Gregg Masters 00:07
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand messaging alive via original or value added digitally curated content for omni channel distribution and engagement. Connect with us at www dot pop up studio dot productions Welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co host of PopHealth Week. Joining me in the virtual studio is my partner, colleague and lead co host of PopHealth Week Fred Goldstein, President of Accountable Health LLC. On today’s show, our guest is Tim Suther, Senior Vice President for data solutions at Change Healthcare. Change. Healthcare is a leading independent healthcare technology company focused on insights, innovation, and accelerating the transformation of the US healthcare system. Tim has a wide portfolio and is responsible for the overall management direction and leadership to the data solutions business including its focus on inspiring a better healthcare system through the effective and responsible use of data and analytics. So Fred, over to you help us get to know Tim’s work at change healthcare.
Fred Goldstein 01:18
Thanks so much, Greg. And, Tim, welcome to PopHealth Week.
Tim Suther 01:21
Good to talk to you again. Happy Wednesday.
Fred Goldstein 01:23
And thanks so much for joining us on the show. We had a really fascinating discussion prepping for this thing. So I’m very excited for the opportunity to talk with you. Why don’t you give us a little bit of an introduction of yourself and Change Health?
Tim Suther 01:34
Well, Fred, it’s always a pleasure to to talk with you and even more so to to talk about Change Healthcare and what we’re what we’re doing. So Change Healthcare is arguably one of the most connected companies and healthcare in the United States. We are the backbone for virtually every hospital, every doctor, every pharmacy, every dentist, every health plan. In America, we play a critical role in routing, financial and administrative, you know, transactions. And we like to think of ourselves as a transformative platform company. And we do all of this so that we can enable better customer experiences. After all, we do this offer for patients. So we should work harder on making that experience more meaningful and valuable to them. We want to ensure efficient and accurate financial transactions. And we want to help our customers optimize decision making all of that to help improve outcomes and health economics. So a little bit about me, I was going to answer the the other part of the question. So I’ve been with Change Healthcare. About three and a half years, most of my professional life has been in the data technology and analytics space, largely in financial services and advertising. As an entrepreneur twice, I work for the largest bank in the United States, one of the largest consumer information companies and all of that was focused on putting data to use to do better advertising to help people buy yet another tube of toothpaste and, and at financial services to help people have yet another credit card. And like all of us, I grew increasingly concerned about the state of health care in America, you know, we spend twice per capita any other developed country, we ranked number 43 in the world and life expectancy. And I had the silly idea that we might be able to take what works in data and analytics and other industries and applied to healthcare. And that, in short, is what my my my remit is here to Change Healthcare.
Fred Goldstein 03:45
It’s interesting because one of the things that we’re keep talking about is bringing in these techniques, tools, etc, from other industries and bring them into healthcare, hoping that we can ultimately fix health care. How have you seen that functioning? Are you beginning to see the impact of some of those in the work you do? Well,
Tim Suther 04:03
the biggest idea is what the industry calls social determinants of health. It’s, it’s widely reported that up to 80% of our health and wellness are affected by social determinants of health. You know, sometimes that’s the circumstances of life sometimes that you know, healthy or non healthy behaviors. They all have a an impact on our relative health and well beings and correspondingly they have an impact on the economics and outcomes in healthcare. So, sadly, though, the health care system organically does not do a great job of collecting that information. So I saw it as an opportunity to take what I learned in the advertising and financial services world, this deep understanding of people, their geo demographics, their attitudes to integrate it with the clinical and claims information that exists naturally in healthcare and we’ve spent a good portion of last year, working on the engineering to make that scalable.
Fred Goldstein 05:05
Yeah, and we should talk about is sort of a natural for the businesses outside of healthcare to have been looking at this data, gathering it to help better drive consumers to purchase things or stuff like that. And so you’re taking it now. And I know in the fall, you launched this new social determinants of health analytics platform. Tell us a little bit about that, and what it does.
