get to the point where your approvals are, I think it's more than 80 or 90%, um, you have approvals instead of getting a denial back then you no longer have to specifically submit uh, certain kinds of approvals anyhow. You're given a golden card that says you're good for this, you don't need to bother it because it's a waste of time. Now if we can get to that for all situations and hallelujah, you know, we're actually, we're seriously empowering rural health systems to do great work with as little busy work as possible and none of this, you know, gut wrenching cycle that they often get stuck into.

John Meyer: Dan, my last question for you. What does good enough look like for royal facilities that actually can't afford a million dollar IT project?

Dan: Yeah, so I think there's a, there's a huge benefit to uh, just take it, you know, one step at a time. Uh, I often use, for anybody who's been to Disney World, Disneyland, they, they use some really simple things to measure the passage of time and do they need to open up more lanes and do they need to update the, the signage, all that kind of stuff. And because this is how I'm wired, uh, you know, I happen to be the guy in line where they gave me a red card that I was supposed to hold onto and give to one of the interim people down the way so they could measure that time. And I've now used that in many situations, essentially that same idea where to automate, uh, any process like these, um, prior approvals you insert into your stack of paper. You insert a red sheet so it stands out and you measure that, you know, the amount of time. What we thought when we were first tackling uh, prior, prior authorization as a problem was the uh, time efficiency on the, on actually doing the, the, the appeal, um, or submitting the initial appeal or the um, you know, the initial request. But it's really the, the bigger opportunities, as I mentioned before, is if you can save all of these costs that are going to come out of your budget, if you let these um, the appeal deadlines pass, then that's money you can, you can plow back into the system to hire doctors so that there are more people in that region to open up, you know, urgent care and other programs and that um, you know, there's sort of a double edge there. One, it's very simple to just track the deadlines and help to automate just that piece that buys back a whole bunch of budget for you, frees up some mind space for the people who were otherwise, you know, juggling stacks of paper and uh, that sets a foundation so that you can then go beyond that and start getting into what's, you know, the more fun stuff, which is automatically drafting appeals back that only have to be verified by a person to, to make sure that there's, it's all kosher and nothing got, you know, got twisted in there. That is, you can go based on the slingshotting idea. You can jump to that once you have a foundation and that foundation does not have to be complicated and it can potentially be put in place in, you know, 30 to 60 to 90 days maybe. And then you, you have that and you build on top of it and then suddenly, you know, you feel, you find a whole lot of relief for your staff who are not just frazzled from this whole process.

John Meyer: Dan, I gotta thank you for joining me.

Dan: Yeah, John, thank you so much. It was good to see you about a month ago and uh, hopefully I'll see you again.

John Meyer: Likewise. To learn more about infocap and how they're helping organizations make work easier through human centric automation, visit InfoCap AI. Whether you're in healthcare, government or finance, there are co innovating solutions that empower your team, not replace them. Great conversation today and stay tuned. There's more to come on health reimagine.