Sharing data more quickly, securely

One of the frustrating things about healthcare data is that they live in silos, so the user experience is far from seamless. Checking insurance eligibility, scheduling appointments and paying a bill each involves a separate interaction.

But that's becoming unacceptable with the growth of high-deductible health plans and the corresponding wave of healthcare consumerism. Health systems and insurers need a platform that functions more like Amazon or Kayak.

For Pokitdok, a San Mateo, Calif.-based technology company, the proliferation of high-deductible plans provided a “use case” for its platform. Patient experience suddenly mattered a lot more, and technology needed to catch up.

“We just kept asking ourselves the fundamental questions,” said Lisa Maki, Pokitdok's CEO, “and then we built it.”

A simple way to think about Pokitdok is to picture the operating system on Apple's iPhone. It has a number of native apps built in, but other software developers can also build on top of it. Pokitdok is like the iOS. It offers a number of “apps” for free—including software for checking a patient's insurance eligibility and claims history—and it charges a monthly fee, by number of transactions, for software developers that want access to its library. Enterprise customers also pay a subscription fee to access its platform and pre-built applications.

What makes this data exchange possible are application programming interfaces, or APIs, which are a fast, cheap and reliable way of bridging information between different services and software.

“We're calling it the API economy, and we've been working on getting our heads around them for the last 24 months,” said Tamara St. Claire, chief innovation officer at Xerox Healthcare, who has been following what PokitDok is doing. “Healthcare historically has been an industry of data silos. It's an API model that enables the exchange of data. We've never been able to do that in healthcare before,” she said.

Maki previously worked at Microsoft and founded a predictive analytics company called BeliefNetworks, which she ultimately sold to Benefitfocus. But it was her own struggle with trying to find medical experts and experimental treatments for debilitating back pain that led her to tackle the challenge of breaking down the medical industry's data silos.

“APIs are not a new solution—they're just new to healthcare,” Maki said. “Our APIs run on the most modern technology. We need it to be today. We need it to be flexible.”

For software developers, APIs mean that they can add functionality to their own technology platforms without building each component from scratch. A telehealth vendor, for instance, can integrate an insurance eligibility checker through PokitDok's API library.

“It also means that on Day One, they can scale nationally,” Maki said, because their technology is then accessible to all of PokitDok's subscribers.

Under the current healthcare model, when providers have a question about a patient's insurance coverage, for instance, they use a clearinghouse. Each time they do that, they may pay a fee and there's a time lag, St. Claire said.

“You had access to this data in a linear fashion,” she said. With an API approach, “You can have the conversation between provider and payer happen in real time, which doesn't happen now.”

Ascension Health, the largest not-for-profit health system in the U.S., is a Pokitdok customer. The St. Louis-based system wanted to create a consumer-facing portal through which patients could shop for, schedule and purchase certain outpatient services, like imaging procedures.

“They can start booking patients 24/7,” Maki said. “They can start experimenting with elastic pricing. No one else is providing the ability to create an end-to-end consumer experience.”

The platform also allows data to be shared securely. Health systems can begin to apply the same big-data analytics that retailers use. For instance, when patients log on to a health system's portal to pay a bill, they can be prompted to schedule certain tests or procedures based on their health and claims histories. As Maki puts it, providers can “start to build a profile around that patient without ever seeing them.”

PokitDok raised $34 million in a Series B funding round in August, and last month received an undisclosed investment from McKesson Ventures, the venture arm of McKesson Corp.

“There's a need for new pipes and plumbing,” said Tom Rodgers, managing director at McKesson Ventures. “Pokitdok is an example of modernizing that.”