Episode Transcript:
Dr. Kathryn Eshelman
What I love about what I do is it is a win-win-win. We are exploring ways where the health plan wins, the docs win, and the patients win. That's what we do. That's what value-based care is doing.
Robert Traynham
I understand you have three kids from 3rd grade all the way up to high school. Yes. What type of activities do you do together?
Eshelman
You know, it's really evolved over the years. When they were younger, it was definitely a swimming pool or a movie. But now that my youngest has kind of turned the corner, if you will, to do more big kid stuff, we're able to do a lot more outdoor hiking kind of things. And I've also gotten them into football and soccer. So we have fun watching it on TV or going to games and things like that. That's probably our favorite thing to do.
Traynham
So Dr. Eshelman, I have to ask you, how do you find calm in the midst of this huge storm that I'm hearing in a busy household?
Eshelman
Yeah, there's a lot of emotions in my house. I have three daughters. The way I find... It sounds a little counterintuitive. We got a puppy, which is not calming, but he's 10 months now. And going for walks with him has been a real way for me to kind of reconnect with the outdoors, the peaceful part of nature, just him and me. And so that's been really one way that I find some calm. But I love being in the mix. I mean, it gets crazy, but it's...
Traynham
And what's his name?
Eshelman
His name is Archer. So we are in a very Taylor Swift era right now. And so there's a song called “The Archer.”
Traynham
I see.
Eshelman
Hence, that is his name.
Traynham
Can we move on to talk a little bit about Inovalon? Walk us through the overall mission of the organization.
Eshelman
Yeah. I've been there for 15 years because of the mission. It's a very mission-driven company. So we are really all about trying to make health care more efficient, better for the patients, better for the providers, better for the health plans, and really doing that through technology. So I was in practice and I kind of experienced the clunkiness that is practicing in U.S. health care. And when I joined Inovalon, I've really just been excited about the journey we're on, to really play a part in how this is all going to get so much more efficient because as we know, health care has lagged behind other industries when it comes to technology.
Traynham
Yeah, yeah.
Eshelman
Just to put it mildly.
Traynham
You mentioned a few moments ago that you were in practice, but it bears repeating, you are a physician.
Eshelman
I am.
Traynham
You worked as a primary care physician on a Native American reservation, correct? Navajo Nation? Tell us about that.
Eshelman
So I worked on a Navajo Indian reservation, which was in Northeastern, Arizona. Really a fascinating... I trained at Penn, so a big academic institution, and then moved out to the Indian reservation, which was a tiny... we had 16 medical beds. We had a four-bed ICU, universal health care in the United States, which is an unusual thing to experience, and still a lot of poor outcomes because as we know, even though all the treatments were free, medications were free, health care is more than just that, right? But it was a really amazing experience to get to know that population, to build trust with that population. I miss it. It was a really great experience.
Traynham
And how does that factor into your current role, the intersection between the two?
Eshelman
I feel like I've had a lot of different views on health care. Again, coming from a big academic center where I did my training moving out to Indian reservation, I also worked at a FQHC in Baltimore, worked at an academic at University of Maryland. So I've had a lot of different kind of views, had sort of the universal health care, had in Baltimore working in a clinic that was predominantly Medicaid or fee-for-service, so people with no insurance. So this is kind of before Obamacare, we had a sliding scale, and so managing patients as best you could with Walmart $4 formulary, knowing that they didn't have any health insurance to get that cardiac stress test or different things that they needed. So going from universal health care to no health care and just seeing the different perspectives on it, I think has really helped inform what we're doing now. Seeing it from different angles has been really helpful.
Traynham
Speaking of health care from different angles, can we talk a little bit about analytics? And I would love to talk about how it could transform health care, but just as importantly, how does it impact patients and also providers?
Eshelman
Yeah. I think analytics already are transforming health care. I think we're in an era of an acceleration of that for a lot of reasons, AI kind of being the foremost, but also there's a lot of different data points that come together when you are taking care of a patient as a physician or as a health plan. There's information not coming just from the EHR, but coming from the pharmacy, coming from the interaction the pharmacist had, coming from if they had an in-home visit or chart review, there's lots of different information all coming together and getting that sort of standardized and then applying AI where it makes sense to that is where we're really seeing, I think the biggest surge in analytics.
Eshelman
But analytics in the old way might be, "Has Kate had her mammogram or not? Yes? No?" Now it's more, "Does she tend to do it? Do we need to worry about her? Is she going to do it on her own? What's her likelihood of following through on that? And how do we combine that with everything else that's going on with Kate and really help the provider know what the next step to take?"
Eshelman
And I think that's really the transition that we need to go to value-based care. We've been in value-based care for a long time. I will never feel more passionate about anything in health care than I do about value-based care, partly because I'm a primary care physician. And as a primary care physician, you don't go into that because you want to see as many patients as you can in a day. But that's the metric that when I was coming up, was the metric. "How many patients did you see today, Dr. Eshelman? Was it 30? Was it 40?"
