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 Welcome to Influence the production of this week in Health it where we discuss the influence of technology on health with people who are making it happen. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to training the next generation of health leaders today.

Matt Hawkins, c e o of way star joins us. Westar provides cloud-based R c M solutions that serve 450,000 providers, 5,000 health plans, and over 2 billion transactions. Westar was birthed from a strong technology, uh, foundation with, uh, Navicure and Zum Med coming together. And this past year they added, uh, con and Ovation to build upon their platform.

And this episode, Matt and I talk about modernizing healthcare experiences with the consumer at the center and technology as the foundation. This podcast is brought to you by Health Lyrics, helping you to build agile, efficient, and effective health. It Let's talk visit health lyrics.com to schedule your free consultation.

And now, Matt Hawkins, c e o of way star. I hope you enjoy our conversation. All right. So here we are from the . Here we are from the, uh, HIMSS event. We're here with, uh, Matt Hawkins, c e o of way star. Thanks Matt for, uh, meeting with us. Appreciate it. I'm grateful to be here. Um, so Matt, give us a little background on, uh, way star.

What do you guys do, where'd you come from and those kind of things. Way Star is a cloud-based technology company that is the combination of Navicure and Zum to market leading revenue cycle. Management businesses, uh, that was put together in uh, November of 2017, about the time I joined the business. And today, uh, we are are a business that has evolved and grown, um, to not only include Navicure and Zum Ed, but also, uh, two more acquisitions, a business called Conn and another business called Ovation.

And, um, we now proudly and gratefully serve, uh, nearly 450,000 providers that use our technology every day in every care setting. So from a physician office to a physical therapy practice, a skilled nursing facility to the largest health systems in the country, in hospitals as well. The, uh, folks use our technology to waste our platform to perform, uh, revenue cycle work, to process health payments and to take care of the needs of, of their system.

It's interesting, so I'm, I'm gonna come back to that in a second. So what we're gonna do is we're gonna, we're gonna march through what we're gonna talk about the community industry providers and technology. We're gonna talk wide ranging on this, but I want to come back to this. You identify yourself as a technology company.

But the two companies you talked about coming together were really revenue cycle services companies. So why, I mean, so you're leading with technology. Technology is sort of the backbone for this. It is. So, um, actually Navicure and Germed were both revenue cycle technology businesses. I. Uh, that were well recognized in the industry.

They both offered SaaS based solutions. Uh, SMED had been invested in a, uh, a west coast venture capital, uh, firm called Sequoia, and they really did an incredible job investing in Zum med's technology stack. We took that technology stack, given its modern cloud-based architecture, and with the, at the outset of, of putting navicure and smed together, we said

Let's take this technology, unify every user on the, uh, a platform that leverages this technology called the Waste Our Platform. And, and we're, we've done that. So now we've united, uh, more than 2 billion healthcare administrative transactions, claims, remittances, eligibilities, et cetera, onto this platform.

We've also, uh, united, uh, all of the Zum Med users. And now several, you know, increasingly every week we add more, uh, of the Navicure side users to the Waste Star platform, and we take a tech first approach. So our, the Waste Star platform today leverages predictive algorithms to prioritize. Revenue cycle workflow tasks to eliminate those tasks because we automate them, um, and, and make it easier for end users to use our technology.

So that's a stark contrast Bill from, you know, uh, uh, someone who had just employ a services organization to replace the service work that's going on in there. Than their clinic or in their hospital or practice. Well, it's a difference between using technology and architecture really. I mean, what you're just describing is if you could put the right architecture together, you can, you can move a lot quicker, you can integrate a lot quicker.

And that's one of the bigger pieces. Right? So if I were gonna do revenue cycle, a lot of services companies would come in and say, look, here's what we're gonna do. We're gonna do Citrix sessions, we're gonna do whatever. We're gonna be looking at your screens. Yeah. And your whatever. And I think what you're saying is, Hey, we integrate directly and we bring it onto the Westar platform, and then we put our, our R p A and our machine learning and our algorithms on top of it, on your platform.

Is that pretty accurate? You just said it really well. Perfectly. Okay, great. And, and in fact, um, we work with every . Uh, you know, health, health information system vendor. So we work with Epic and Cerner and Meditech. We work with the, the practice management vendors as well, and we do embed nicely with their technology so that um, anyone who's using those solutions can interact with our technology as well as theirs.

