The Edge of Healthcare: Real-Time Revolution: Innovative Data Sharing in Healthcare

Martin Cody: Welcome to the Edge of Healthcare, where the pulse of innovation meets the heartbeat of leadership. I’m Martin Cody, your guide through riveting conversations with the trailblazers of healthcare. Tune in to gain exclusive access to strategies, experiences, and groundbreaking solutions from influential payer and health system leaders. This isn’t just a podcast, it’s your VIP ticket to the minds shaping the future of healthcare right now. Buckle up, subscribe, and get ready to ride to the Edge of Healthcare, where lessons from leaders are ready for you to use today.

Martin Cody: Hello again everyone, and welcome to another episode of The Edge of Healthcare: Lessons from Leaders to Use Right Now. My name is Martin Cody, SVP of Sales and Marketing for Madaket Health. And today we have one such leader that I’ve been looking forward to because he has exceptional private industry, if you will, experience from the financial sector, but also healthcare industry experience. And I am talking about Stuart Hanson. Stuart, welcome to the program.

Stuart Hanson: Thanks a lot, Martin. Good to be here. I’m looking …

Martin Cody: I’m excited to get into this because you have a lot of leadership experience. But before we jump into kind of the specifics and details of that, I’m really curious for folks that don’t know, you’re the CEO of Avaneer Health. And what is Avaneer Health?

Stuart Hanson: Yeah, so we are an industry-backed, I’ll call it a decentralized network for interoperability. And when I say decentralized, what I mean is a network designed to help payers and providers share data in real-time, directly with one another, to enable better patient experiences and better cost of care.

Martin Cody: And then give me an example or what do you mean when you say industry-backed?

Stuart Hanson: Yeah. So this organization was originally founded by a group of industry stakeholders that really wanted to change how the infrastructure of healthcare worked and break down the data silos that typically inhibit a lot of progress around trying to streamline care provisions, care interventions, claim processing, and basic financial transactions that support a better consumer and lower cost provision of health care services.

Martin Cody: It certainly seems like that is needed at scale, because every time we turn around, it does seem like there’s more sand in the gears of efficiency and trying to remove some of that. So is that kind of the motivation behind the group that got together that says, We need to make this experience easier, faster, and less expensive?

Stuart Hanson: That was definitely the impetus, right? To take some of the sand out of the gears, to break down the data barriers and the walled gardens that typically inhibit good experiences for consumers. And also, I think you hit on an important point, which is scale, right? A lot of great ideas die in health care. Even a lot of great legislation dies in health care. Right? Because it’s so complex and because there’s so much sand and so many gears. So getting to scale was one of the things that was important for me, trying to tackle some of these difficult data interoperability problems. So it was a perfect fit to partner together with the group of founders. So it was a group of, you know, major payers and major providers, as well as a financial institution and a technology company that kind of jointly recognized infrastructure of health care needed to be reinvented from the inside out, as opposed to waiting for it to happen from the outside in.

Martin Cody: You’re right about the complexity, and it’s interesting you mentioned the word interoperability because that word has been around for, I’m going to say, three and a half decades or more. And I don’t know that, I guess you can point to some examples of where it’s occurring. What do you want to see or what are you guys kind of building to make certain that that happens to produce the end user experience you’re after?

Stuart Hanson: Yeah. Part of the challenge of interoperability, number one, it does mean different things to different people. So I’ll be specific in terms of what I mean. But part of the big challenge has been sharing the data between the parties in a real-time way. Right? Because as consumers and I, you know, had this very similar experience in the financial services space. Do you remember the days when you used to have to go to a specific ATM network that was printed on the back of your ATM card, or you couldn’t access your bank account? That was decades and decades ago, right? But the banking, the financial services industry solved that. Very similarly, sometimes you’ve got access to real-time data, other times you don’t. And really solving that between payers and providers directly is the key. So when you ask about what we’re building, what we’ve built at Avaneer is really a direct connect framework. Almost think about a new operating system or a new cellular network for the healthcare industry to be able to share data through applications in a very safe and secure way, which is obviously super important, and banking as well as healthcare. But being able to share that data in real-time, in a really secure way, directly between the payers and providers involved in your care, as opposed to going through the existing latent, batch-based, intermediary-heavy, centralized model of sharing data, that was really kind of a nature of some really good intended legislation in the late 90s around HIPAA and administrative simplification to try to facilitate a lot of that movement of data to move electronically, the industry wasn’t really ready for that. The infrastructure wasn’t ready for that, right? The HR companies weren’t ready for that. The back-end systems and the payers were not ready for that. So it created this kind of cottage industry of people trying to solve for an old infrastructure to do new things. And it’s become now part of the layer of technology debt that the industry has to grapple with.

