Camille Baxter: Hello and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Camille Baxter. Today's consumers expect a seamless experience when it comes to their health. In this episode, we'll explore how organizations can leverage technology to drive satisfaction and engagement. For this important topic, I am excited to be joined by Robert Connely, healthcare market leader at Pegasystems. And Jennifer Zellinger, vice President of Product Development at enGen. Robert is a recognized healthcare innovator with over 35 years experience in healthcare and information technology, helping organizations pioneer new approaches centered around social dimensions of healthcare. Jennifer is a leader with extensive experience in healthcare operations, focusing on information, technology, data, and finance. She is known for expertly guiding cross-functional teams to align with overarching strategies, policies, and best practices. Robert, Jennifer, welcome and thank you both for being here today.
Robert Connely: Thank you, Camille. Looking forward to the conversation.
Camille Baxter: I'm really excited about our conversation, so let's dive right in. Robert, as a global market leader in healthcare, set the scene for us. What are the key challenges organizations are facing today?
Robert Connely: Well, in healthcare, that's a big concept. Look at it from many different dimensions, almost like a Venn diagram of what payers have to do, what providers are doing, and as we recognize healthcare as a much more holistic thing than what we've thought of in the past, we bring in the patient consumer centric view of the world and tying in communities in those social dimensions of healthcare that we've not really dealt with before. But the challenges are pretty immense right now. I mean, clearly we can't turn on the news and not know that people aren't getting sicker. I mean, we have things like deaths of despair and concepts like that now. Providers are burned out. We have so much pressure on the system. In fact, healthcare serves as a backdrop, it seems like, for all of our social ills and other things that we happen to see in life.
Combine that with some of the equity issues we have today, and what you see is the landscape that's having to use technology and evolve to sort of meet these rising needs. We see it especially in the payers and providers side right now as they move toward value-based care, as they start using technologies and new ways to really create a consumer-centric, clinically integrated system. And this is really the goal that we have now. We know what works. We've seen that in the past. We know that care management works these high touch sort of interventions that we have, but we don't know how to scale it yet. And that's where a lot of this future goes to in some of the work that we’ll be talking about in a second. But I think that's where our real focus is, is in these big global areas where can we find a way to use technology and in a way that actually achieves value, not just uses technology, but gets us to that thing. And I think that's the biggest challenge is how do we take all this technology, we've built all these challenges that we face and not only achieve those, but drive the value that we need at the business level.
Camille Baxter: Robert, thanks for outlining some of the key challenges across the healthcare landscape. Jen, as Robert mentioned, enGen is on a mission to address some of these challenges. Tell us a little bit more about enGen’s vision and strategy.
Jennifer Zellinger: Absolutely. And so I think Robert was spot on with technology, not just for technology's sake, right? And so here at enGen, our vision is really to be the leader and engineering a healthier world for all. And coupled with that is our mission to drive a remarkable health experience through innovative health tech. And so while technology enables us to achieve scalability and impact to the member, at the end of the day, it's about outcomes. When you see on the news and you see all the healthcare conflicts and struggles and complexities that go along with it, how do we engineer a technology solution, a product in a way that really helps to achieve the outcomes for a member living healthier lives, reducing friction with the providers, getting members the care they need when they need it, and not prolonging a process or a decision point with the technology? What we're really trying to do in our ever-evolving healthcare landscape is understand that at the heart of it is really trying to reduce manual workloads, trimming those administrative costs, maximizing efficiency, and turning that back into a really solid customer and provider experience.
Camille Baxter: Thank you for that, Jen. Robert, I want to come back to you for a second. You mentioned that healthcare data standardization is still a challenge. How do you see technology addressing this issue and bringing together data from different sources?
Robert Connely: That's an interesting question. Really, our standardization and interoperability efforts, things along those lines have really gone a long way to achieving the data that we need, bringing it together at a moment in time. The next challenge, again, to use that value term, is how do we gain value from it? This is one of the bigger challenges that we face. We have the data, but we sort of have to tie that to the who, what, where, and when of a person and that moment that matters that all that data comes to use. This is really the challenge that we face in what we've proven that humans can do in a care management situation. We believe technology can now do it in an automated sense that allows us to achieve that scale. Really, I think where interoperability standardization comes into play to understand the data enough that we can predict behavior, we can anticipate needs, and then we can interact with people in these omni-channel feedback loops that suddenly give us new insights, what I like to say, seeing in the dark, sometimes just see what's happening in people's lives that we don't normally capture in data. And I think this is where the standardization piece comes into play and feeds back into what Jen talks about: how do we use that to actually further those outcomes that we are so desperately trying to achieve?
