Greg Boulton, Executive Delivering Corporate Development and Relationship Management in the Payments Space

The Role of Consumer Payments Products in Healthcare with Greg Boulton, Executive Delivering Corporate Development and Relationship Management in the Payments Space transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez is here and today I have the privilege of hosting Greg Boulton. He’s a corporate development executive with experience in the financial technology industry who has spent the last 10 years focused on payments and payment products in the health care space. We are going to be discussing the impact that the financial industry, technology, and products can have on improving health care delivery, knowing all of the challenges that exist and how we pay for health care. I think today’s discussion with Greg is going to be a really interesting one. And so with that, I want to give you a warm welcome to the podcast. Greg, thanks so much for joining us today.

Greg Boulton:
Thank you so much for having me.

Saul Marquez:
Absolutely. So you have been focused on basically how we pay for things in health care. Greg, what has been your inspiration to spend the time that you have in the sector?

Greg Boulton:
Sure. So I came to the health care space from the financial services industry, specifically looking at payments products. So credit cards, debit cards, prepaid cards. And in a lot of respects, the industries have a lot of similarities. They’re obviously very critical industries and the services they deliver are critical for the lives of our members or our customers and inherently complicated products, complex products. But in many ways, we’ve sort of felt like the financial services industry had maybe made faster inroads into bringing automation and customization to our products in the financial services industry. So coming into health care, we were really looking for opportunities to streamline and make participating in engaging in health care easier for the members. So that sort of dovetailed with the health care industry really getting more deeply into consumer-directed health care and focusing on the members’ decision-making and the role that plays in health care. And so we really saw those industries coming being well aligned. A lot of the financial products in the health care space have not really been around that long. The very first tax-advantaged accounts around health care were the very late 90s going in the early 2000s. And so one of the things that we did early on was to try and attach a card to some of these tax-advantaged products and make it easier for administrators to move the money and also for the members to understand what they were spending and make it reduce the amount of paperwork and manual actions required for them to take advantage of those tax-advantaged accounts.

Saul Marquez:
Yeah, it’s interesting and you’re right. There’s so much that has happened in finance that I mean, it just sped past health care. I had an interview several months ago with the Chief Information Officer at Philips, and he came from Citibank. All the innovations that they were taking advantage of at Citibank now they’re getting leveraged by Philips and that company. And so there’s a ton that we could learn from the financial industry. And so talk to us a little bit about some of those things, Greg, and maybe how this particular approach can add value to what we’re doing in health care.

Greg Boulton:
Well, I think some of the things that we’ve been engaging with a lot, of course, as I mentioned, automation. And that’s really almost entirely contingent on standardization. There were a lot of advantages the financial services industry has had compared to health care, that there’s a much higher level of standardization and the bodies that would create and maintain both system rules, as well as the legal constructs behind all that that allow enforcement of rules. We’re so much stronger in the financial services area than they’ve been in health care. So in the financial services we’ve had Visa and MasterCard, we’ve had not had a very prescriptive central planning function operate in financial services. And that’s allowed all of the companies to code robustly to build a very robust infrastructure around a data set and communication standards that didn’t have a lot of variation. In the health care space, of course, we do have HIPAA standards, but they’re far looser and there’s a lot more variation. There’s a lot more variation in health care plans and there’s a lot more variation in the kind of diversity of approaches across the health care space. And that makes it all much more difficult to approach. But overall, our approach very much has been that is that we’re going to try and create a consumer product built on a mountain of technology and complexity, but try to shield that and make it seem as easy to the consumer as possible. Make that decision point to essentially when the member or the consumer is at a point of sale. We want them to go into their wallet, know which card to bring out, trying to keep it as simple as that in the health care space.

Saul Marquez:
I think it makes a lot of sense and there’s not a lot happening here. I mean. To see a lot of innovation around the payment models, You talk about payment products like credit cards, I’m not sure if you’ve heard of a company called Sidecar Health.

Greg Boulton:
I don’t know, Sidecar.

Saul Marquez:
So they have a basically you pay a monthly plan and they give you a credit card and you have ten thousand dollars. Well, for example, one of the plans, up to ten thousand dollars a year to cover your medical expenses. You present it as a cash pay patient and you just pull from there. And just these different approaches to how we pay for health care are critical in a time when there are so many people that are uninsured. And how do you do it if you’re not getting it through your employer or are you basically self-employed? There are many opportunities here.