Martin Cody: You know, it’s interesting. History repeats itself because you can see shades of that in the Affordable Care Act and the No Surprises Act with regards to the industry, not having the tech infrastructure or the rails to be able to update provider data within 24 hours and 48 hours, and then member directory. So it’s almost as if legislatively we’re kind of forcing the industry to move, which I’m not opposed to. I’m curious, how long have you been at Avaneer?

Stuart Hanson: Coming up on three years later this summer.

Martin Cody: And is it the first three years in health care, or was there some other stints prior to that?

Stuart Hanson: No, I spent the better part of the 20 years before that in health care, mostly from the financial services space but I spent three, three and a half, maybe almost four years at Change Healthcare, one of the clearinghouses in the space. It was Emdeon when I joined them back in 2015. But a lot of my experience has been from the financial services perspective, but specifically focused on health care for all of that time.

Martin Cody: Interesting. And you asked if I am old enough to remember, you know, the ATM scenario, and I like the financial examples. I’m old enough to remember Stuart walking to the bank and having a savings book that I would get my deposits and withdrawals, usually more withdrawals than deposits recorded in a book that you could keep and…

Stuart Hanson: Passbook savings. It was a type of account. Right? You probably also, like me, used to reconcile your bank account at the end of every month. I can’t remember the last time I did that at this point.

Martin Cody: No, and it is interesting how fast the financial sector has moved as it relates to member experience, and certainly the investment at the analogous point of care in health care to what the members experiencing. I mean, I’m stunned with some of the sophistication of the taking a picture with your smartphone of a check and depositing that in seconds. Whereas in health care, some of that stuff is still seemingly five years, ten years, 15 years behind. Do you believe that is a lack of leadership, a lack of will, or something else?

Stuart Hanson: That’s a good question. I mean, I think it’s probably more a lack of a collaboration framework for the wills of different stakeholders to come together and solve those problems. Like, I think within any organization or most organizations, even within a lot of the legislative efforts, there’s been good leadership and even TEFCA at some of the things that are being mandated, even through CMS today, are all super well-intended and results of good leadership and a good desire and a knowledge of how to solve the problems. One of the big challenges has been bringing payers and providers together to kind of jointly solve some of these use cases, which is also one of the unique things that I have the benefit of at Avaneer being backed by payers and providers; we can actually convene, you know, stakeholders that may have diametrically opposed incentives on some things, but one thing they can agree on is trying to enable a better patient experience, trying to drive down wasted administrative costs, frustrated physicians, all of the things that are not controversial, right? It shouldn’t be pain points that are part of the payer-provider and natural business friction around reimbursement rates and things like that. Lowering the cost is in everybody’s best interest and improving the member experience and the cost of care is also in everyone’s best interest.

Martin Cody: That is a huge help with regards to having them at the table, because I think from my observation, there’s too many leaders today or mid-managers that, like you just talked about, they look at it myopically, they look at it as diametrically opposed, and I can’t work with this entity because we butt heads. It’s like you can be diametrically opposed to some people or some organizations on one level, but say yes and instead of no, but. If you say yes and we can agree to this, or we can agree to that, and I don’t understand why more of that collaboration isn’t happening. I’d like to see what you’re doing, because if you’re accelerating it and then you can, it should feed on itself, shouldn’t it? I mean, it should raise all boats from that standpoint. And some organizations outside of the Avaneer framework can look at that and go, Hey, those guys and gals are doing it. Why can’t we do this?