Camille Baxter: And I want to dig into that data a little bit more. Jen, how can bringing data together help minimize friction for health plan members?
Jennifer Zellinger: So that goes back to getting the whole view of the member, and so leveraging as much data as we can procure. It's not enough anymore to look at just the claims data for a member or just their demographic information, but augmenting that with social determinants data, data as someone is having an episode in a care setting, how can we tap into that as it's happening to be able to affect their outcome and their experience? And that's the one tenant of our Predictal care management product that's been built on Pega is really leveraging that data streaming technology to pull that in as often and as is accessible as possible to affect the outcome for that member. Again, getting that whole view of the member is critical and presenting it to a clinician in a way where it's at their fingertips and they don't have to traverse multiple different systems to be able to see what's happening to this patient at this time, how can I help them? So, it's not only just data, it's having the right data and bringing that all together.
Camille Baxter: Earlier, Robert, you shared about the importance of real-time communication and feedback loops with patients. Can you give us some examples of how Pega enables proactive consumer experience and improves outcomes?
Robert Connely: Yeah. Let's take one that's personal for me, which is a surgical event in your life. Many of us encounter these occasionally. It's actually one of the most extreme points in our life. If you think about it, how sick we are when we've just been taken near death in a surgical room. Then there's a discharge and a recovery period that is really dangerous for us as individuals. The way the world works today is we just don't have the ability to really follow up. So the patients take on a great amount of responsibility of doing the things they need to do when they need to do it. So what we're doing with these omnichannel interactions is basically creating a more frequent interaction. We reach out to remind somebody to do something or to think about doing something. We might use it to actually train them. This is an interesting aspect.
Then we talk about the social aspects of healthcare, how do we learn to do things? Well, human nature, it's repetition, reinforcement. So we can start taking care plans and start turning them into sessions through technology that actually train people to learn, to take their medications correctly, to learn to let us know when the nerve block wears off and the pain begins, or to understand what's happening across their various healthcare journeys. So this is where this whole notion of these feedback loops give us that as to what this person in that moment is, to anticipate that need in that particular area of their life. And this is where it gets really almost game changing. When we can get that level of insight to combine with the data we are already collecting, now we're going to start generating those opportunities to drive real outcomes and value.
Camille Baxter: That really does sound like a game changer. Jen, what results have you seen particularly in terms of cost savings, member satisfaction and engagement?
Jennifer Zellinger: We've been thrilled with some of the outcomes we've seen with the role out of our Predictal product. One of our health plans, our payers, whenever you're switching technologies, whenever you're switching from System A to System B, you expect there to be a learning curve for your end users, for administrators, and there's a certain expectation of when do you get back to pre-productivity levels from before that switch? And so, when we rolled out our utilization management platform within Predictal, within six months of going live, one of our clients saw an increase in productivity standards by 20%. So, turn that into how that affects a member as authorizations come in and as users and clinicians have to make decisions about that procedure or about that service, think about getting that decision 20% faster and be able to churn through more of those decisions at one time.
Not only that, but the self-service capabilities we've enabled with the technology on the Pega platform, have really turned this into a highly configurable workflow for our end users. So, it's not enough to roll out a new care management platform and then let it be. It has to evolve as the business evolves. So as business rules change, as mandates come in, having self-service capabilities to afford our users to be able to pivot quickly is a game changer. It keeps our productivity high. The other thing, too, is the ability to have that user satisfaction. So, 95% of staff that were using the Predictal application responded favorably to their experience, which is huge. It's not enough to just be able to help the member, but you want the interaction, the users to be able to do that as well.
Camille Baxter: Yeah, that member satisfaction, those results are really huge. Robert, we've touched on how healthcare technology needs to keep up with a complex fast moving industry. How do you see Pega's technology helping healthcare organizations overcome these complexities and move towards value-based care?