We're not. Forcing the end user to make a choice. We think that when they, when they step into using our solution, it, it's a very elegant, uh, technology experience and gives them a, a lift, so to speak. It helps them, uh, supplement the work that they're doing within their own systems. And so we like the approach.

It's bidirectional integration. Absolutely. We can talk about the technology all day. Yep. Alright, so I, one of the couple of things I wanted to talk to you about is we're seeing a lot of, um, I think the trend I'm gonna talk about in HIMSS 2019 is social determinants, right? So, very hot topic. Uh, we've, we heard it from, uh, Karen Salva this morning.

Heard it yesterday at the CHIME conference. Um, the, uh, uh, VEC murthy, uh, former surgeon General talked about . Uh, loneliness. Mm-hmm. . And he said, you know, the impact of loneliness and isolation is, uh, more impactful than, uh, obesity. Mm-hmm. on a person's, uh, health. And so we're, we're seeing this whole idea of health, and yet 80% of really health outcomes are non-medical.

Mm-hmm. , how do you think that's, I mean, how are we gonna get our arms around ? All this data that lives outside of the, I mean, we used to say we need all the, all the information at the point of care. Um, but the reality is if 80% is, you know, genetic and other things, how are we going to, how are we gonna start creating this entire record for people so that we have all that information?

Do you think that's gonna, that seems like a big lift. It's a, it's a monumental lift, but one that will . transform healthcare. Yeah. In ways that need to be transformed. I think the phenomenal realization is that, uh, with social determinant information, we can add so much context. To how to care for patients.

Um, you know, it's, and in ways that are not easily discoverable or not necessarily self-identified by the patient. Um, uh, the, the simple example I use when I, when I think about social determinants of health is when a patient discloses their physical street address. Uh, that's interesting. But when you add a little bit of, uh, social determinant context around that street address, for example, they may say, I live on 150 West and Main Street.

Well, 150 West and Main Street by itself is nice to know, but when you realize that that's a. Third floor walkup that doesn't have an elevator, right? And we can add that contextual information to the, and present it to the caring, uh, provider who's looking after the patient. We can learn a bunch of interesting things about that, that patient that would help us create better care plans, help us create better engagement with the, with the patient in, in their own healthcare and make for a better experience.

Uh, and I, I think that that has to come about. You know, when you look at , Um, the current practice management solutions and the current e h r, uh, electronic Health record solutions, they're, they're mostly provider centric today, right? I think the breakthrough technologies will become much more patient centric, and so this patient record will include social determinant information as well as other clinically valuable information that

The patient, in essence, owns providers, look in at that information and can then care for the patient in new novel ways. And I think that's the promise of the future. And we're just working to realize that sooner than later it's, it's, it's gonna be interesting. I mean, one of the things I heard from providers when I was a C I O.

And some of the clients I work with is they have too much information today. Sure. So how are we gonna, I mean, how, how do we get beyond that? I mean, so now you're saying, Hey, you should look at their education data. You should look at their housing data. You should look at their family history. You should look at, and they look at some of these things today.

But, but let's just assume we start getting housing data and, and you realize. Hey, they probably don't have an air conditioner. They're going up three flights of stairs and those kind of things. Mm-hmm. , um, how, I mean, that's a, that's a different set of services than traditional providers. That's a lot of data to process and to be able to process that information while you're with a patient is near impossible.

Right. So, how do we . Create, uh, algorithms that can basically capture that information and create, uh, industry standards that that would, uh, help dictate, you know, green, yellow, red, easy dashboards or easy monitors for a provider to then, you know, look across, uh, maybe a certain set of . Of, uh, factors to say, here's how I need to engage with this patient.

Yeah. In order to optimize their care based on, uh, geography, based on, um, family history, based on diet, based on education levels. And that's what's gonna lead us to offer better care to the patients. And the, and it almost might lead, it almost might just be simple things like alerts. . I, you know, the health system alerts, the community services that's gonna provide another and those kind of things.

Example, great example. It's interesting. Well, let's, you know, you have a, you have a, uh, m and a background and those kind of things. So let's talk a little bit about that. So let's talk about the industry. Um, one of the things we're, we're seeing a lot of mergers and we're seeing some murders fall through.

I, I, I haven't confirmed this, but I heard, uh, yesterday that the, uh, uh, the Baylor Scott and White and Memorial Herman, uh, fell through. Uh, which wouldn't be a surprise. They're complex deals to put together. Um, I'm actually a displaced c i o from a merger that, that was successful and I think is going pretty well.