Stuart Hanson: I think for sure. I mean, I think that’s why when I talked about reinventing the infrastructure or the data model, right, if you will, data fluidity between payers and providers needing to happen from the inside out, it’s because of that. If you can align around a shared business incentive and drive change from that, as opposed to reacting to a CMS mandate or reacting to legislation, right, that you can probably check the regulatory box one way without really creating a lot of value or unlocking a lot of value. And there’s not necessarily a strong enough incentive unless you’ve got your counterparty at the table to understand how to do it in the most value-added way and drive down costs for both of your organizations. You know, I don’t want to dwell on unintended consequences, but oftentimes if you wait for a legislation or if you’re reacting to legislation you’re dealing with, how do I get the intended consequence without over-highlighting or burdening myself with the unintended consequence of some of these things, because they’re typically viewed from one perspective more than the other, and maybe don’t take that full collaborative value into account?

Martin Cody: Well, I think you’re right, because if you’re waiting for a legislative mandate to do something, you’ve likely missed the opportunity. And you could probably accelerate the end results that you’ve talked about with regards to a less expensive experience, a more efficient experience, a better user slash member experience, which should then they will be your best salesperson, if you will, out on the street. This is why I belong to this network. This is why, no different than when we have a great experience at a restaurant or a hotel or what have you. It is getting a little bit more personalized, and I don’t like to see organizations waiting for the stick, if you will. It’s like, pursue this because it’s the right thing to do. And you mentioned CMS speaking of legislation. If Stewart could wave a magic wand and say, This is where you guys, if I were running CMS, this would be the top two areas I’d focus on.

Stuart Hanson: Oh man, I don’t think I can hold myself out as a brilliant legislator. I’ve never chosen to even go down that path because I think it’s virtually an impossible task. Right? Which is kind of the counter to don’t wait for it. Right? The nice thing about our legislative process and CMS mandates is that there’s public comment periods and there’s long review periods, and usually the stick is several years out. And oftentimes that stick even gets pushed out a little bit further. So the industry’s got visibility in terms of where the legislation is going or where CMS wants to go. I think if you can take some of those ideas and payer-to-payer data exchange, maybe is a good example, right? What is that trying to accomplish? It’s trying to enable payers to get access to prior payers, claim data on new members that they’ve either just inherited or just gained, employer change or whatever it is so that they can provide better care plans and better care management, be more proactive with those consumers. It’s an awesome legislative goal. And there’s ways now that we see the path that CMS wants to go with some of those things. There’s ways to enable that goal and collaborate together between payers and providers or as technology partners to both to figure out how do we not only comply with where CMS wants us to go or where the legislation is clearly leading, and create a value proposition for both of us so that this becomes something that’s not funded by the stick. You’re trying to avoid the stick; it’s actually self-funded by a mutually beneficial value proposition. So that’s where I feel like, and I give that advice to a lot of early-stage entrepreneurs and startups in the space: If you can align really tightly around a joint value proposition, you can make way more progress than if you’re trying to sell regulatory compliance or value-added solutions that may be ambiguous or based on one stakeholder’s perspective of where things may go.

Martin Cody: I think it’s an excellent point, not only just for earlier or mid-stage entrepreneurs and startups. The joint value prop: it should be the name of a book if it’s not already a college course type of thing. Because, and this is age-old wisdom, right? This isn’t anything new. And as a person who has carried the bag, so to speak, for years, we learned a long time ago: If you take care of your customer, and that’s giving them value when you cut right through it and helping them succeed and achieve their goals, they will take care of you. And I’ve told reps that I’ve managed over the years, and I’m sure you’ve said something similar that, Yes, if you don’t take care of the customer, someone else is going to, so we might as well take care of them. On the payer-to-payer data sharing, that joint value prop is fantastic. Why do you think there’s been such hesitancy on the payer side to not want to participate in that remedy?

