Hi, everyone. This is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare podcast series. It's great to have you. Excited for a conversation on the foundational role of accurate provider data in modern healthcare. Care. And I'm very excited to be joined by Joey Soliske, director of digital health operations, Alghedi Health Network, and Preeti Subramani, vice president product management at Highmark Health for
our conversation today. Joanne Preeti, thank you so much for being here today. It's great to have you. Yes. Thanks so much for having us. Yeah. Absolutely. I wanna kick us right off. We have a lot to talk about. There's a lot of elements to this conversation. I wanna talk about with something very start with something very important. What is the single most important area where Accurid provided data makes a difference within your organization? Joey, why don't we start with you? Sure.
Yeah. So, just quick background on Allegheny Health Networks. We're a 14 hospital system in Western PA, with over 3,000 physicians and clinicians, and we have a great partner in Highmark Health. So I know Preeti will talk about that collaboration we have from a a payer and provider perspective across the network. But for us in the in the health system lens, you know, I think the single most important area where it matters is in relation to the clinician information being consistent.
And what I mean by that is it's consistent across the various channels for how our patients could access our system. So whether that be through Google, whether that be through our website and find care, that same information about our clinician or location should be the same. Mhmm. And if we have if it's the same, then it builds that trust, and consistency so they keep wanting to come back. Yeah. Pratib?
I think Joey hit on a key point here, which is trust in the information that we're providing. And the single most important area from, our Highmark Health insurance perspective is that member experience and their ability to find compatible care options. And one of the first things that people do when they get their insurance is look for which doctor is in network, and they want to understand exactly what network they're in, how much things are gonna cost when they go to that doctor, how to
schedule an appointment with that doctor. So there are a lot of information that we need to kinda collect and bring together, for those individuals so they can understand how to go get the health care that they need and use the health insurance plan that they've just purchased. Yeah. And I think what's very interesting about this conversation, and and you both touched on it a little bit, it's sort of this
this ecosystem approach. Right? There's so many connecting pieces to this, so many dots that need to be connected for this to be able to be successful, and and to be a successful approach, which is really important. And I wanna talk a little bit about some of the disconnects that you're observing in this, process in itself or then in turn also the opportunities that it Sure. Yeah. So Sure. Yeah. So for for us, it's also, you know, providers and the locations
data. Again, because I think something we find is that there is inconsistency even in, like, you know, some of our branding name in downstream systems or, again, I'll use the Google example displaying this. The patient may go to their MyChart patient portal and see there have an upcoming appointment at a different facility name than what they saw on our website and Google. So if we get all that connected across a different, pillars within an enterprise, it makes that be consistent and feel easy
for our patient and members again. And so for us, that is, really making sure that facilities, departments like our credentialing department, you know, for medical staff services is sending their information for to us. Also that our real estate department, they'll have the updated facility info is sent into this, like a platform, that you have the reviews about your clinicians
coming in. And so when you connect all those different areas together into one, it allows for you to have that, I'll call it, cohesive experience downstream then, by doing that. And I think that the biggest opportunity, which I know Preeti will talk about, is for us being a pay biter or a payer and a provider health system here is we can really connect and have that clinician information be as up to date as possible for our members as well, which we're really excited about.
Yeah. Priti, talk a little bit about that. How important is that piece? I think Joey hit on it, you know, pretty well. We know that providers are struggling with managing their own data and the accuracy they have with that data. Mhmm. And then from a health insurance perspective, we have a multitude of providers that are in that same boat, and we are receiving a lot of inaccurate data from all of those providers.
And then trying to determine what, data is accurate, what's inaccurate, and how do we showcase this to, our members in the right way. And so that that's one of the biggest disconnects upfront in the journey as we think about this. And we're starting to deploy different capabilities in that space to validate and ensure that data accuracy is
there. Then the other disconnect comes more downstream in the customer journey when they're actually looking for care and then trying to schedule an appointment with that clinician or provider office when they don't have enough information on how to actually go get an appointment. So they might get only, that far in the journey, and then they can't figure out how to schedule an appointment. Sometimes they just give up or if they get frustrated through that process.
And so those are both upstream and downstream. We're trying to figure out how do we solve that for people that we give them the right information and we tell them how to finish that full customer journey so they can actually go get the health care with that clinician that they need. Yeah. Actually, managing that relationship is so key, and that happens through that collaboration and and identifying those opportunities for improvement, which I think is is so important.