Robert Connely: Well, I think pieces that we've talked about are the building blocks of that. I think where Pega's focused right now, in a lot of areas, is bringing some of these newer technologies to further our efforts. I mean, we talked about the learning curve that Jen just spoke of. One of the areas that we see as a huge opportunity is by doing what we call agent-assisted AI experiences for customer service agents. We can suddenly bring them into the world of understanding how to handle a call, how to manage that process much more effectively to reduce the onboarding time. This is a huge issue in many of our client bases and pushing that out even further in how we wrap up even call summaries, things of that nature. But those sorts of applications of AI are going to be really prominent as we move more into integrated care, right? We're starting to see a lot of work on the pharma side, independence going there. How does this consumer-centric model expand out beyond the worlds that we're focused in now, into the sort of next generation? Like I said it earlier, imagine if you could take this same consumer technology we put in the hands of the call center agent into the field. What if it's the community health worker that has the same AI-assisted interaction that says, let me listen to what you're listening to. Let me participate in the conversation and educate you in real time while I learn and act on these things in the background. That's where we see this going, not in an earth-changing sense. It's not trying to achieve the singularity of AI at all. It's just using it in a very narrow, very applicable sense to actually activate people instead of the reverse. They think we're replacing jobs. I think we're actually starting to accelerate them more toward 21st century, socially based jobs. So just an interesting thought there.
Camille Baxter: Yeah, it really is because AI and just that aspect of training, helping to train the individual is such an important distinction. Jen, I wanted to ask you, how is enGen using technology for competitive advantage in delivering better experience to your members, clinicians and employees?
Jennifer Zellinger: Absolutely. So, with Predictal or with any platform, with any technology change, that's a big decision for a payer/employer. It takes a lot of investment in time and money and your users. And so, from a Predictal perspective, one of the outcomes we've seen is that the time to implement this is measured in months, not years. So, the ability to move from an existing platform to whether it's utilization management or case and disease management, within Predictal, it’s measured in months. And that has allowed for acceleration of not only using the new technology, but then translating that new technology into the outcomes we spoke of earlier to the member and to the providers. What really we're looking to accelerate and put forth is allowing our clinicians to practice at the top of their license. So allowing not only a quick implementation time, but also once they're on the product, being able to cut through administrative red tape and focus on caring for the member. That's been one of the key tenants of our implementation is to really allow clinicians to practice medicine and care for that member.
Camille Baxter: And that is such an important distinction and something that clinicians are really looking for. So, as we wrap up, let's think ahead to 2024 and beyond. Do either of you have parting thoughts on how AI and machine learning will be used to improve consumer experience and patient outcomes?
Robert Connely: Well, just to keep the order going first, to me, what's happening is we're really applying this technology to create what we at Pega call the autonomous enterprise. The ability to understand these connections. That engine does such great jobs, so if we understand the flow of data in the payer environment or the provider environment, connecting those dots together is where a lot of this administrative overhead will be taking out; the ability to predict when an authorization should be approved or to make sure the data from the claim is there at that moment of claim and not create a pen or something of that nature. We're going to be seeing it in that area. So sort of outside out of mind. Hopefully it's not going to be as spectacular as gen AI every day, but it's going to be in the real value-based areas of healthcare. We're going to see it really taking root there, and this is where our focus is. I mean, you can read the papers for all the exciting stuff, but the real work's happening in the background and trying to bring these things together and automate as much as we can put decisioning at the right moment to reduce that friction that we described earlier. This becomes the challenge over 2024 and 2025 all the way up until 2030, sort of the decade of change that we're facing.
Jennifer Zellinger: I would like to add to that, Robert, spot on that with AI, we're already leveraging it in some facets on identifying the right patients, the right members that need care. So how do you take all that data we spoke about earlier and bring that to that whole member view and say, these are the members that need our help right now. We're leveraging it from that perspective already and identifying members for care plans, for interventions or assistance as we can help them. But the other thing moving forward is we're not using AI just for the sake of AI, and we're not using that to replace clinical, but to augment that, and we really want to help automate that process. Again, going back to let's allow clinicians to practice at the top of their license, but put forth as much automation and documentation or data gathering for them to do that. And again, going back to the faster decisioning, the faster interventions are really there to help the members at the end of the day to live their healthier lives.
Camille Baxter: This has been such an informative conversation for our listeners. Robert and Jen, thank you so much for this conversation and for being here today.
Robert Connely: Thank you.
Jennifer Zellinger: Thank you. It's been a pleasure.
Camille Baxter: Thank you to Pegasystems for sponsoring this episode of Healthcare Insider. Pega provides a low-code platform that helps top enterprises adapt and solve business challenges. With AI-powered decisioning and workflow automation, clients personalize engagement, automate services, and streamline operations. For more, please visit www.pega.com. To our audience, thank you for tuning in today. To hear more episodes of Healthcare Insider, you can go to the multimedia section on modernhealthcare.com or subscribe at your preferred podcatcher. I'm your host, Camille Baxter. Thank you and take care.