Creating Realtime Access To Health Information with Ryan Howells, Principal at Leavitt Partners

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

: Welcome back once again to the outcomes rocket where we chat with today’s most successful and inspiring healthcare leaders. I thank you so much for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today’s podcast because he is an outstanding individual and contributor to Health Care. His name is Ryan Howells. He’s the principal at Leavitt Partners and the greater Atlanta area. He is a senior healthcare and business development exec. He’s focused on a lot of areas including state federal and commercial Klein experiences in health plan claims Operations Program Integrity consulting medicare medicaid insurance exchanges. He’s got a wealth of knowledge and his success includes overseeing large scale complex time sensitive political and highly visible tech implementations. I want to open up the mike to this outstanding man and have him fill in any of the gaps of the intro. Ryan welcome to the podcast.

: Thanks so appreciate the opportunity.

: It’s a pleasure to have you. And I just want to know Ryan we heard a little bit of the amazing stuff that you guys are doing during Health 2.0. But why did you decide to get into health care to begin with.

: Well when I was in undergrad school I was trying to think of what I wanted to be when I grow up. And there’s probably a little bit of that still left in me. Curiosity left but as I was thinking through that I wanted to I think kind of center in the business world but then also focus on trying to make a difference in people’s lives. I didn’t want to go pure business but I wanted to find a way to make an impact as well and healthcare seemed to be a natural option. But at the time I thought that the only way that I could get into healthcare with actually running a hospital. So I went and got an MHRA degree and said that’s where I want to be and recognize that healthcare is far more complex and far more difficult than anybody could imagine and through all kinds of different avenues into that kind of spending most of my career actually in health I.T. over the last 20 years and that has been a nice growing field and continues to evolve over time but it’s been great. I love complexity of solving problems and both are significant opportunities here. Specifically healthcare.

: Totally agree with you. You don’t like complexity or solving problems. Healthcare is not for you.

: There you go. That’s right. Yeah.

: And so Ryan and what a cool story you got in from the provider side. An administrator and now you kind of just gravitated toward I.T.. Plenty of challenges in I.T.. What do you think a hot topic that should be on every medical leaders agenda today.

: Well so one of the things that we’re focused on here in Leavitt Partners is this idea about interoperability but not necessarily looking in from a traditional perspective of how two different covered entities exchange data with one another via HEPA but we’re actually focusing on how consumers can gain access to that data outside of Hippa. It’s a project we like to call the Charron alliance and it’s an opportunity to actually share electronic data exchange with consumers in a meaningful way and we’re we’re pretty excited about it.

: That is pretty cool and listeners you got to check out the Charron alliance we’re going to dive into this a little bit deeper. But if you’re if you want to ask your friend Google it’s actually carin alliance and so definitely going to hear a little bit more about that from Ryan today. Ryan what do you think now is an exciting project that you’re working on.

: Yeah. So I guess just to continue Saul the kind of that overview of kind of where things where we think things are moving towards. I think there’s. With the recent announcements for example with Amazon and some of the other kind of employer plays that are out there in fact a couple of years ago there was a group called the Health Transformation alliance out there too we see kind of the market shifting towards kind of 3 primary payers Leavitt Partners is it just a little bit of background for your listeners other partners as a group of consultants that were organized by former Secretary Mike Leavitt of public office about nine years ago as secretary of Health and Human Services and so what he told us is that there’s this broad arc of 40 year change continuum within healthcare we’re about 25 years and that was a 40 year change process. And I think what we see is from especially from a payer perspective when a decision maker perspective kind of three main drivers of the health care economy over the next few years. One is employers. One is state governments and then the other would be the consumer themselves. We see the consumer the individual to be primary in their care. Over the ensuing years and we think that’s a really significant opportunity. So from answer your question or project perspective that was one of the reasons why we started this caring alliance is we felt as though there was an opportunity to take advantage of the great the ability for consumers to get access to more of their data. And by so doing they can make better decisions better choices on behalf of themselves and their family. As a result hopefully be able to achieve the triple aim in healthcare which will try and achieve that.

