November 21: Today on TownHall Linda Yang, CIO, talks with Todd Carlson, VP of Application Development and Enterprise Architecture at CareSource about leadership in technological advancements in the healthcare insurance industry. How is generative AI shaping the quality and efficiency of healthcare and how does it hold up to the unique challenges of the healthcare industry? Also, we explore the importance of a human-centric design in the development of healthcare systems, the risks and rewards of innovation, and the critical role of strong leadership in promoting innovation while maintaining accuracy and efficiency.
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The number one thing to create innovation is you need to incentivize and encourage them to take risks. And it may sound like, well, that's way too simple.
Most organizations say they want innovation, but they're unwilling to deal with the level of experimentation and risk that it takes with experimentation.
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All right, welcome to another Town Hall Show. I am Linda Yang, and today I have Todd Carlson as my guest. Todd is Vice President of Application Development and Enterprise Architecture at CareSource. Thanks for being here today, Todd, and I know that you have many years of experience in the healthcare insurance sector, so please share with us about your background and Also, how you've seen technology used within this space to provide life changing
Sure, so thanks for having me. I've been in 25 years, and I've been in the healthcare space for the last 5. And I have to be honest with you, in the 20 years before I got into healthcare, I'd been in some very complicated business domains. Nothing prepared me for healthcare. anD as a consumer of healthcare products, we think that insurance is simple.
The reality is it's very complex. So the technologies we deploy to simplify those complex data structures, how we automate the processes, how we go back and do validations, how we do communications and integrate with third parties become key. So when we look at new technologies, we try to look at it through the lenses of not do technology for technology's sake but how do we make sure when we're implementing solutions, it ties back to the benefit of our members and provides two things.
One, a level of operational efficiency to drive the cost as low as possible for our members. And then two, that allows us to improve our employee experience, right? Because they're just as important as our, consumers. So that's kind of how we look at technology from a broad strategic perspective.
That was startling. And obviously technology has significantly changed for the healthcare industry in the past few years. So what kind of technology are considered advanced or emerging technologies? And you believe that these types of technologies would have a really profound influence on the healthcare industry going forward primarily for healthcare insurance.
So, there's a lot of technologies in buzzwords right now, and some of them are more applicable than others, but I want to talk about That generative artificial intelligence is the biggest buzzword in healthcare. It's got some strengths, and it has some weaknesses. The strengths, oddly enough are...
Very focused from a technology perspective, meaning I can optimize code. I can clean code up. I can do documentation on code. I can improve our, not necessarily our architecture, but our coding practices through generative AI right now. And there's plenty of products in the market that allows us to do that.
So, back to the strategic approach, what it allows us to do is have higher quality, which reduces our costs. It allows us to have better performance and allows us to have a better experience. But in the healthcare space, generative AI is not the end all, be all, because healthcare is specific to certain data sets, and public generative AIs don't have that.
Large language models don't have that knowledge. So the main use cases, honestly, outside of IT. Our call center, right? How do we optimize that? Just the member experience. So instead of having to make a phone call, can you chat, but then, but have a meaningful chat and with human level responses. So that's a big use case for us.
And the other thing is that how do we make sure is our clinicians are going out in the field? How do we automate those processes and simplify the processes to keep the member at the center? So from a technology perspective, those are the two large Gen AI components that we're looking at. And there's a lot of detail that I'm watching out but those are pretty large.
The second thing is actually not a technology component. It's a mindset. It's called human centered design. And it is the shift from creating these large systems designed to automate processes to creating large systems designed to keep the human at the center. And so we're thinking about how is the member going to interact with the application?
How our employees going to interact with the application? And then how do we use the right set of technologies to build the best capability to automate the process while maximizing the experience to the member? And so as a result, kind of the two convergences of that, I can tell you that at CareSource, we've embarked on building a new digital platform.
And there's several components in that not only cover generative AI and human centered design, it's also about how do we automate current health care processes that are not automated today? How do we streamline the data that we communicate back to government organizations? And how do we ensure accuracy for that data to make sure that regardless whether the member is insured by us or another insurance company, they still have the same level of continuity of care.
So if you wrap all that up together, we are applying those digital thought processes to that platform and we're very excited about where that heads. Yeah, that
sounds amazing. So with these initiatives going on within CareSource, what does it take from technology leaders such as yourself to really lead your teams towards leveraging these technologies?
Aside from hiring outside of the talent pool that you already have within that organization, how do you help your technology teams really add the most value or return on investment for the organization?
So leadership is a long topic, but specifically when you're trying to drive innovation and innovative solutions, yes, you need to hire great people and you need to empower them. The number one thing to create innovation is you need to incentivize and encourage them to take risks. And it may sound like, well, that's way too simple.