Eshelman
And so getting that pivot where it's really how well I take care of my patients. And you can't do that without data. You have to have it. I have this dumb analogy I make all the time, but bear with me. It's a terrible analogy because I'm comparing doctors to car salesmen. However, if you are in a model where you're trying to see everyone that comes through the door and sell them a car, that's how you make your money, that's fee-for-service in a very crude way. And then you're asked to switch to, okay, you're not trying to sell a car to everyone that comes through the door. You want to know which person really needs a car, who to sell to and then when you do, you don't get paid on a commission. You get paid on whether or not they get the oil change, their tires rotated, how well they're taking care of their car. You need a lot of data to tell you how to navigate that. And that's-
Traynham
How far they've driven the car.
Eshelman
How far they've driven. Are they likely to come in for their regular service? Are they somebody that needs maybe somebody to go to them and go get their car and bring it in? And so that's kind of what we're transitioning to. And the reality is you need a whole lot more technology to manage in that way. It's the right way. It's the way we all want to manage. It's less expensive and it's better care, and it's better for provider burnout, right? Because again, it's more about how well you're caring for your patients than how many patients did you see. But still, a lot of physician friends that I know are still in a very fee-for-service. I mean, at the end of the day, their paycheck is still largely driven by volume. So we've got our work cut out for us.
Traynham
Dr. Eshelman, you mentioned obviously analytics, and I want to talk about ePASS, which as I understand it, is the Electronic Patient Assessment Solution Suite.
Eshelman
You know, it's my third child.
Traynham
Your third child?
Eshelman
It used to be my baby and then I had a baby.
Traynham
Okay. And is it in 5th grade, 6th grade? I mean, if you want to keep this analogy going.
Eshelman
Oh my goodness. Yeah. It's about 6th grade now.
Eshelman
Okay.
Eshelman
Yeah. So the whole spirit of that was, it's kind of like an EMR created for physicians by physicians.
Traynham
And just to pause, Dr. Eshelman, EMR stands for?
Eshelman
Electronic medical records. But what it really does is it gives the provider a whole lot more information than they can get because it's really the health plan's view on the patient. And this is something, when I was in primary care, I struggled with. The health plan would know if my diabetic patient had their eyes examined. I wouldn't because they paid the claim. I may not know because the ophthalmologist may never send me a correspondence, let me know. And that's gotten better in time. But still, there's so many different systems out there. Most of your eye doctors are not on your same system and-
Traynham
So it sounds like there's a lot of conversations happening, but everyone's talking past each other.
Eshelman
There's a lot of conversations happening. Everyone's talking past each other. And I think everyone... The genesis of ePASS was really to tell the provider everything that's going on with the patient, what medications they're filling, what's happened with them, but also what gaps in care. It's a term we all use. Have they had their colonoscopy do? Do they might have a condition like diabetes that hasn't been treated and assessed? And so it's kind of bringing that all together and making sure that the provider is documenting everything properly. And I think we're getting closer. Again, it's taken a long time, but the amount of information sharing that's happening now is unprecedented.
Traynham
Inovalon's ONE Platform, what is that?
Eshelman
So Inovalon's ONE Platform is really around trying to centralize everything that needs to happen with the patient in one platform. And again, that can't be the EMR, the electronic medical record, because there's so much that goes on with the patient outside of that EMR. So again, we've got a pharmacy platform where we're talking about the dispensing of the medications and the interaction that the pharmacist has had. We're looking at different interactions that the patient has had with the health plan.
Traynham
I see.
Eshelman
Have they had someone come to their home? Are they eligible for some disease management program that they didn't know that they were eligible for? All of those things in one platform, because what happens right now is on the health plan's perspective, a chart review happens for the patient because sometimes charts need to be reviewed, see what happened. That information flows back into the health plan, but it doesn't all come into one centralized place where you know what happened, the results of that, combine that with results of the EHR, the claims, all of those things together in one platform that can really help service everything that's going on with a patient, because it's so much more than the doctor and the health plan. There's a lot of other entities. If you think about anyone in your family's journey, it's so much more than that. There's the pharmacies, there's the home health, there's all these different other things that are happening to really help care for the patient.
Traynham
Super helpful. Can you tell us a little bit more about the value-based contracting? What is the importance of that?
Eshelman
Oh, man.
Traynham
You're laughing.
Eshelman
Get on my soapbox. No. Value-based contracting is where we need to be. We need to be managing a patient based on how well we're caring for them. And I think what happens a lot when people hear the term in the industry, they think about utilization, control costs, that's value-based contracting, make sure you're not ordering too many laboratory tests or unnecessary MRIs or trying to keep the patient from going to the ER if they don't need to go to the ER. Those are utilization metrics. That's what everybody focuses on, and that's very important. But it is three legs of a stool. It's utilization, it's quality. How well is Dr. Eshelman taking care of her patients? That matters. And that's why we have quality measurement to say that because utilization doesn't tell the whole story. The other thing is the risk adjustment, the disease burden of the patient. How sick are Dr. Eshelman's patients?