Uhhuh, . Um, the question I hear all the time is, has this been good? Is this good for healthcare? Is, is this creating the kind of, uh, outcomes we want for Well, let's, let's take it from two perspectives. Is this good for healthcare from a patient perspective is one of the questions. And then the other is . Um, how does scale benefit these large health systems to be able to, uh, provide, I don't know, better services?

Mm-hmm. for the community? I think if you look at other industries where, um, m and a work has occurred and consolidation has, uh, occurred, in some cases it has been beneficial for patients or consumers in those industries, if you will. Yeah. It's not always clear that it is. And so, uh, and, and I think you see evidences of that in healthcare.

I believe that the, that most, uh, m and a, uh, work in healthcare today, especially on the provider side, is driven by the belief that consolidation will, um, enable scale. I. And will enable providers to leverage, um, their know-how across a broader network. They'll be able to serve a broader population of patients and deliver them more services or offer them more capabilities or direct them to the best sources within their network.

Um, that will over time ultimately lead to better care and also kind of a better financial profile. Uh, and I, I do think there are some evidences of that, uh, beginning to succeed, but I do, I also at the same time see that, um, that the, that the health system provider side, mergers that take place, that don't keep the patient, um, front and center in their, in their investment thesis or in the reason why they do these deals, that it's.

It's subject to kind of not have the impact that they're, they're hoping to achieve. Uh, and, and I think, you know, if, if you kind of then kind of helicopter back just a little bit and, and say, well look at all of the other m and a work that's starting to take place around . The providers that are doing their own m and a to serve those providers more effectively.

I think that's interesting as well, right? Uh, the, uh, but you know, when you have the m and a and you have the big players, sometimes they don't, do not move as fast as they used to. And so then you have new entrants, right? Yes. And so we, there's a couple, couple of interesting entrants, not necessarily a small player, c v s Aetna.

And when you look at that, I think what, what I'm hearing their play is, and I . I could be wrong on this, but it's really to disintermediate, um, the patient from the health system in terms of care navigation. Yes. So they, they want to step into that role and, and help them with everything from handling their bill to, uh, where they should direct them to, to get care.

Um, that's interesting. And I guess that speaks to your consumer centric. So if you were c e o of a, of a health system and you saw the C v s Aetna thing, how would you maybe adjust your strategy to make sure that nobody could come in between you? What, what are some areas that you would work on? Yeah, so when you look at what is c v s good at, They are good at understanding the consumer as a retailer and offering services and products around that.

What is Aetna good at? Well, they're good at health plan administration and so if, if I'm a modern, you know, decision maker in a health system, I would take note in in those, in those areas, I would say, and I think. You know, many are that how do we offer more consumer-like experiences within our health system and how does that drive or give us conviction to acquire a physician network or an additional hospital or.

A surgical center or a, you know, minute clinic or some type of, uh, easy access care site. And, and not only acquisitions, but how do I invest in more consumer-like experiences in either care settings or in the ways I engage with the consum the patient as a consumer. Um, patients like web experiences, they like streamlined bills.

They, they, they like, uh, . Things that are easy to understand and intuitive. And so if I were a decision maker today in, in, in healthcare, in a large health system watching C V SS and Aetna, I'd be paying extra attention to those types of capabilities so I could, I could offer them to the consumers I served.

I I saw a presentation two, three years ago and it was C v s, I think it was the C M I O and he was talking about, uh, you know, what they're doing and they're IMP implementing Epic. And finally, you know, one of the providers stood up at the microphone and said, uh, my question to you is what makes you think you can compete with us?

He said parking. Ah, that was it. That was his whole, whole answer. And we, everybody laughed because it was like, oh yeah, that's really true. 'cause parking's horrible at a hospital. Yep. It's great at c v s. Yeah. Um, it's, it's free in their parking lot in most places. And, you know, in a recent hospital visit, I went to visit a friend who, uh, was in the hospital and, uh, had to pay $10 to park there for an hour.

Um, You know, and, and so you start to think about things like that, that are really not healthcare delivery related, but they're experience related. Yeah. And how do we create experiences, um, for consumers? I think another really important factor is quality. . Um, in healthcare, you haven't necessarily seen patients vote with their pocketbooks yet because they're for the most part directed to where they should go receive care based either with high deductible plans.

They're still directed into a network. They're still directed into a network in some or most cases, uh, when you, and so if I were a healthcare decision maker today in a big health system, I would say how do we ensure that we have quality measures in place? They don't necessarily measure just clinical quality, but experiential quality.

