It is rare that a company will agree to sit down to answer tough questions, but Clarify Health was up for the challenge. Healthcare IT Today sat down with Keith Florance, Senior Vice President and General Manager of Payers at Clarify Health at the recent #HLTH2022 conference. We grilled him with 3 questions about the state of the healthcare industry.
After a decade of focusing on reducing healthcare costs, have we made any meaningful progress?
To actually lower costs, you have to be able to talk to providers about the clinical and quality performance measures that are truly driving better outcomes, not the ones we think are leading to better outcomes. If you can then take those measures and show how improving them will also drive down cost – then we will see real behavior change.
There is ample opportunity to be able to improve both. We just have to be able to deliver the information to clinicians in the right way. We have to help them understand which clinical measures are going to create better outcomes and also have an outsized impact on costs. When you do that, we’ll see meaningful progress on reducing costs AND improving care.
We’ve been talking about Value-Based Care for a while now. How come we remain predominantly fee-for-service?
We haven’t done a good job at putting the right incentives in place that will encourage the adoption of Value-Based Care (VBC). We need to encourage value-based behaviors that allow for a smooth transition to where providers are accepting of new risk models.
Essentially, we need to think about how we nudge providers to do the right things. That way, when they come into a broader risk contract or any kind of risk arrangement, they are already doing the things we want them to do in a VBC world.
I would love to see us put an incentive in front of a doctor tomorrow for the action they did yesterday. If we reward doctors for the right actions they are already doing then they will do more of that. This is opposite of how VBC incentives are structured today. Today we expect doctors to do something completely different than they are used to, for an entire year before they might see the payoff.
Are we finally at a place where AI and Machine Learning are more than hype? What are the practical use cases that are really moving the needle?
I’m going to use Clarify Health as an example. Clarify has massive amounts of claims data, massive amounts of enrichment data and supplemental data. With all that data, we have the capability to understand which measures out of hundreds are actually driving better outcomes. We are only able to do this with the help of machine learning and AI.
It would be impossible to do what we do at scale if we had to rely on spreadsheets and manually stitch the analysis together by hand.
I agree that machine learning and AI were overhyped a few years back, but now I think we are all being much more realistic in how we deploy these technologies.
Clarify Health
Clarify Health wants to improve healthcare for everyone by fundamentally changing the way healthcare is paid for and, therefore, delivered. They help payers, providers, and life sciences companies deliver better care, therapies, and outcomes while lowering costs for all key stakeholders through trusted and actionable insights into complete patient journeys mapped across 300M+ lives. Clarify’s customers leverage its cloud analytics and value-based payments platform to drive growth, improve performance, optimize networks, and move to higher-value care.
The company’s dedication to improving health equity and driving accessible care across the US was recently recognized by UCSF Health Hub, who named Clarify the Best in Class winner for its 2022 Patient Cost Savings category. The company was also named a Healthcare Data Analytics Market Leader by Frost and Sullivan in a recent report.
Watch the interview with Keith Florance to gain additional insights into healthcare costs, value-based care, and the power of AI.
Learn more about Clarify Health at https://clarifyhealth.com/
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