Tim Suther 05:25
So again, our the the objective was to resolve an underlying data gap, you know, so if so much of our health care, our health and wellness is determined by social determinants of health, you have to ask yourself, Well, why why isn’t it naturally available in the healthcare system? And I don’t know that there’s a great answer to that other than there’s, you know, differing priorities that exist in providers and payers. But all the same, we wanted to correct that. So there are two things that we were focused on doing one was reliably connecting what we see naturally every day in the healthcare system, which is claims with the major social determinants of health. So we, we now have about 117 million Americans where we can connect their descriptive attributes, so their ethnicity, their income, their wealth, their health literacy, housing vulnerabilities, transportation, food vulnerabilities, the major social determinants of health, we can connect those to the claims that are naturally flowing through our system every day. So it gives us this rich mosaic of connecting what happens in the doctor’s office with the circumstances of life. So that was the path, the major innovation, the other half is making sure that its use is always on side with HIPAA, which is one of the barriers that you face. So there are a lot of constituents that are interested in this, your clinician should know what your health plan should know it. But those doing research and trying to determine the effectiveness of new therapies and interventions, they too should know it. And those in particular, have challenges of making sure that de identified information about patients stays that way. Because when you start to connect, de identified clinical information or claims information, with the social determinants of health, you mathematically are likely to increase the odds of re identification. And that brings with it civil and criminal penalties. And that has had really a depressing impact on those who want to understand the variances in health outcomes.
Fred Goldstein 07:42
So you’ve sort of set it up so that the backside essentially allows for that data to link up without being able to identify it. How do you see it? How are you pushing that data out to providers? I know, there’s three different ways you can use that data. And then what are they doing with it?
Tim Suther 07:59
Well, two out of the three, the data never leaves change healthcare, you know, because when you’re talking about information that is highly sensitive, so a diagnosis or care that’s been rendered, and you’re adding social determinants to it, you know, you need to treat that information with with care. So two of the three services, it never leaves Change Healthcare. The first one is something that we call a social determinants of health portrait. So any payer, any provider can identify a particular population cohort, and we will go do the analysis to determine which social determinants of health attribute matters most for that population. So we’ll tell them, which attribute drives more emergency room visits more inpatient admissions, or outpatient visits, it’s a great way for payers and providers to look amongst a sea of alternatives to prioritize which attribute matters for the population that they’re most concerned with. So in that circumstance, it’s just a report that we do that helps an organization prioritize.
Fred Goldstein 09:07
And go ahead when you think about that, it’s really a factor that’s associated with that population, seeing, say, for example, higher ER visits. So we’re saying, well, it’s a transportation in this population that seems to be the most associated with that. And then the providers can then take that information and use it to implement programs up against it is that essentially
Tim Suther 09:25
Yeah, that’s right. So it’s so as an example of those that have low economic stability, they’re more likely than than average to visit the emergency room and to be hospitalized. If you have high economic stability, you’re more likely to engage with outpatient care. It’s well reported that those that are of color are more likely to be diagnosed with COVID and then ultimately to have a bad outcome. So understanding those variances by particular population segments, allows both provider and payer to You know, implement programs that are targeted that attribute, as opposed to trying to deal with social determinants on this abstract, you know, conceptual level,
Fred Goldstein 10:09
right. And then I guess the next step would be to take that say, we have this population, we’re going to focus on as you said, maybe it’s transportation or food or one of those issues. And then it’s determined at an individual level within that population by the provider group. Okay, now we know that Fred Goldstein is actually has one of these issues, and we’re going to go work on Fred’s transportation or something like that.
Tim Suther 10:30
That’s right now you can use it if you’re a health system or provider to help prioritize what you might do with community based programs, you have an accountable care organization arm to now it’s really starting to affect reimbursement so you can identify steps that you can take to better manage that, if you’re a health plan, you can incorporate that into your member engagement programs. If you’re a life sciences company, you can account for that in your adherence outreach program. So the list is, is pretty, pretty endless,
Fred Goldstein 11:06
right. And then the second way this data is, is given out to providers or payers.