Stuart Hanson: I don’t know if I’ve seen hesitancy. I think what I’ve seen is payers trying to understand how much consumer adoption and consumer consent is actually going to follow the CMS mandates. So I think to take it up a level just to address the question, maybe a little bit more broadly, and outside of the specific use case, I think that the joint value proposition is important. You’re right. It’s absolutely not new wisdom. I’m not espousing something that I think I’ve got any unique credit for at all. I think that what is really unique in the market right now are two things. Number one, I think value-based care, right, is a tremendous initiative. It’s been, how long have we talked about that? Maybe half as long, at least, as we’ve talked about interoperability? Exactly. The reality is value-based care provides that mutual incentive. Right? It’s actually a risk sharing. It’s designed to help solve, almost not from a legislative but from a top-down perspective, trying to solve this joint value proposition case. So I think there’s tremendous opportunity as more payers and providers partner together on risk sharing, especially around Medicare and Medicare Advantage-related plans, because I think it starts to drive the right outcome from collaborating together, which is beneficial financially to both parties. The second thing that I’ll highlight that I think is really interesting is given what the industry struggled with for the past few months, some major technology outage issues and some data breach issues that have surfaced. I think really highlight for industry participants some of the risks of that centralized, intermediary-heavy model that was a natural outcome of where legislative, you know, unintended consequences took us in the early 2000s because parties weren’t ready to share data directly. There wasn’t a network ready to enable payers to providers to communicate in real-time. The technology has come a long way since then. So I think that now that we’ve experienced kind of some of the downside of the tech debt that the industry has taken on, I think there’s a renewed enthusiasm amongst payers and providers, or at least a renewed openness to consider new ways to exchange data and also to drive a little bit away from the, Hey, how do I buy more and more solutions, right, that I need around my data from fewer and fewer companies, which has just created a little bit more of the aggregation issue that we’ve suffered from, and how do we look more aggressively at some of the newer technology capabilities that have emerged in the industry? I’m excited by both of those things.

Martin Cody: I’m certainly excited about anything that automates, enhances efficiency, and removes kind of that administrative burden, especially on the frontline clinical workers. As you have, I’m sure, experienced working with your stakeholders and customers, you know, the physician and nursing and clinical burnout is very real, and it’s something that we have to remedy because at some point in time, every single one of us is going to touch the health care system. When you come into the world and when you leave the world would be first to that, I think of. But if we can make it efficient, and you talked about the tech investment, it does seem bizarre to me that the amount of trillions of dollars that we’ve spent at the point of care, whether that’s in the surgical theatre or at the bedside, and then you go upstream from that and large percentage of information is still being moved via fax, you just, you scratch your head and say, What is wrong with this picture? Because I don’t think we designed it this way if we had to start over. What are your thoughts on some of those sorts of things?

Stuart Hanson: Yeah, I think the around the joint value prop, I’ll say there’s a similar kind of mutual incentive between payers and care providers and insurers and care providers is improving the member experience. And I’ll give you a personal example. As I was making my decision on moving out of my last role and accepting the role to be the CEO for Avaneer, I was in an ophthalmologist’s office, and I was there because I was starting to had some flashing lights and it turned out I needed a quick laser procedure to make sure that my retina didn’t detach. And as I was going into the office and coming out 35 minutes later, I witnessed a gentleman trying to care for his elderly father, and he was trying to get the exact same laser procedure for his father. And because of either the insurance company that his father was confirmed through or whatever it was, the physician’s office really wanted to provide, obviously, they wanted to provide this care because they didn’t want the patient to have a detached retina, which results in a lot of really bad extreme costs and really bad patient experience through trying to get that repaired. But they couldn’t confirm his eligibility for his insurance, and it was the second time that gentleman had been back with his father and he was almost in tears. Right? He’s like, I know that bad things are going to happen or could happen if I don’t get this done for my dad, I can’t afford to pay $4,500 or whatever it was out of pocket. And I can’t get Ahold of my insurance company either for my father. So everyone’s hands were tied. And what were they tied by? They were tied by lack of real-time data access to the information that the physician needed to provide that care. They weren’t tied by the insurance company not wanting to pay for that procedure. I’m sure. They definitely were not tied by the physician not wanting to perform the procedure, and the patient really wanted it and really needed it. But because of the lack of data fluidity between that provider and whoever that insurance company was, he wasn’t able to get that done at that time. And it’s, everyone’s got the right intentions there, right? I’m sure the payer, if they could be reached or if their data had been able to be accessed online, would have gladly said, I’m trusting, right? Of course, that’s authorized. Of course, you need to have that procedure. He’s eligible. But like nobody had any mal intent. It was all broken in the data, right? It was broken at the infrastructure tech level. It’s like having the wrong ATM card and needing money really desperately for something really important. Right? Back in 1984, the financial industry solved that and now it’s the time for healthcare to solve it.