Greg Boulton:
Absolutely. And that approach where we’ve kind of we’re pulling together a lot of different concepts together under the umbrella term of consumer-directed health care. But essentially that belief that there’s just too much diversity of people’s individual situations to have a one size fits all when it comes to health care and that we’re going to be better off supporting a wide range of approaches in order to handle all the different nooks and crannies of our market. That the payments industry absolutely, I think has a lot to bring to bear to support that. So that what you describe as Sidecar, that’s a really interesting one to just go ahead and start off by from the assumption that we’re going to be extending some credit to the individual and then that’s going to give them that sort of buttress that they need in order to handle health care bills. There’s a lot of things that need to come together to make that work. And I’m not speaking specifically to Sidecar, but rather to consumer-directed health care in general. Cost transparency is generally the biggest obstacle that we encounter towards truly making the purchase of health care services as easy as the purchase of a financial instrument or mortgage. It’s something of what you would think might be comparable level of complexity, but it’s truly a much more difficult buying experience for the member. So there’s still a lot of obstacles left to try and address to really bring the health care purchase experience on par with other consumer-directed experiences. And without that, that’s where we struggle. And I don’t know that anybody’s really found an answer to that because I think in the long term, we’re going to always be in a diverse marketplace unless something really wild, something not really in the cards along the lines of a single-payer overthrow of the health care marketplace happens. Barring that, I think that we’re going to see an environment where you have fully insured traditional health care models alongside cash pay models, and those could not be more different. And yet you want to try and support them with as much of the same infrastructure as possible.

Saul Marquez:
Those are some great call outs. And Greg, just thinking through the different approaches, what would you say makes the approach you’re thinking about different or better than what’s available today?

Greg Boulton:
I think the first thing is that trying to establish that sort of locus of the relationship between a plan and a member, regardless of what kind of plan it is, whether it’s simply access to a network with relatively limited financial support or whether it’s a traditional plan that has a huge amount of financial support, the member needs to have sort of that relationship and in the payment space, the existence of a physical card and in more recent years, augmenting that with an app on the phone where you can see all of your activity and have that conduit for messaging, notification reminders, creating that relationship is going to have benefits in a number of different ways. And we have worked with insurers all across the socio-economic spectrum. And in some corners of that, it’s really about just struggling to have any kind of direct relationship with their member. They’re trying to find out who these people are, get just the rudimentary understanding of their health situation so that they can begin to tailor some health treatment, everything from that extreme to the opposite, where you’re really trying to where you want to be. You’re going to have individuals that are participating in multiple treatment plans and you want to have some robust communication. All of that is on a spectrum that I think the financial relationship can help to secure and do. And so that then opens up the avenue toward using things that we’ve learned around loyalty and relationship development, gamification, and some of the more modern buzzwords and approaches to keeping members engaged in aware of the relationship that we’re trying to maintain with their with health and with their health plan.

Saul Marquez:
Mm-hmm. And so as we look to options like these, the ones you mentioned to improve that experience, what would you say is the best thing that could come out of this approach?

Greg Boulton:
I think it’s going to have to be a series of small steps. One of the things that I don’t think anybody that you talked to who tried to develop product ideas in the health care space will tell you that there’s it’s very rarely a technological obstacle. It’s an implementation and adoption obstacle that if there are just so many different stakeholders in any particular transaction and that it’s just about impossible to get all of them aligned around something new, it’s essentially impossible. And so what we find is that we’re trying to graft on incremental improvements onto an existing system. And so the government creates a tax-advantaged account. You could set aside money tax for health care spend. And there’s been a number of these medical savings accounts, flexible spending accounts, health reimbursement arrangements, health savings accounts over 10, 12 year period as those accounts were rolled out, attaching those to a card, a website or an app so that we can make it as easy as possible for the member to instead of pulling out the additional card, pull out of health care card, go straight to their health, their tax-advantaged funds, and create as much infrastructure as possible to reduce the need for them to have a paper receipt afterward. Trying to make that a seamless and effortless experience for them to take advantage of the money they’ve set aside.

Greg Boulton:
That particular product requires very little of the rest of the health care infrastructure in order to adapt to it. We already had a copay. It was simply a matter of making sure that that card was accepted. And then there were some industry innovations on the payment side to allow a little bit of extra data center along so that a health care transaction could be treated differently than a non-healthcare transaction. Those required some coordination, but they were mostly in the financial and retail space and it worked and it’s worked great for 12, 15 years. Didn’t require doctors to change the practice, didn’t require the front office and back office to make changes. It didn’t require plans to make any changes. So this one kind of worked and it went out the door. There are a lot of really interesting and very exciting opportunities that are very hard to get going because they require more participation. We’ve talked about eligibility platforms that could work better at the point of sale to identify a copay and go ahead and clear the entire transaction. But really, the rest of the health care infrastructure is not set up. That would be our adjudicate a claim long after the member has left the physician. And as long as that’s the case, it’s always going to be an obstacle to hit some of those funds.

Saul Marquez:
And so would you lump that into some of the biggest setbacks or what would you classify as some of the biggest setbacks we’ve experienced?

Greg Boulton:
We’ve had some learning experiences around what it would take and how big the obstacle would have to be to really set us back on a new product. We’ve worked with some products that were really innovative, for instance, in the state of Indiana when Mike Pence was governor and Seema Verna, the current CMS director and she was working with that state, they rolled out the Healthy Indiana plan. That program we’re very excited about it in the payment space because we really saw this as a way to kind of get a little bit more of that central controlling influence to make the industry move towards a much more real-time adjudication claim. And this was in the Medicare space excuse me, in the Medicaid space that was going to mimic a lot of the consumer-directed aspects that we see in private insurance and the public space and really make members aware of the monies that were flowing through the benefit they were receiving from their plan and the amount of money that was moving around based on their decisions. Very innovative. And we saw some hoops to jump through, but the industry was able to make it happen. It was fascinating, but it did require the providers to change their processes for a subset from most practices, a relatively small subset of the folks walking in the door. And that was really not going to work for them. And so we had some obstacles to rollout and ultimately we didn’t get the volumes to the program that would have liked. Great product. It worked. It just didn’t pass the adoption hurdles that we see and a lot of health care innovation really struggles with that last hurdle.