Eshelman
Because when you have those three things together, now you have value-based care, because if my patients are really sick, of course their utilization is going to be higher, and their quality metrics might be a little bit lower, but that's okay because I'm managing a sicker population. And so those are the three variables that we need to make sure are all in play in these value-based contracts, and we need to make sure that the providers are getting the information that they need so they know how to succeed in those contracts. And that's really where it is.
Traynham
Sure. Before the cameras were rolling, you and I were chatting about just how fast we are living and in terms of all the technology that's out there and that it's constantly changing. I bet you at the end of this podcast, technology probably would've changed at least two-fold, right? Seriously. I'm not dramatizing.
Eshelman
It's amazing, the exponential curve-
Traynham
Indeed. And here we are in the middle of this decade. I'm just curious to know from your perspective, how do you envision Inovalon's... our products evolving throughout this ever-changing dynamic that we're living in?
Eshelman
Yeah. I see our products as, again, having this platform that's kind of the one place where everybody can go to have sort of that single source of truth about what's going on with the patient, including the patient. And we're already using AI. We're going to be using AI where it makes sense with human supervision. This is health care. So we're not ready to let the genie out of the bottle quite yet. But there's a lot of areas where just reading a chart and summarizing a chart and telling us what can happen and learning from that. There's a lot of great AI use cases, and we're exploring a lot of different ones. But where we are with AI right now is select use case it can do this, right? It can do that, but it's not it can do everything yet, yet. And so we're really trying to build on how can AI make things better for the patient and the provider and the health plan with human supervision.
Traynham
You have a lot of product, but also clinical experience and obviously clearly medical experience. How does all of that play into Inovalon's product lines? How do you show up in terms of helping to shape that narrative?
Eshelman
Yeah, I am always putting the provider's perspective in. I think there's a lot of companies in this industry that don't do that, and I think it's really important. We're losing health care providers right now. So I think it's really important to have that provider perspective and say, "That's great and all, but how would the provider actually use this information? How would they get to the information? And then will they find it helpful?"
Eshelman
And then also the patient as well. So I've had a lot of experience with patient's journeys both personally and professionally, and making sure that whatever we're doing is going to be useful to the patient as well. And what I love about what I do is it is a win-win-win. We are exploring ways where the health plan wins, the docs win, and the patients win. That's what we do. That's what value-based care is doing.
Eshelman
And so it's fun and it's exciting because we're really trying to pioneer this and be a part of everything that's happening and really trying to advance things. There's a lot of work to be done, but there's so much progress being made that I think in five, 10 years, my anticipation is one, we're going to get a lid on health care costs because there's a lot of unnecessary stuff going on that's not even really helping the patient. And we're going to get to the point where the patient and the provider are in sync
Eshelman
And so I think we're really getting to a place where we're going to be a lot more synchronized, a lot more kind of going in the right direction. Right now, there's still a lot of chaos of getting all the data in the right place and actioning on it, but I am very optimistic about where it's headed.
Traynham
You just took the words right out of my mouth. I'm smiling because you sound very optimistic about the future.
Eshelman
I am.
Traynham
Which is exactly where we need to be, so thank you.
Traynham
Sure.
Traynham
And in your own words, Dr. Eshelman, what is the next big thing in health from your perspective, keeping in this optimistic frame that you're in?
Eshelman
I think the next big thing in health is really around trying to re-foster the patient-doctor relationship. Right now, it's been, I don't know, invaded by administrative burden and that computer in the room where they're like this and we're not really having a good conversation. I think we're going to come back to that, ironically with technology. Technology put us there. But I think technology is going to bring it back around where when you see your doctor, you're actually going to have a solid 10, 15 minute meaningful conversation guided by technology, but the technology's going to be a little more in the background, kind of where it belongs in those interactions.
Traynham
It sounds like it's almost full circle because before technology, it really was a meaningful conversation.
Eshelman
It was you know.
Traynham
And then technology happened, and then it's just this right?
Eshelman
Yes, yep.
Traynham
And I think what I hear you say is we have all this data to have a very significant and meaty conversation, but let's talk eye to eye. Let's look eye to eye. Let's have this meaningful conversation about you and your health and your relationship with your own body, whatever that looks like for you.
Eshelman
Yes, let's eliminate a lot of the stuff that's not going to be relevant, and let's use the technology to really focus on what are the three or four things that we want to talk about today where I'm going to leave the office feeling like, "Okay, I was heard. I know my plan. I'm on a good path" right? Back in the day, it was wonderful, except that information in my chart went nowhere, right? So it was very siloed. Now with technology, we've brought all the information together, and we can use that to really get the most out of that visit again. And I'm really excited. I think everybody in America is excited for that
Traynham
Well, thank you again, Dr. Eshelman, for your time. I look forward to continuing this conversation.
Eshelman
Me too.
Traynham
Three months from now, six months from now, where we can have an even more meaningful conversation about the data. So thank you.
Eshelman
Sounds good. Thank you.