Most organizations say they want innovation, but they're unwilling to deal with the level of experimentation and risk that it takes with experimentation. So if you want real innovation, and you have to, from a leader perspective. One, you have to build a structure that allows your team not to fail fast, but to experiment, which means all of your dollars are not going to be fixed.
You can't quantify exactly how much each project is going to cost. You don't know. So you've got to, you've got to build relationships with your business partners to make sure that they know. And that there's a level of trust between them and yourself, that we're going to create innovative solutions, which means we're going to try things.
And some of those things maybe fail and they may get squishy, but that's okay. And then two, it's really about encouraging the teams. We really want you to be innovative in the healthcare space. A lot of times it's very risk averse you're dealing with members. You're paying millions or billions of dollars in claims a week.
You need the accuracy and data matters. So risk taking. Is not top of mind, but for an innovative digital transformation work, that's exactly what's key. So the number one thing from a leader perspective is finding ways to not only encourage your people to try new things and be innovative, but then to applaud when they fail.
And be willing to take risk yourselves because as a leader. Sometimes we can get wrapped up in how we look versus the outcomes we're driving and risk equals reward, right? So you want a big reward. You have to take a big risk. And the big risk is to really enabling your team to have innovative approaches and ideas and sometimes.
Those innovations may be contrary to what you think as a leader. And then having that open mind and listening to your teams and getting feedback really is a game changer. So that's really the two things. You got to have a backbone to be willing to deal with the risk, but at the same time, you need to be open minded enough to listen.
Yeah, certainly. It sounds like an organization would be, just traditionally healthcare organizations are very adverse to taking risks. Because I think it does involve a matter of life and death for that patient and positive patient outcomes. So, how do we put up kind of guardrails as leaders, technology leaders of these organizations to minimize the risk, but also promote that innovation within our teams?
That is a great question. And that's where a little bit of the science comes in. But some of this is actually more old school. It's about data decisions and accountability. So you can have a framework of innovation, but you still need to have enough data on underlying your beliefs that your innovation is going to drive.
And you need to measure that. Are we getting the results we expected to? And then if we're not, we need to hold the right people accountable to the outcome. And you may think I'm talking out of both sides of your mouth. You're saying, well, be innovative and take risks on one side, but the other side is use data to make decisions and drive accountability.
How can those connect? Well, they connect very cleanly because the reality is this, just because you were looking for innovation and you want risk doesn't mean that you don't set expectations and it doesn't mean that you don't have. A level of guardrails that are clearly understood by the organization and that you're not constantly reviewing for progress and performance to those guardrails and the metrics around that.
And then from an accountability perspective, at the end of the day. We do need to make sure we've got the best service possible. We do need to provide accuracy. I can tell you a story when my youngest was born, we had a semi lawsuit with our insurance provider because they billed us for our daughter having a baby when my wife was at the hospital and my wife had the baby, but the insurance company thought my daughter had the baby and it took six months to work through that.
Right. And that's a sign when you get these big bureaucracies, they don't function effectively. So you don't want to build a big bureaucracy, but you do want to make sure that you're driving the right outcomes. So you look at what are the key outcomes, measure the data around that, hold people accountable to it in the framework of innovation and risk taking.
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Right. Right. And so from what you shared, it just sounds like organizations, it's critical for organizations to have knowledgeable, strong, and most importantly, compassionate. technology leaders So from your perspective, what happens to an organization where there is a dearth of good technology leadership? What are some signs or possible tools that organizations to assess this?
It's a great question. I'm reading a book by McKinsey called Rewired and I'm no way I'm saying go read the book and I'm not generally a McKenzie fan, but what they put together in that book is really powerful because they've broken down the basics of how you do a lot of this. And so really what I would say is from a talent perspective.
So sometimes it's just simply gauging, if you look at strategically, where does the organization need to be in two years? What's our application development strategy to get there? And what are the people that we need to make that happen? What's the skill sets? what are the technologies going to work?
And what are the type of people we want to have? But most importantly, it's what is the culture that we want to have? Going back to the culture of innovation, means risk taking, encouragement, empowerment, but it also means taking feedback from a leadership perspective. So when you wrap all that together, when you're looking at it from a just a pure talent management strategy, you need to know where you're going, you need to understand what kind of, what talent you have today, and then you need to listen to your people to create the right culture and make sure you have a high degree of trust between leadership and individual employees.
Because at the end of the day, we're all a team, right? And we can't get to that future state approach if we don't know our strengths and weaknesses, if we're not working on them, both as a leader and as the organization, and we're not encouraging our talent to explore, to try new things. I'll give you an example around that.