Tim Suther 11:11
The second one is for the data scientists in the world who want to understand a patient journey or a member journey if you’re a health plan. And the idea there is to model the progression of patients diseases members, which leading organizations are doing already, but in this way, adding the social determinants of health dimension to it. So it’s not just a simple report, but rather, something that a health system can do to make a prediction about whether unfortunate circumstances are likely to befell a patient in the future, whether if you’re a health plan, understanding whether the member journey is steering off track, Life Sciences company, whether or not there’s a, you know, an adherence issue, and they do all these things today, but they largely do them based on clinical information. And what we’re trying to do here is to add the dimension of what is going on in the rest of their life, which is, you know, 99% of their life, and incorporating that into the decisions that all these organizations are already making, you know, every day,
Fred Goldstein 12:22
yeah, it’s essentially a greater way to risk stratify that population, you know, you think back to the day when we would say, Okay, one or more hospitalizations, and two or more ER visits in the last 12 months, and that’s my high risk category, you know, and those were the simple days, and then you added more data. So now you bring in the social determinants of health, which really are those underlying fundamental drivers, allowing people to then better segment their population, and understand what that go forward risk is,
Tim Suther 12:46
yeah, we’re trying to unpack the average, you know, it said, if you have a foot in boiling water, and the other foot in a bucket of ice, on average, you’re perfectly comfortable. And in a way, that’s how outcomes are being measured to, they just are not breaking down the variances of the circumstances of life. And understanding those variances are really key to helping patients have better outcomes, and for all of us to improving the economics of health care being delivered in this country.
Fred Goldstein 13:16
And then the third way you’re producing these,
Tim Suther 13:19
the final area is for those organizations that have gaps in their operational flow, so a health system or a health plan, and you actually want the social determinants of health made available in your workflow. But we’ll do that too. So we’ve done the hard work of integrating at a individual level. And if you’d like to, as a health system, have that information available in your EMR system, fantastic. If you want to do it as a payer, in your care management system, no problem, we’ll help supply the information and support you in the integration of that information so that you too, when you’re interacting with a patient or a member, you actually have the external information available available to
Fred Goldstein 14:06
that’s really fantastic. Because I know a lot of people have been saying, Yeah, we really want this data, this we recognize the value of this data, but how do we get it? Where do we get it. So putting that together in one shop and being able to use a because you’re already in healthcare integrated into their EMR or other systems is really a fantastic way to go.
Tim Suther 14:23
That and it’s actually hard to contract with healthcare. So one of the virtues of Change Healthcare being so interconnected with payers and providers and pharmacies all across America as we already have contractual relationships. So, you know, adding yet another service to what we provide to these organizations already is much easier, you know, given given that we have these contractual relationships already in place,
Gregg Masters 14:50
and if you’re just tuning in to PopHealth Week, our guest is Tim Suther their senior vice president for data solutions at Change Healthcare. Change Healthcare is a leading independent healthcare technology company focused on insights, innovation and accelerating the transformation of the US healthcare system.
Fred Goldstein 15:07
And given that you launched it last fall, I believe it was, how are you seeing that being used? Are there some examples you can discuss? Or things? Or is it still too early?
Tim Suther 15:16
Well, we have dozens of academic medical researchers across the country who are exploring the intersection of social determinants and COVID diagnosis. You know, as we talked about last time, we felt it was really important that, you know, the smartest medical data scientists in America have access to up to date information on the, on the status of the pandemic, and, and every day, you know, we get new tests, new diagnosis, new inpatient, admissions, new discharges, and we’ve intersected that with social determinants of health. And these these folks are, they’re not bored, and they are extremely creative. So they are examining by various disease states, they are looking at various interventions as to whether or not they work, they are looking at how care is, is shifting, you know, from care settings, to virtual care, that that type of thing. So a good number of these academic medical centers have incorporated social determinants into the the work that they’re doing, and it touches everything, there’s, I don’t know, probably 150 ish, you know, different research projects that are, you know, presently underway, some of them have been published. The other thing that’s important is we are working with a very major health system to explore health disparities across you know, the United States, and in particular, looking at the role of ethnicity into health outcomes, both in terms of cost and utilization. And, you know, later on this year, we we intend on releasing not just the identification of the disparities, but as importantly, the identification of interventions that are meant to do something about that. So we’re very, very excited about the possibilities of that becoming, you know, standard of care and health care.
Fred Goldstein 17:21
It’s so interesting, because we’ve looked at this issue, and it’s we know, it’s out there COVID obviously highlighted it to an incredible extent, Gregg and I focused on a number of shows around health disparities, etc, associated with COVID. And, and obviously, brought to the fore by this disease and the pandemic. And but but what you said is really fascinating, because the end of the day, you want to measure true outcomes, we know there are issues, so did the programs that were put in place actually show improvements, and whether that’s based on as you talked about clinical examples, maybe looking at some treatment approaches, or social terms of health targeting, and things like that, I think are all going to create amazing opportunities for us to try to fix the healthcare system. So hats off to doing that it’s really a great example of how we could successfully use data to make a difference.