: Ryan This is interesting. I love the framework. And thank you for the synopsis there on what it does. I tend to gravitate. And I think a lot of people in general that our health care leaders gravitate toward vision. And you’ve got to make your own vision but you also have to learn from others and so you painted this picture of a 40 year change that’s happening. The three main changes being employers government and consumers. What is the end for only twenty five years into it. What does your 40 look like.

: Well I think you’re 40 is going to look a lot more in terms of of a value based care continuum or value based care model than it does today with fee for service. I think we have noticed we do a lot of work on the Hill in Peckham in D.C. here today are very close and we find ways where when opportunities we talk to folks on both sides of the aisle both Democrats and Republicans and one thing that they definitely agree on is health care costs too much. So from their perspective no matter who’s in office or who’s running Congress we see an opportunity for these groups to come together and find ways in which they can reduce costs. Now how they reduce costs is a matter of consternation a little bit but they definitely see that health care does cost too much and are finding ways to be able to make sure that both from a cost and an access perspective they can make health care more affordable but also more accessible to and that’s also a passion of ours in trying to find a way to make that happen.

: Very cool. That’s very insightful. So when thinking about the Carin alliance should the listeners think and associate that with one of the three pillars.

: I think so. I think they associate it with the pillar of consumerism. So let me give you I know a lot of your listeners are in the Provider space so just kind of practically speaking how this would relate to their potentially their current life. All the ITAR vendors in accordance with. So there was a law passed. I’m sure your listeners are aware of Macra and specifically within Makro there is a component of MEPs associated with that and MYP actually offer within minutes there’s a specific stipulation within the call the payment program that these providers about a half million of them that are participating in this program need to actually exchange data via API with third party applications. And so all of the H.R. vendors got together a few years ago and decided on an approach for how they’re going to exchange that data. It’s called The Argonaut project and they agreed on what the format would be and how they would exchange it and how the safety would be configured into their systems and so as we speak Cerner was about six or eight weeks ago and they had their kind of certified technology out there Epic’s was a little bit last year. But all of them were being implemented as we speak. And as a result a lot of these providers are having questions about well if I saw all these API eyes they give third party access to my data. What does that mean. Is that part of hip. Is it outside his hip. Do I need to actually validate with this is a good application. How do I ensure that the data is secure. How do I syndicate these users that are coming into my system. There’s all kinds of questions or policy questions. Business Questions technology questions and so what we do is I mention about two years ago we got a group together and said under the leadership of David Traylor and David Blumenthal and his Chopra and Mike Leavitt who are cofounders and said What’s interesting about this new world that we live in is we’ve always thought about interoperability as it relates to covered entities exchanging data with each other. The optional data exchange it’s not necessarily mandated under any law and that’s the reason competitors don’t share data with each other. But what’s interesting is when the API is given SPELD this year there’s an opportunity for a consumer to invoke their individual right of access under hippo which actually mandates that that data exchange be sent from a covered entity to a non covered and we don’t like calling ourselves covered entities. But we are a consumer and as a consumer we’re a non covered entity so our right to request that data is mandated under help. But the exchange itself is outside of Habba. So why does that matter. It matters because we don’t have to sign big BSA agreements or Durso like agreements to share data with consumers. We just give them their data. So we are working on the workflow technology workflow the policy workflow some of the operational workflow associated with a data exchange and how we can potentially expedite the ability for these systems to be interoperable using and leveraging the consumer at the center of that data exchange process. And that’s kind of the exciting work that we’re we’re focused on.

: Yeah that’s super super exciting and we’re chatting with one of our previous guests Ryan and I think that to saying that the law was actually going to mandate these API requirements this year but it was pushed to next year is that right.

: Yes so under MIPS provider that’s actually participating in the program based on the FBI to solve by January 1st 2018. And you’re right the previous guest is correct they delayed that for one year primarily because the vendors weren’t ready yet so they got a little bit of a delay on that. But hard pressed to believe that they’re going to get another delay on it. I think everyone is getting to the point where they are ready and they’re moving toward that that point. In fact I think you’re going to see this year a significant push by a lot of different individuals both in the administration and other aspects of the hill and other ways of saying that you know interoperability specifically this consumer directed interoperability is giving patients access to their data is a primary important piece of the puzzle is how we actually solve for developing value based care model.