Joey, let's talk about some of the the strategy pieces to this and how you're achieving this. Right? Can you share, an example of something that's worked in terms of a strategy that you've implemented, that's really improved this process? And and what are some of the things that you've learned throughout this? Yeah. I think there's a couple different things that, you know, from a process perspective, that we need to think about. Because, you know, if you have a technology or the
connection points in place, that's great. But if you don't have the upstream data or information or the right operational leaders that know where and how they request a change and what needs to happen, then it's not gonna be accurate downstream. So you need to fix as well at the very start, core process item. And for us, one of the big buckets is, you know, annual review
of the information with operations. So how do you do, you know, like, a yearly help check up, you know, on your information for your data with your clinicians, with your operators, for locations? And is that phone number still accurate, you know, for that primary care clinic in Pittsburgh? Is that clinician specialty still up to date? Then do they, you know, do they get additional information they want in their biography now to display on Google in MyChart again in
member portal for our Highmark members? So the annual review and expectation setting, having a team who does that is important. The second point then is how do you make sure to make a request for a change in one location? So as a clinician, you know, if something doesn't look right, downstream, you know exactly where we need to go to to make a request for a change and that there's service level arrangements on that change being, you know, done by the next day by appropriate
teams in your enterprise. So, those are a couple of the process related items we're really trying to think through to make sure the data can be clean. Yeah. Absolutely. Pretty same for you. What what have you observed? What what's working for you? So we we're doing a couple of different things, and I talked about one of them.
So we're really taking all of the information that we're getting from providers and using a third party company, that looks externally at different, sources of information when using AI and ML to really validate all the information we're getting. So they look at credentialing systems and other, CMS and other, areas to say, hey. This information is accurate or not accurate, making sure that flow is going,
through. We also took a look at our provider directory and how it was structured on the back end over the last couple of years and have completely untangled or unraveled it and then reorganized it into a cloud infrastructure, which actually just went live today.
So we're super excited about that. And what that helps us do is, one, it drives better quality of how all of those all of that provider data is connected to our plan and network data, but it also drives accessibility of that information across a lot of different channels. So customers can engage with it through a chat, through an agent, through a voice channel, or through the search tool that we have today. Yeah. It's it's constantly advancing, it sounds like.
It's you're evaluating constantly, which is which is awesome. Yes. Exactly. That's right. Yeah. You both talked about the importance of sort of this accuracy piece. Right, Joey? You talked about the fact that, hey. We need to know if that provider's address in Pittsburgh is still correct. That needs to line up. So that's a simple that's the simple accuracy piece. Obviously, that's what provided data does in itself.
Can you talk a little bit about why it's also so important to leverage when it comes to sort of the more overarching theme of improving care coordination and then in turn really improving the patient and member experiences. We talk about trust, etcetera. Why is it so important from an overarching perspective as well, not just the accuracy piece that we already touched on?
Yeah. Sure. I mean, I think for, like, Preeti sort of talked about it earlier too, but, a big strategy of ours as an organization is called the living health strategy and something we're working towards in the payer and the provider systems. And, ultimately, a big part of that is how do we reduce, you know, stress or frustration or fragmented approaches for our members and patients and make it feel seamless. And I think this is
a huge part to it. You know, when we can have this accurate info that's integrated seamlessly into the member portal that Preeti talked about to know what's up to date and they can make their appointment more easier, that that really reduce that fragmentation. And it strategically helps our patients trust us and then continue to want to come back and, and to come to our facilities.
I think the other thing we're really thinking about is, you know, once this info now if you have all this centralized about your locations and your clinicians, how do we redesign the way that a patient could come to our facility? Not traditionally, I was find a doctor. Now let's say, make it find care truly. You know, you should you now have all your locations info and your provider info. You know, a patient or member could search for my right knee pain hurts.
What do I need to do? And we should know that that means, you know, orthopedic. You live here as your ZIP code, here's the nearest facility with an open appointment. It allows for us to get to that true fine care experience faster. So that's something, you know, in the future, we're really excited about designing and building. We have all this, you know, data accuracy upfront, in there.