To say that I'm creating a, a, a, um, a trusted, uh, unique experience for the, the patients in my community, and I'm treating them in a modern and contemporary way, it's, it's interesting. I'll, I'll pass three c v. S. Pharmacies before I get to my provider. Mm-hmm. . And so the question becomes how do they compete with that?

And I guess if you're thinking experientially you, you say, okay, well we're not gonna put three locations between here and his house, but we can do telehealth. Sure. Uh, and so, you know, you have consults. Your first consultation is via telehealth, and now you're. , you're, they've actually jumped c v s and gotten closer to the patient.

Yeah. But what are health systems good at? Well, they're good at delivering clinical care. Can we deliver that clinical care via video, a video consultation, or a telephone based consultation? Absolutely. Can we deploy apps that, um, you know, measure heart? You know, could we deploy or give people devices that measure other vital statistics that could be meaningful in a.

In a, in a dialogue with a provider, and I, health systems could leverage those types of capabilities to stay relevant. So let, let's talk, uh, yeah, so experience is interesting 'cause yesterday I was talking to a C I O and he, he mentioned that they have a team working on a single bill. So this gets closer to where, where you're living right now.

Mm-hmm. . Um, do you find that systems that have spent that time to simplify the billing process that . Collections are better, easier people understand it, fewer phone calls, fewer, those kinds of things. I mean, I would think, I would think that's absolutely true. I mean, well, patients, uh, increasingly equate their clinical experience with their financial

Follow up from the doctor's office or the hospital or health system. So we know that a simple experience wins every day. Um, and at Way Star, our, our mission is to simplify and unify the healthcare payment process using modern technology for every care setting. And, and so, um, our belief is that . There's a lot of folks that are probably very interested in, in what you could call the holy grail of, of, of healthcare, uh, financial responsibility, which is really the payment estimation piece, right?

If you can get that right, think about all the work that you save downstream, all the hassle and headache that you also save. For, for both those that are following up on the administrative side and ultimately those that are consumers and receiving bills and trying to make sense of them. So this, this idea of a single bill is powerful.

It's even more powerful if you can estimate that bill based on. Insurance eligibility based on pre-authorization, informed by patient propensity to pay their bill, um, and, and, and, and then present that to a patient at the outset of their experience. Um, not 90 days after their service episode. So, um, that's not easy to do.

And at Way Star, you know, we're processing about 2 billion healthcare administrative transactions a year. So we've got . A lot of rules that govern and automate and streamline that process. Um, and we're helping to make that possible with the clients that we serve so that truly they can present estimation, um, payment estimation upfront.

And I think that will be in the days and months and years ahead if we can, if we can drive more of that, um, information forward and create this single . The single bill, like you, you, you know, you mentioned, um, that becomes empowering and will unlock a lot of dissatisfaction, um, at, at the, at the patient level.

So that's a lot better. Well, . Okay, so the intent of the C M Ss, O O N C, you know, price transparency was what you just described. Mm-hmm. , I mean, so that people could know, hey, this is what it's gonna cost. Now that the practical, I, I've gone out onto a few of the websites and looked at the, I, there's no, I mean, one of 'em had a spreadsheet and I think it had, I don't know, uh, like 1800 columns.

So I would have to figure out which M R I I got and . I mean, it was very hospital centric language. Yep. Uh, around it. Um, but that gets closer to the, to the spirit of it, right? Of people want to know what they're going to, um, what they're gonna be charged and how much it's gonna cost, what their experience is gonna be.

So what would be, what do you think would be better than just, Hey, here's, here's our, here's our price list. Um, would it be, you know, some sort of way of calculating and, and how are we going to, how are we gonna get from where we're at? From a policy standpoint? This is what they . , this is what they said, um, to where we need to get, or is it just we're now looking at, um, a consumer centric focus and that's gonna drive us to different kinds of solutions.

They're gonna look at a health system and go. I can't understand, you know what this is gonna cost me, and they're gonna find another one that you just pull up your app and go, oh, you're doing this. It's probably gonna be around 2,500 bucks. Yeah. Yeah. I, I, you know, I think Cmm S'S intent is, is very good to drive price transparency.