Saul Marquez:
And it’s getting the people to use it. It’s getting people to adopt it. And what do you think went wrong there? I mean, what could have been done differently?

Greg Boulton:
I’m not sure what could have been done differently. The real struggle is and I think that if I had it all to do over again, I would probably start the practice management side and work that direction because I found adoption by consumers is always a challenge, I don’t want to minimize that, but I found that to be a challenge that we kind of all understood. It’s a matter of member communication. It was presenting and helping them to understand what it is that we’re asking them to do. And we’ve found that consumer adoption would go forth but getting providers to support that, anything that required a different change on their side or data to flow differently or for them to be different water operations was a huge challenge. There were some eligibility products that kind of went through that same process. Gosh, going back more than 10 years, I think, on some of those pilots, very promising. The technology was all their product worked. It just didn’t fit into the flow because we don’t check that until this point in time. We can’t change that just for 20 percent of the people walking the door, much less 10 or five and not so interesting.

Saul Marquez:
And ultimately, it’s the way that we get folks to adopt. The way that we adapt these things is so critical. So what would you say you’re most excited about then today, Greg?

Greg Boulton:
Well, I guess there’s there are quite a few products that I’ve been really interested in. And for the last six or eight years, we’ve seen more and more interest and innovation in the area of incentive products. So for a number of a plan, as we’re trying to get them engaged in the program, we’re trying to get them to reach out and provide some information to their health plan, draw up treatments where they have a chronic illness that requires treatment or just to participate in basic wellness activities that the health provider industry has known for a long time, that an ounce of prevention, that preventative, that wellness activities are preventative and improve population health. And so trying to find ways to encourage people to learn about those opportunities to participate is enormous. So some of the incentive products putting actual money behind or points or other kinds of mechanisms as well, but really trying to incentivize a member to learn about their plans, learn about the options that are available to them to take advantage of them and to see some rewards for that engagement. I think it’s very exciting because it can have a real impact on the wellness of the individual and of the population overall. So we’ve seen a number of plans, both private and public plans, interestingly enough, that has innovated a lot and are providing a lot more engagement tools and then incentives for engagement. Again, trying to create that stickiness of a relationship where the number sort of understands where they are with their plan and what they ought to be doing next is a huge opportunity. And it’s in its infancy at this point. For me, the point of comparison and again, back to the financial services world is a loyalty program, air miles, and then points programs for credit cards. And this is about companies trying to create a relationship with their member where the member starts to invest in that relationship, tries to coordinate and pull their activity together in one spot. Trying to do that in a health care context, I think has enormous benefits, not just that they’re going to use your services or not. That’s not really the axis of competition in the health care space. But what you do want to do is to actually let them have them reach out, have some interaction with them, be able to direct them to a less expensive solution or to act in a preemptive manner that’s going to ultimately improve their health and also save you as the insurance companies save you some money.

Saul Marquez:
Yeah, and Greg, I think it’s a great point in health care. If you’re not using the benefit, then there’s usually no interaction. And these mechanisms you’re referring to, they’re great ways to engage with a customer and not just wait when they actually need you. You’re building that relationship throughout and not necessarily just getting them at the point of care.

Greg Boulton:
That’s right. By the time that they’re there, they’ve already made some of the decisions that you would have liked to have influenced.

Saul Marquez:
Yeah, that’s super interesting. Well, there’s so much we could learn from finance in health care today was just kind of the tip of the iceberg. So I’m really appreciative of you, Greg, and coming on and sharing some of these insights with us. Before we conclude the podcast today, I’d love it if you could just leave us with something to think about. And then the best place for the listeners can reach out to you if something today struck a chord with them.

Greg Boulton:
So we used to joke a lot that health care was a target-rich environment as we were looking for things that were inefficient, that we could possibly improve with a product. We couldn’t throw a stick without hitting something that we thought could be improved. And there are obviously it’s a lot more difficult than just spotting one of those. But it is an exciting area because fundamentally, we’re not just what we’re providing. The services can actually improve people’s lives and so it’s been a very rewarding area to try and create some innovation and try to improve the environment for people. As far as my own contact. The best way to contact me is through my limited presence, Gregory L. Bolton via ULTLN on LinkedIn. And I’d be delighted to talk further with some of your listeners.

Saul Marquez:
Love it, Greg. And folks, go to Outcomes Rocket Health in the search bar type in Greg Bolton. As he mentioned, it’s B o u l to. And you’ll see the links to today’s podcast. You’ll see references. You’ll see a link to Greg’s link then so you could get in touch with them. So with that, Greg, I want to say thanks again for spending time with us today, and definitely looking forward to staying in touch with you.

Greg Boulton:
Thank you so much.

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