Martin Cody: I completely agree, and part of the solving and solution deployment is going to come from CEOs. You are a CEO and I’m curious, what was the thought process you had matriculating through the financial industry and then the healthcare industry, where you wanted to be the one where the buck stops here, you wanted to call the shots, and you wanted to help move the direction of a company? Where did that originate?

Stuart Hanson: Oh, that’s a good question. I don’t know where that originated. I definitely know where my passion had originated for trying to solve some of these problems, because working in financial services, I was really committed to trying to help payers and providers improve the patient financial experience, which we know from data. Right? A lot of great medical experiences are ruined with a bad patient financial experience, and it costs everyone, including the patients. Costs a lot of bad debt. It costs bad member experiences. People want to change insurers. They’re going on Google and complaining, right? That financial experience has always been really important. And I started to really connect with that personally through the HSA plan that I helped kind of design some financial products for and then tried to utilize. And it was really difficult back in the early days, but I think that there was never anything in my mind that clicked and said, Hey, I need to be a CEO or I need to be where the buck stops to really impact this. But I’ve always been excited by new roles to create a positive impact for patients.

Martin Cody: I like it, and if you were going to give some suggestions on career upward mobility to anybody that’s either in the healthcare industry or thinking about joining the healthcare industry, what type of advice or guidance would you tell them to focus on? Which areas for them to achieve kind of maximum fulfillment?

Stuart Hanson: That’s a good question. I’ve always, so I’ve gotten asked about career advice a lot before. And, you know, I’ve been on panels where some of the co-panelists have almost embarrassed me because I’ve never really actively managed or tried to schedule out my career path at any point in my career. My advice to folks in terms of career management is always be prepared to be surprised, right, and to take advantage of opportunities that may come your way that you don’t expect. And number two, always be bold with any new opportunity that you’re presented, right? Any job description you may have or receive or be considering for a new role is a starting point for a role, and I think there’s always an opportunity to shape that into something where you have, hopefully, some ability and implied authority to be a little bit bolder than what was crafted in the job description.

Martin Cody: So how does that manifest itself? What do you mean by being bolder?

Stuart Hanson: Just thinking bigger, right? It’s really, really easy. And I’ve worked in financial services and healthcare and consulting a lot of industries for a long time. It’s really easy. And healthcare is probably sometimes I say the ultimate example of the tail conditions, right? Because if we spend 4.7 trillion, how much of that is on people late stage in life or with multiple chronic conditions? Or maybe another example is how much of the revenue cycle costs of a health care provider are dealing with all of the exceptions, and it may be 2% of, you know, my claims are denied and ultimately able to get appealed and paid? Like those 2%, those 3%, those tail conditions cost a lot of money. So when I say be bold in terms of thinking a little bit bigger, thinking a little bit outside the box in terms of, Hey, we could solve this problem this way, but wouldn’t it be way better if we spent, you know, 40% more to solve this problem in a much more valuable way? And it might be a little bit harder to get the funding, or might be a little bit harder to get the trading partner in the room to collaborate with you around how to solve it, but it’s almost always worth it to think a little bit bigger than the problem immediately in front of you.

Martin Cody: And it’s interesting, if I’m going to pull on some kernels of wisdom that I heard there, which I think are uniform, regardless of healthcare industry or any industry, it’s I especially like the concept of be prepared. And a perfect example of this is the backup quarterback. Backup quarterback takes us just as many snaps as the starting quarterback in practice, and he has to be prepared in case that quarterback gets injured to fulfill the starting role. And so there’s a lot of ways that can actually appear in your day-to-day job. I love the concept of being bold or applying more value, again, we come back to that value term, to the role than what the role or job description reads. And the last thing I heard in there is you will probably encounter and see areas of inefficiency, areas of dysfunction in your organization. Anybody can point those out. I think the leader can point them out with a proposed solution on how to remedy said problem. And that’s right, I think you’ve hit upon that type of leadership. And maybe ultimately it does end up with you getting promoted to be CEO because you’re the problem solver. And organizations love problem solvers.

