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Dan Wilson:
Hey everybody. Welcome back to the Outcomes Rocket. I am here with Dan Wilson from Moxe. Good to be with you.
Dan Wilson:
Yeah, you as well.
Saul Marquez:
So we’re having incredible discoveries conversations here at HIMMS and had a great opportunity to connect with Dan. Dan, why don’t you tell us a little bit about you, what you do, and why you do it?
Dan Wilson:
Yeah, absolutely. So focus on reducing costs in healthcare, and we do that particularly by looking out payers and providers work together and share information to best support a variety of payment and operational use cases. I got into this about 15 years ago, so I’ve been working mostly with providers at the onset and then have transitioned to working in this kind of payer-provider space over the last 7 or 8 years or so. So you can think about it as really like a next generation of the whole clearinghouse infrastructure. So rather than building kind of the business of healthcare around claims data, we’re looking at how you can use clinical data to rethink a lot of those processes that are currently claims-driven, to instead be more prospective, more timely and effectively allow for more automated decision making by both the payer and provider, all with an eye towards taking cost out of the administrative side of healthcare.
Saul Marquez:
Excellent. How do you guys do that? Like what’s the mechanism to do that?
Dan Wilson:
So the EHRs have been investing quite a bit in different APIs, different data exchange kind of tools for quite some time. Those tools are general purpose, and so what we do is we kind of connect into all of those, so we connect directly to EHRs. And then we effectively allow the health system to set a bunch of rules around what data is allowed to be exchanged. So we start thinking about data exchange with an untrusted or less trusted group like the health plan, it starts to look very different from data exchange with other providers for treatment use cases. So what our technology is doing is connecting to the EHR, acquiring the data required for the payer use cases, applying a series of access control rules over it to make sure we’re in accordance with health systems, policies and procedures, and then ultimately structuring the data to inject it directly into the different payer tools. And so it takes out a lot of the complexity that currently would fall to an IT department and a lot of manual effort that would otherwise go into setting up these connections.
Saul Marquez:
Wow, that’s really interesting. It sounds like it’s a seamless way of sharing data.
Dan Wilson:
That’s always the goal.
Saul Marquez:
A better way to provide transparency, and ultimately everybody benefits from it.
Dan Wilson:
That is the goal. I think the idea is effectively that we have too much money that’s currently not sitting with the payer and not sitting with the provider. Candidly, there’s too many vendors in this hall that are siphoning off too much of it. And so our whole thought is that if you can make the payer-provider operate better together around areas where they have good PNL alignment or good shared incentive, you can effectively take the reduced cost and then reallocate those dollars to both the payer and the provider, and they can both improve their margins. It really is about how do you actually align the payer and the provider from a financial sense and use that to then drive more efficiency into the system.
Saul Marquez:
And it’s about data and transparency. I mean you think about the vertically integrated systems that have that built-in transparency.
Dan Wilson:
Yeah.
Saul Marquez:
You guys are layering it in to those that don’t, giving that advantage.
Dan Wilson:
That’s right. Those that don’t. And actually, you’d be surprised that the people who are, you know, highly integrated and yet still have, due to politics, different IT systems, really still a lot of friction that sits in between the institutions. So a lot of health systems who are setting up health plans will still have complexity within the institution. And we have a lot of health system clients where we are doing a lot of exchange with their own health plan for that reason.
Saul Marquez:
Dan, thank you for that distinction. You know, you oftentimes make these assumptions that, hey, because they’re vertically integrated, they got their stuff together. But there’s a lot of complexity, like you said, and there’s an opportunity for more. You were about to say something.
Dan Wilson:
Well, it was just like, oh, for years people have talked about we want to be like KP, with this idea that Kaiser has got it all figured out, is this like highly integrated system. And I think everyone knows when they look at their own operations that there’s a better way. And everyone kind of has put KP in this, this kind of position. The reality is KP has their own challenges as well. Like this is a very complicated, very messy problem. And it’s messy technically, but the data is messy really, though, it’s about people and process and the politics of the situation, which is present in every single institution. So I think there’s always every organization has an opportunity to find more efficiency here. And that’s kind of what we’re helping to advance.
Saul Marquez:
That’s great, Dan. Well, look, I appreciate you sharing the valuable work that you do. For anybody listening, payers and providers listening today and watching, where can they visit you and learn more about you?
Dan Wilson:
Yeah, absolutely. So our website is just MoxeHealth.com. M O X E Health.com. And we’d love to talk more. So love this stuff.
Saul Marquez:
Thank you, Dan.
Dan Wilson:
Yeah, absolutely. Nice talking to you.
Saul Marquez:
Likewise.
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