We encourage our key people to move around departments and you may say, well, that's really disruptive for the teams that they leave. And that's true. But the reality is, is what's happening is we're creating our most important people because they now know the entire end to end process and business systems from end to end, which is incredibly valuable.
But if you hold people to traditional team models and you become. Kind of possessive of those, then you actually preclude yourself from getting benefits associated with people that are, call it end to end experience with your entire business process, long winded answer, but in, in the short version, that's kind of how I would summarize it.
certainly it organizations who not necessarily permit from within, but develop from within are those that I believe reap the most benefits from the. Their talent and within their teams. So for those emerging leaders who are on these teams and are looking to hone and enhance their technical leadership skills, what words of advice would you give them?
And how can they really further develop their technical leadership skills?
And so that's a good point. I think technical leaders typically come from one of two tracks. They've either started as a technologist, and myself, I was in Oracle DBA for a long time, or they've come from kind of the people management maybe the system analysts out of the house.
So, if you've already got the technology chops, just staying current, reading things, you know, periodically getting a new certification that comes out, I think that helps with the technology. If you don't have a hardcore technology background, doing a week long boot camp to understand it, not that you need to code, like, a manager's job is to run their teams and to remove impediments, not to code.
But they can if they need to but learning more from a, from a pure technology perspective, if you don't have that lens, it's important. The reality from both sides of it, leadership is based on how you help your people. How are you growing them? What's the culture that you're creating?
How are you rewarding and recognizing your people? You know, there's 9 Minutes on Monday. It's a primer on good management, and in it is 9 different topics. And the ask is that you spend nine minutes every Monday to review each topic for a minute and what you're going to do that week to improve those things.
And I would tell you, if you're a new leader, go get that book and go read it, because the reality is it tells you the mechanics on how to be a good leader. But the one thing I would add to that is that sometimes leaders, we become way too tactical. And by tactical, meaning we're focused on the day to day, or we're myoptically focused on our team.
We as leaders need to be strategic. It's not what the team needs next week. What does the team need next months from now, two months from now? And then, how do you realistically solve real problems, not just solve the little problems? What I mean by that, it's like coding. Do you just slap a Band Aid on top of the issue, or do you actually spend the time to figure out the root cause and go fix that permanently?
Leadership is the same way. Tactically, slap the Band Aid on the personal problem because two people aren't getting along together. Strategically, get the right career development and coach people the right way, and help remove the impediments in your team at the root cause level. So. That's kind of from a high level what I would recommend.
Well, certainly, I think that's great recommendation and picking up a book, anybody can pick up a book and just get a wealth of knowledge from reading those books. And I think most leaders should take up books and read. Yes. I certainly want to ask you this last question, Todd.
It's really about your perspective on health equity, right? It's this really changing topic, but. This health equity is a cause that really has drawn me into the healthcare industry. So how can we as a society increase access, delivery, and quality of care for traditionally underserved patients to improve health equity?
Health equity is probably one of the biggest challenges facing healthcare in the United States today. And I think there's a wealth of information on the market. I can tell you the care source takes it very seriously. And the focus is really, how do we level set the playing field? And so as a leader in a technology organization, Our strategy is to really kind of live and breathe the core values of the organization to make sure that we've got the right diversity of thought and action, and then going through and making sure that there's no predefined kind of biases, which is the challenge with Gen AI, right?
In some cases, it's got biases inherently in it, so making sure that we're not. dependent upon solutions like that, that we've got the right level of thoughtfulness across the solutions. And then to making sure that we're championing and encouraging, the health equity transformation opportunities in our organization and in the community as well.
certainly. I've also recently seen that I think our government has really put out a good number of grants for non profits to kind of work in this area as well to partner with organizations, healthcare organizations, providers, all the way to the insurance sector to help make these improvements for our underserved community.
So it's a really exciting time, a merge of technology plus health equity initiatives. But yeah, I, those are all the questions I have is there anything additional that you'd like to add?
I would just add one thing from a leadership perspective. Good technology leaders are continuing evolving.
Just because you solved the problem in one way two years ago doesn't mean that's gonna, come up and work this time. I think constantly, you mentioned reading a lot is important. Applying new things, being willing to listen, but always challenging yourself. How am I learning? How am I changing the game?
It sounds kind of trite, but the reality is it makes a difference. We as leaders are constantly evolving, and regardless of our background and experience, I think there's always still more to learn. Just as when we were hands on keyboard. And so we just need to keep that mindset and keep that focus. And at the end of the day, if we do that, I think we're good leaders in our organizations and our team's benefit as a result.
Currently. All right, Todd. Well, thank you for your time and providing your insights and I appreciate it. You enjoy the rest of your
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