Oh, absolutely. But to your point. The price lists are long and there's lots of ways to kind of obfuscate what the real price is. And, and that's part of the age old, you know, game of, uh, payer provider interactions, um, that impact patients. And so I, I think it's gonna be a combination of several things,

First, we've never been able to do more with technology than we can do right now. We can process technology, we can leverage algorithms that be, that create rules that govern techno, that govern data and the use of that data. So really we using eligibility information, using pre-authorization information, you know, in the case where a patient has some form of, of insurance.

We can get pretty close to determining, uh, patient estimation, uh, or excuse me, payment estimation for payments now. That's complex. I think that can inform a simple bill, a simple bill that says, this is what insurance will cover for this particular care, uh, this particular treatment, and this is what your responsibility is.

And, um, I. I think that's what's required for us to break through, uh, and, and, uh, really create a consumer-like experience that, uh, we're all accustomed to in other industry settings here. I don't, I don't pretend that it's easy, uh, and I, I think people, there's a lot of talk about it, but it will solve a lot of issues if we can get to that, that point.

Yeah. Yeah. We're on a. 40 year journey of we are instant transformation is what, yeah. And every dev derivation of it with capitated plans and everything else to try to simplify things, we've gotta crack the code. So if I were to ask you to sort of, you know, 10 years from now, 10 years from now, hopefully I'll be re now I won't be retiring, but if I were retiring in 10 years, hopeful playing a little more golf.

Yeah, exactly. That's get out, get out to get back to Pebble Beach and do those things. But . Um, let's assume I'm retiring in 10 years. How is healthcare gonna look different? I mean, are we, how's it gonna look? Social determinants, technology, . Uh, predictive algorithms, uh, genomics. I mean, just dream a little bit about what you, what you think it might look like in 10 years.

I'm gonna think big for a second. I think it's totally consumer-Like I think most of my healthcare is consumed on my, by my choice that, um, and by that I mean . I have a patient, a truly patient-centered health record, not a health record that is about me that exists on a provider domain, right? I want it to exist on my phone, my device, my own technology, and I want to take it

In a very consumer-like way to a provider, whether that's in a retail clinic or it's in a primary care physician or it's for some complex case that re I and I, I'll present that to any caregiver so that they can quickly learn about me. Within my own patient record that's portable, truly portable, the design of hipaa, right?

Mm-hmm. , that's my record. That's not, it doesn't exist on the provider's domain. I just wanna underscore that one more time. Um, I have all my family history. I have that, that's important to know when someone's caring for me, whether it's a co, it's a flu shot, or it's something far more complex. Um, and, and then I understand, uh, where, what the payment requirements are in every single interaction.

And it's simple. And I, I can see a single form of payment that I can make for any type of healthcare service I want to receive. And I understand what insurance will cover clearly from the outset. I understand what my copay. Or financial responsibility will be if copays still exist. Um, and, and I'll, you know, I'll have information that is pushed to me.

Perhaps it's on a phone, perhaps it's on another device. Perhaps it's on a watch. That will remind me or alert me to how I can day to day, to better control of my own health. Walk more steps. You know, don't eat the lucky charms. Eat the, eat the Wheaties or the Cheerios, uh, you know, whatever. Yeah. Absolutely.

Well, that's a good vision. Uh, I'll look forward to, uh, retiring in 10 years. We'll play some golf at Forward Pebble. That would be great. Yeah. Matt, thank you for your time. Really appreciate it.

I hope you enjoyed this, uh, conversation. I had a great time with, uh, with Matt. We, uh, got to talk golf before the conversation and then afterwards. . We had a, uh, a conversation about the future of payment models within healthcare. I wish I could have, uh, had the foresight to record that. It was just sort of a spontaneous thing.

After we got done and we got out pieces of paper and we were drawing out the future of healthcare, I. And, uh, when we got done, we thought, man, I wish we had captured that, but, uh, maybe, maybe for another show at another time. Uh, I hope you really appreciated the conversation. I, the thing I love the most about it is just the concept of we don't have to replace the old systems that are there.

Sometimes we just have to get the data out, put it onto a platform that has access to modern and new technology so that we can do the things we need to do on top of it. And then once we get the results, we can push it back down, uh, into those transactional systems. And I think that's one of the things that they have done in order to, uh, really transform the, the experience of the consumer around the bill, which we know is extremely important.

Anyone who's had to deal with that understands that there's a lot of frustration that that comes, uh, with people trying to figure out, uh, you know, copays and . And, uh, and reimbursement and all those other things, not for the phantom part, and definitely not for something we want a consumer to try to figure out and, uh, appreciate the work that, uh, Matt and Wave Star is doing to make that a better experience for everybody.

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