: That’s super interesting. And listeners if you’re like me I like having visuals and they’ve got some really good visuals. carinalliance.com if you click on the what we do link there’s a really great picture of the current state versus the future vision. I’ll have a link for you all on outcomesrocket.health/carin Again you’re going to have all the shots that Ryan and I discuss here today and the insights that he provides as well as links to any of the things that we provide. So anyway just something to think about really shows the current state could be very fragmented and in a future state very neatly organized with access. What would you say one of the highlights and progress points that you would say is one of the proudest. Right now with this project.

: I think there’s two. One is this breakthrough of what we call must share versus may share. This goes back to the point I made earlier which is hipper related data exchange between two covered entities. They may share situations if I want to do pop health for example and I’m trying to get every single hospital in my civic city to be able to share data with me so I can have a better understanding of what’s happening there. It’s all about a shared type of greed. I don’t have to share it with you. If I don’t want to Lesseps obviously mandated by state law. But there is no kind of must share associated with hip related exchange. But when a consumer requests access to the data it is a must share situation in all situations and so as a result of that pothouse starts with the individual. So you could be able to start to aggregate that data through the individual. So that’s one big breakthrough I think the other breakthrough is what we have seen and what’s called Tascot. So the o n o n c of national coordinator overseas help us see for the country. Just recently in January released what’s called the draft trusted exchange lead work and it’s a portion of what’s called common agreement. And that was a mandate that they had under 21st Century Cures to release that some time last year and they they ended up doing that here in early January. What we like about the test that at least the draft trust of the exchange you can see that in health I.T. Daugava in their home sites or their web their homepages on their website is that they’ve had an opportunity to be able to hold that information and a lot of the comments we can your listeners can see that on our page and under our own C draft trust we exchange comments that we made back in August. They’ve been able to incorporate a lot of the ideas that we had about how to exchange data better with patients. And one of the breakthroughs that we had in the common agreement the trust exchange framework collection Incorporated is the fact that on trying to solve the problem of identifying patients across systems. So what we call identity proofing and authentication. One of the last summer as well nisse which is the group that is the government agency that’s actually oversees purity and I.D. proofing and other items for the federal government they actually developed a set of principles associated with trying to I.D. proof somebody across a system that is basically saying is Saul truly saw across system a b and c. Think of it almost like a digital DMV now where you can get a digital credential and that digital credential is the same as if you went into a DMV or a TSA for example to get your identity authenticated. Well there’s technology now that does that. And there’s also guidelines now for myths about how that should be done. And so we were one of the first organizations in the country to request that and seeing look at trying to ID proof someone what’s called identity assurance Level 2 and so I won’t get into a lot of technical detail probably too far and to this point but I’m pretty interesting. Here’s what’s great about it. We think that we have it and ability and we can get into more detail later but we think we have an ability to be able to identity proof and authenticate someone across systems at a near 99 percent plus content level. Basically the same as if you would see it kind of at the DMV level. And we have a way to authenticate you without using a username and password harvesting across systems and do it at a secure. Much much more secure way than we do it today with usernames and passwords. And as a result of that we think we can actually start to exchange data more securely with consumers and that alone is obviously going to be able to significantly decrease the patient matching issue that we have today or the record matching issue that we have today we’ll be able to do a lot better in the future.

: Now I think that’s a really great call out and congratulations on those two things I mean really great progress and when you were talking about the patient privacy and matching correctly and think of the unique patient identifier and so what are your thoughts on that and how this fits into it.