Tim Suther 18:09
And we’re trying to take the friction out of doing it. So not being having been around healthcare all my life. But being quite knowledgeable of data and analytics, I’d never quite understood, why is it that this dimension that has such an outsized impact on our health and wellness, why why hasn’t it been incorporated in decision making and health care? And the answer is, it’s just been too hard. You know, whether it be technology, whether it be operational, whether it be the regulatory environment. So working for a technology company that understands governance, and has a lot of data scientists at our disposal. And we spent a good portion of the last year engineering solutions to this. So we recognize that it’s hard. And what we what we’re trying to do is to help organizations prioritize amongst what seems like an endless list of potential things that you could incorporate in terms of social determinants, to prioritize them, have an environment that’s available for those that want to do some advanced math, and then make it easier to incorporate the results in their operational workflow. So that all this hard work that we’re all doing shows up at the point that matters, you know, the moment of truth is that interaction between clinician and patient, and that’s what we’re trying to, you know, trying to inform and support.
Fred Goldstein 19:37
And providers have been under really a huge I don’t want to use the word assault, but it’s been a major change as the system tries to change and move to value based care. And then you throw on top of it, integration of IT platforms and then you throw on top of it social determinants of health. How is the response you’re getting from the provider community, I get a sense the payer community and prticularly one of your surveys I saw is it’s further along in that move to value based care in social terms of health care providers, beginning to say, yeah, we want this and need it, or is it still a little bit early from your sense?
Tim Suther 20:10
I think it varies anytime that you’re talking about the diversity of, you know, providers health system versus primary care versus, you know, virtual care. So I think it, you know, does does vary, but what excites me is the work that we’re doing with this major health system, they are absolutely on the forefront of looking to transform the way that healthcare is, is delivered, I mean, it different people experience healthcare in different ways. And there is a substantial portion of the population here in America that is does not have the same experiences you and I do. And we should do something about that and doing something about that first means, you know, getting clarity on the magnitude of the problem. And that problem is going to vary by disease state, it’s going to vary by geography, both parts of the country, and whether you’re urban or rural, or suburban. So it isn’t, like there’s an easy button here, you know, where we just have one answer. And magically, you know, everyone gets, you know, much improved health care, it’s just going to vary. And what we’re trying to do is to make it easier to do that. So I, I would project that when the results of this work with this major health system becomes public, later on this year, I think a whole lot of providers are going to get religion related to this.
Fred Goldstein 21:41
That’s, that’s really good to hear. I think about what you said, and to get back to that point, how all healthcare is local. And, and so even within localities, you have health care systems that treat extremely different populations within their community. And so obviously, the social determinants of health being targeted by one health care system in a community may be different from the other, depending upon which parts of that community they’re serving. So until they get that better sense of that, obviously, they can’t then drive those community based improvements, we’re looking for what most excites you about what where we’re going with this information,
Tim Suther 22:16
the opportunity to help people’s lives, you know, it’s easy to look at it and say 80% of our health and wellness is affected is impacted by social determinants, and there’s certainly a direct economic cost to that. But that pales in comparison to the suffering that, you know, individual people have people can be living longer people can be having more fruitful lives. And, you know, if we can use these services to help people, you know, head off, you know, worse health outcomes. Wow. I mean, I don’t think I don’t think it’s any better than that.
Fred Goldstein 22:53
Right? And let me ask you that your your set of data is across all types of payer sources and populations, is that true? So Medicaid, Medicare, commercial,
Tim Suther 23:02
where we do business with Medicaid and Medicare, but the the vast majority of the information we have at our disposal comes through commercial settings. So we, you know, we see claim information on virtually every commercially insured person in United States, at least one claim, at least, that’s what our analysis in 2020 indicates. And you know, what we do with those that want to do research for access vulnerabilities. So I want to project what the healthcare experience might be for Medicaid or Medicare, we have enough of that data. So millions of people who have claims that are Medicare, Medicaid, we have enough of that to be able to normalize to any population that an interested researcher would would like to explore.