Stuart Hanson: They do. And they love problem solvers that think a little bit bigger than the problem may initially appear and try to solve it in a really meaningful way. So I think that’s it. I think be surprised or be prepared to be surprised and be bold enough to seize those opportunities when they come.

Martin Cody: Yeah, I think it’s a great idea and great wisdom. All right. I’m going to transition to the word association speed round for you.

Stuart Hanson: Okay. I’ve not done one of these. So I’m looking forward to it. I heard a few of your podcasts, so I’ll try to perform as well as some of your past guests.

Martin Cody: It is interesting to see what folks will say. And it’s a delightful because it’s just fun to see what’s going on in someone’s head. And the speed round usually produces some great results. So for you, I’m interested in you. We kind of touched upon this earlier. You may have even mentioned it in the sentence without even knowing this was coming up. So I’m going to say a word or a phrase, and then you tell me the first thing that pops into your head, good or bad. Prior authorization.

Stuart Hanson: Data.

Martin Cody: Good data, bad data, or just data?

Stuart Hanson: Data access.

Martin Cody: Data access. I think there would be others that would say prior auth are an entity actually intentionally throwing sand in the gears. And so.

Stuart Hanson: I don’t think so. I mean, I think that to providers and even the patients, sometimes it feels that way. But I’ve also seen really good outcomes of prior auth requests, resulting in maybe a different procedure or a different diagnostic scan or something to be done that may be more suitable, given that the payer sometimes knows more about the patient’s conditions or medical history than a provider in an imaging center, for example.

Martin Cody: Then we probably need collectively as a whole to shine lights on those examples more so, so that there’s an equal balance. I like that idea.

Stuart Hanson: I won’t say I love prior auth, I’m just saying I don’t think the intention is to throw sand in the gears. I think it’s really, it’s trying to manage the best care provision path for a patient. Maybe that’s the altruistic goal behind it and sometimes it feels sandy.

Martin Cody: That’s a good point. All right. Next one. Servant leader.

Stuart Hanson: Essential.

Martin Cody: Medicare Advantage.

Stuart Hanson: Pineapple. I don’t know if I’ve got a good reaction to a Medicare advantage. Yeah, I’m going to pass on that one. Pineapple is my safety word just so you know, Martin.

Martin Cody: Intriguing. All right. The last question is, and you’ve got a great background with which to draw from because you’ve probably benefited from standing on the shoulders of others, you know, going up the employment chain. And I’d be curious, anybody living or deceased, who you would like to sit down with and pick their brain and have an adult beverage in health care, discussing topics, who is the person and what are you drinking?

Stuart Hanson: I would love to have a discussion with Larry Allison. Right? Because I think that the data background of Oracle and his entire life in the ecosystem, paired with some of his ambitions for health care, would be really interesting cocktail discussion. If I was drinking something specific, I’d probably want to make sure he had a very strong old-fashioned, and I had a probably a lime club soda. Exactly. Just to make sure that I could get the nuggets of wisdom and not forget them. That’d probably be what I would be drinking.

Martin Cody: That’s awesome. I like it. Stuart, it’s been an absolute pleasure. I thank you so much for taking some time and sharing some of the leadership guidelines that have helped you excel and succeed, and we know that will help others as well. So appreciate the time and I look forward to catching up with you soon.

Stuart Hanson: Thanks a lot. It was a lot of fun. Appreciate it.

Martin Cody: Excellent.

Martin Cody: Thanks for diving into the Edge of Healthcare with us today. I hope these insights will fuel your journey in healthcare leadership. For more details, show notes, and ways to stay plugged into the conversation, head over to MadaketHealth.com. Until next time, stay ahead of the curve with the Edge of Healthcare, where lessons from leaders are always within reach. Take care of yourselves, and keep pushing the boundaries of healthcare innovation.