: Yes. So we don’t like say a patient identifier because people start to freak out when you say stuff like that. So we use the term digital credential okay and there’s a difference. So when you hear Dr. Rucker from the O and CC he’ll say things like you have a national patient identifier it’s called a social security number and then kind of healthcare and she says no that’s not good enough. We don’t. We’ve already been down that road before so we’re not going to have the industry isn’t really. There’s all kinds of reasons why the industry is never really going to have a national patient identifier. People on both sides of the aisle on the Hill are really ready to do something like that. But what Haddi are willing to do. Yeah. But what they are willing to do is they’re willing to be able to establish these digital credentials. So again think about it like this kind of digital DMV you get a trusted credential from a source that is essentially user proof and that digital credential could be used anywhere you need it to whether it’s through banking or through telecom or through health care or wherever you see that set because it does a lot more than just having one single number. The folks that I’m speaking to in the ID proofing world and identity and access management world have some pretty amazing technology that talks not only about just the regular identifiers you think about name address date of birth all the things that we normally think about those are all publicly available information. But even behavioral analytics how you hold your phone which applications you select when you’re on your phone how long you’re actually involved or engaged in a telephone conversation on the phone itself which cell phone towers you hit over the last 30 days they can do some pretty interesting things with your phone now. It’s pretty amazing really know that you are who you say you are. Wow. So it gets beyond just having a single number associated with you it actually gets into all kinds of other data elements as well that’s associated with you.

: Very very interesting right. Sounds like you definitely have been taking a deep dive into this and very intriguing the direction that this will take at this point. On the back end you know everybody’s talking about fire and integration to this. Can you touch on a little bit. I know maybe some of listeners may or may not be familiar with it. Maybe you can highlight what it is and how you guys are using it for your program.

: Yes. Fire the fast fill in operability resources an API standard that has been developed it’s no wonder 7. That is really the standard that these major vendors are using to start to change data. The AIS folks are excited about it because of my kind of reach of 72. It’s a lot more flexible. It’s a lot more supported and it’s a lot more better documentation as well. So within that all kinds of reasons for it. But these RESTful API is providing the ability for data to be exchanged in a very meaningful way. There’s been really thousands of them have been created in facings part of.

: The uptake is amazing isn’t it.

: Yeah it is. It really is amazing I think people have been wanting this type of a solution I think for a while. I mean Naypyitaw have existed for a while but physically within health care is having a flexible solution I think is about evil for it. The agency is part of the testier really that they had earlier also released was called the U.S. CD. Yes corrugate and operability set which outlines a roadmap for the different data elements that need to be in place they would like to see in place over the next 10 to 3 years or so. And what’s exciting many of them but all of them are actually fire based and they have an ability that start to change this data in a meaningful way. We think that consumers can play a key role in that going forward. And we also think that third party applications and open standards now so play a key role. So we’re working with the industry to develop more of those.

: That is super fascinating Ryan and I’m excited for the things that you guys have going on there. Obviously we really have limited time on today’s podcast so maybe we’ll do a part two to this but what would you close this discussion on. Carin as far as like what should the listeners take away from Carin.

: As a takeaway I think if you’re a provider especially and you’re frustrated with just interoperability in general you’re frustrated with the fact that you have kind of these patients coming in and the records aren’t matched appropriately et cetera. I think this is just a new way of looking at those problems. And they said it’s a way in which you can involve the consumer patient the families or caregivers in the process of trying to be able to link their records to them as specific unique individuals. I think definitely the technology is there and it’s also a chance for you to be able to share data from your EHR to third party applications to make them meaningful useful relevant have the data analytics that you’re looking for as well. I think there’s so many of these applications out there. Someone told me at one point there’s over 200000 health I.T. applications out in the Apple store. That’s a lot but they’re all ready to be able to make use of the data they can get access to it. So I think engaging the the application community in some of the work that you’re trying to do strategically as an organization I think will help tremendously as we try to accomplish those goals. And certainly if you’re a consumer and want to get access to the data I think that’s relevant I think and I just leave with this last item which is this is public information the Apple just announced and it was about a week ago now that they have the ability now on your iPhone to go with the 11. 0 3 release to be able to as a beta release to access all of your data that you have from your different providers. So as long as you go and register with the portal and you can access to that you can be able to supply Apple that information and making go out and get your data. And the great news about it is highly secure it’s actually downloaded to your phone not from a cloud. So it’s on your hardware and you can actually aggregate your data from all the different providers and you can too. So that’s a really exciting development and it’s an important one and I think you’ll see more of that in the future.

: Yeah. Ryan thank you so much for that I think you did such a great job of simplifying and explaining a very complex topic. So you know it takes somebody that really is understands it to simplify it the way you have so really appreciate you doing that.