Yeah. Priti, you you touched on the the strategic lever that this can be, right, and sort of the the initiatives too that that you're working on to improve this. What does this look like for you, and and how is it streamlining that care coordination piece too? Yeah. And I think, you know, we've been using the word trust a lot, and we know that all of the provider data being accurate, that's bad data is just gonna erode people's trust. And when there's good data, it builds
that trust. So that's obviously core to everything we're doing. And then on top of that, we're layering in additional information to make sure that when in the moment that they're actually looking for a provider, how do we give them information that they need to complete that task or journey? So how do we provide information about appointment availability? How do we make that more personalized with care gap information as well and make sure that they get the right information in those moments?
We could suggest preventative screenings. We can also provide information if they don't have a, let's say, physical therapist within a 30 mile radius, how do we connect them to our virtual physical therapy services and make sure that they get access to the care that they need regardless of where they're located or their ability to kind of physically go into a location?
And then the other piece of that is also to make sure that we're connecting them with information that they want to know about these clinicians. In some cases, they wanna have more personal connections if it's a primary care doctor. And we learned this a lot through our research that people are interested in understanding, you know, they speak their language, can they relate to this person? Do they offer virtual care options?
And so we wanna make sure we provide that enhanced provider information beyond just location, and how to contact them so that they can make that decision in that moment and don't have to do additional research on third party sites to, get the full picture that they need to make a decision and move forward with their health care. That extra Googling takes a lot of time. So I agree that this does really improve the patient experience.
Exactly. And I'll say they've we've in our research, we saw they were using Google, Yelp, Nextdoor, everything they could to kind of find that information. Yeah. Absolutely. I wanna close this out with sort of a a little bit of a forward looking view on this. Right? So we've touched on what you all are doing, how it's working, and sort of the initiatives that you're you're trying to move forward in the next couple of years or even immediately right now.
When we are doing this correctly and everything that we've mentioned so far, how does that accurate provided data then also set sort of the foundation for AI initiatives and other initiatives in your organization, and what should we consider as the prerequisites for success there? Joey, we'll start with you. Sure. Yeah. Thanks. I talked about it briefly,
I think, on the last topic there. But, ultimately, if you have the information about a provider and the location and all this data about them, you can feed that information into, in the future, your AI agents for call center, your chatbot experience, and website or member portals. And a patient or a member could ask any question or they could say, if I may, doctor Joey, where he practices, and if we have all that feeding it, they can respond quickly and then also surface when
that appointment's available with them. And so if you have a infrastructure or base of all that connected from the various parts of the enterprise, with the phone numbers, fax numbers of a facility, again, that clinician specialty where they work and their schedule availability, you can then truly enhance the next layer of engagement for our patients and members wherever that may be in the future. So you need that base layer,
though, to enable that experience. I mean, I know Preeti is leading a great initiative across our enterprise, or our call center that can also help feed into that. Yeah. Brutee, feel free to elaborate on that. Yeah. And I think, you know, what Joe is referring to is we're really trying to shift the model in our contact centers from assistant service to self-service. We know that's much more efficient for members, and then they can use a twenty four
seven support model. So if they're laying in bed at 11:00 at night and need to find a doctor, they don't need our contact center to be open if we establish the right self-service capabilities. And the other place we're trying to start thinking about the AI utilization outside of just the conversational AI and, you know, virtual, assistance is also personalization. So if somebody has a care gap, how do we connect them to the right clinician and look at, hey. You have five clinicians
in your area. We see that you're not attributed to a PCP, and these five have appointments available within the next thirty to sixty days, whatever the acceptable threshold is for that service type, and make those recommendations proactively. If we have a provider or a clinician that leaves our network and they need to find a new doctor that's in network, how do we proactively engage them and let them know that instead of saying, hey. Your doctor is no longer
in network. You need to go find another one. How do we actually just use AI to make a recommendation on some new doctors based on what we knew about their previous physician, and also, you know, where they live, what their preferences are for virtual versus in person,
and then make recommendations based on that. So we really wanna start utilizing, AI to drive those intelligent provider recommendations, and also driving more self-service capabilities so our members can serve, through any channel they want and when they want. Yeah. And I love that at the end of the day, this always comes back to improving the patient and member experiences across the board, whether that be through, again, improving trust or just streamlining this whole process,
which is a fantastic goal to have. Joy and Priti, thanks so much for your time and insights today. This was a fantastic conversation. Thanks for being here. Thanks so much for having us. Having us. It was great. Yeah. Absolutely. And we also want to thank our podcast sponsor, Kairos Health. You can tune in to more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview.com.