Fred Goldstein 23:55
Right. So they could take that and then apply it to that, because obviously, you know, we know that big social disparities, particularly the Medicaid population, that we’ve been working on for a long time, and I see a lot of companies now targeting that. So getting that unique information would obviously be a benefit to those groups, whether they’re payers or providers in that space.
Tim Suther 24:14
Right. And, you know, we have information on people, right, so we have information on those that have that we’ve seen a claim on where we have rights to de identify, but we also have information on, you know, virtually every person in America where we have, because that’s what geo demographic information is. So having the ability to link that up with the claims experience allows us to understand the makeup of the health population in any geography and in the United States, whether or not they’re receiving care from change healthcare.
Fred Goldstein 24:50
And from a technical perspective, did you go out and just begin to pull these various data sets together to create that overall model?
Tim Suther 24:59
So One of the great benefits of having spent a lot of time in financial services and advertising. I know, I know the sources of data, I know what to what to look for. I know processes that are best in class for ensuring accuracy, ensuring that they remain updated. So we evaluated lots of different providers. And we did, we did select one. But the hard part of all this is not locating the data. That actually is, is relatively easy. The hard part is integrating it. Because in healthcare, healthcare is, you know, highly fragmented in its delivery. So first of all, making sure that you know, this, Tim Suther, there is the same as that Tim Suther there is that, you know, that that just gets referred to in different ways in healthcare. So that has to be normalized. And then to connect it with information from other sources. It took us a good portion of the year to to do that. And we knew what we were doing. And that’s just a function of the difficulty of resolving identity across different sources. So I’d like that, I’d like to think that’s one of the the core strengths of Change Healthcare, the ability to integrate data, and to provision it in a way that is onside with, you know, the privacy and security regulations that govern healthcare, which are not for the faint of heart.
Fred Goldstein 26:36
No, obviously not. I mean, you, you get this stuff wrong, and health care, and we know what the problems can be in the security, privacy, you know, I think to myself, even Wow, so I’ve seen my physician, a few others last year, I’m sure I’m in your data set, which actually, if it’s being used, you know, in the ways you’re talking about it, de identified etcetera, is really for the good and something that we need to keep moving forward on. Because at the end of the day, we’ve got if we know now, what these underlying problems are, it’s not that we need a whole lot more studies of identifying what the problems are. It’s, it’s a, taking those problems, applying them in the right community, and then going ahead and implementing these various programs to see if we actually make a difference and measure those results through systems like yours at the end, because you’ll have the data, excuse me, you have the data on the backside of this, which will show whether or not progress was made, I assume.
Tim Suther 27:27
Yeah. So you know, if you’re covered by commercial insurance, odds are we do have claims on you, but there’d be no way for me to tell you because, you know, we go through a process that De identifies and it’s a it’s a one way hash. So once it gets hashed, there’s there’s no way for me to know who it is. And the reason why we do that is there are some problems in healthcare that require data to be aggregated together. I mean, for example, you can’t do research, you can’t do safety, you, you can’t do comparative effectiveness unless you amass data together, because data about you is an anecdote, you know, data about all of us now, that’s research that’s, you know, comparative effectiveness. And that’s what our country needs, if, in fact, we are going to rigorously improve the outcomes for all of us and to, you know, to get more mileage out of the money that we we spend on on health care. And that’s kind of what my core remit is, is, you know, looking through the data, looking for opportunities to, you know, to help improve outcomes and healthcare economics.
Fred Goldstein 28:36
Well, fantastic. It’s been great having you on the show today, Tim, and really looking forward to that report coming out from that healthcare system you referenced. So thanks so much for joining us on PopHealth Week.
Tim Suther 28:46
Fred, it’s always a pleasure to talk to you. I really enjoyed it and all my best to to you and yours.
Fred Goldstein 28:51
Thank you so much. And back to you, Greg.
Gregg Masters 28:53
And thank you, Fred. That is the last word for today’s broadcast. I want to thank Tim Suther, Senior Vice President for data solutions at Change Healthcare for his time and any insights today. For more information on Tim’s work at change healthcare, go to www.changehealthcare.com or follow them on Twitter by at @change_hc. And Tim at @TimSuther. That’s T I M S U T H E R.