: Hey you’re welcome. No. You know Ryan one of the things that we do here is is a course we build at a quick syllabus for the listeners. And so it’s what it takes to be successful in medicine today. The one on today of Ryan and so we’re going to put a syllabus together for questions lightning round style followed by a book and a podcast that you recommend the listeners you ready.

: All right I’m ready.

: Awesome. What is the best way to improve health outcomes.

: The best way to improve health outcomes is to measure it correctly and ensure that you’re engaging both the provider and the consumer with the information. The data that they need to be successful and make different decisions more informed decision when they have made in the past.

: What is the biggest mistake or pitfall to avoid.

: Running after the next big bright shiny object.

: I love that. How do you stay relevant as an organization. Despite constant change.

: Talk to a lot of people the more that he don’t get centered on just the same folks that you talked to previously talked to multiple sectors. We have a really unique business model here of other partners where we frequently talk to multiple sectors within the healthcare industry. We developed like 30 alliance of the year and have this opportunity to really engage with folks from across healthcare. And when you do so you gain some really interesting new fresh insights.

: You guys are like a think tank over there.

: Well we. We don’t like to sit around and pontificate per se. We are like actual results. So what is the difference. That’s a big difference here.

: That’s true.

: We love bringing these books together and just trying to actually create solutions. But we’ve got a lot of freedom and flexibility to do that and we have a great leader that has helped us in navigating the waters associated with that.

: Now OK let me rephrase. You’re an action taking organization of thinkers.

: There you go. Folks who make me think we’re pretty smart but we love hanging around other smart people too and solving problems.

: But you know I love it right. And one of my favorite quotes is You are the average of your five closest peers so I guess you are who you hang out with that. What’s one area of focus that should drive everything else in your organization.

: What’s best for the consumer the individual themselves. I don’t like using the word patient because that assumes they’re going to come visit you somewhere and I don’t like using the word members. What the health plans but I like using the word either individual or consumer. I think what’s best for the person is really what we are we need to get to and healthcare and everything around the drive. The answer to that basic question.

: Love it what book and what podcasts would you recommend to the listeners.

: Well the book that I love a lot and I’ve read a few times is a book called What Got You Here Won’t Get You There. It’s by Marshall Goldsmith. He’s a USC professor and he basically he’s world renowned to actually be a vizor and essentially a life coach to folks that are uber successful to try to help them get even more successful. And he outlines a series of steps on areas where he’s seen super successful people. Not be able to get to the next level that they want to. And I find myself actually picking that list off a number of them from his life I should say. So it’s a great reminder about potential areas or blind spots. You may have ways you can improve your life and that’s been a good book.

What a great recommendation. Right.

Podcasts wise I’ve only heard a few of them so far but I like them it’s a podcast called healthy dose by bestman Oxfam partners. They’re the two guys that actually do some D.C. work in San Francisco and they attacked some pretty interesting folks on their podcast so there’s a lot of them out there.

: I love it Ryan and listeners take note of these recommendations and the syllabus. But if you’re driving or running or doing something awesome which you probably are go to outcomesrocket.health/carin and you’re gonna see Ryan Howells thoughts the things that we shared the full transcript as well as links to the book and podcast that he shared and his organization. So Ryan this has been a ton of fun. What would you conclude as a closing thought here and then maybe you could share where the listeners could get ahold of you.

: The concluding thought is that over the next few years there is going to be a proliferation of open data in the market both in the commercial side of Medicare and Medicaid as well where data is going to be a plus for the industry. I think that the folks that are going to win the future the folks that actually can be able to incorporate that data into their business make sense of it and make it actionable and really change their business as a result. So data is really going to drive the future and think within healthcare. And that’s where you’re going to see a lot of this going in and how we shape delivery systems and financial reform to start getting hold of me I’m going on Twitter at @aryanhowells. And then Carin Alliance is actually out there on Twitter too @carin alliance as well out there on Twitter so feel free to follow us.

: Outstanding Ryan and listeners. This is definitely a gentleman you want to follow an organization you want to follow. And Ryan I just want to say thank you once again for carving out time in your really busy day to share these insights with us really appreciate it.

: Happy to. Thanks for the time.

So thanks for listening to the outcomes rockett podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

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