Reducing Healthcare Waste and Cost with Data
Episode 420

Swati Abbott, CEO at Blue Health Intelligence

Reducing Healthcare Waste and Cost with Data

Tools We Use and Recommend

Save time, Make a Bigger Impact

Check them out

Get The Latest In Your Inbox

SUBSCRIBE

Reducing Healthcare Waste and Cost with Data

Episode 420

Recommended  Book:

Who Moved My Cheese?

Best Way to Contact Swati:

info@BlueHealthIntelligence.com

Mentioned Link:

BHI

Reducing Healthcare Waste and Cost with Data with Swati Abbott, CEO at Blue Health Intelligence transcript powered by Sonix—the best audio to text transcription service

Reducing Healthcare Waste and Cost with Data with Swati Abbott, CEO at Blue Health Intelligence was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Swati Abbott. She’s the CEO of Blue Health Intelligence, a privately held healthcare analytics and intelligence company with access to the largest, most current and conform health care data repository in the US. Ms. Abbott has a proven record of providing focused health care solutions and services and has been recognized for extensive domain knowledge and industry leadership and payer, provider and supplier markets. She is dedicated to making health care analytics usable for improving outcomes that positively impact lives. Today’s focus is going to be on how do we do that exactly? How do we improve outcomes? How do we reduce costs of care? And I’m so privileged to have this discussion with Swati and share it with everybody today. So, Swati, thanks so much for joining us.

Swati Abbott:
Oh, you’re welcome. It’s my pleasure.

Saul Marquez:
So tell us, Swati, what is it that got you into health care to begin with?

Swati Abbott:
You know, it’s really interesting. And it was purely by accident. You know, I got a job with a company called Softmed, which is not part of 3M. You know, literally my second job and it was in healthcare working with providers for various solutions, quality assurance, quantity utilization, management, coding, abstraction. And you know, and that’s how I got into health care. And from then, I just stayed in and I was fascinated by the extent of change you can bring. And so, you know, that started my career purely by chance.

Saul Marquez:
Wow, what a chance. And you’ve found incredible work with that. And the change that you can make. I mean, it’s incredible that that was the inspiration for you and still continues to be your driving force.

Swati Abbott:
Yeah, I am very passionate about not only the data and analytics part of what we do, but also about how do we one step at a time chip away and improve healthcare and the lives of so many Americans.

Saul Marquez:
That’s beautiful. And and it’s one of those areas where you could make that impact. Tell us what you believe needs to be front and center on health leaders agenda today and how are you guys tackling it?

Swati Abbott:
Right.. I do think that there are two main things we need to focus on. One is healthcare, as you know, is going through a huge, massive change. You know, we had the Affordable Care Act a few years ago. There’s been a lot of debate on the Hill and others. And so with all that in place, there’s also an emerging older aging population. So there’s more pressure on Medicare. Medicare Advantage, you have consumerism, you know, with the millennials and the younger population. And so in the midst of all this. I think the healthcare leaders have still two basic issues. One is and you know, the other dynamic, I’m sorry to say. I mean, is that if you look at the per capita spend in the entire world, the US is spending the most. We’re not very good outcomes. The quality of care and the quality and outcomes are not that good. So that has to be top of mind. And for all health care leaders, how do we reduce cost? And when I say reduce cost, I’m not saying not provide services. Denying services is not what I’m talking about. I’m talking about. There is a lot of waste in the system. How do we attack that? How do we reduce the cost by taking out unnecessary services and waste and then improve every individual consumer of health care health and outcomes? That should be top of mind. And the other thing we can’t overlook is that, you know, in today’s world where every industry leverages the power of data, we hear about it all the time. Health care needs to understand what are the patterns of utilization, what are the patterns of outcomes, and then understand from your own data what other things you’re not doing so well. What are things you doing well? And then if you’re not doing well, how do you improve that? So that has to be top of mind. I think.

Saul Marquez:
I love it, you know. And now let’s zoom in on the on the waste. You know, I feel like waste is we could be a little more like specific on the types of waste. There’s so much of it. If you can just hone in on that for a second for us.

Swati Abbott:
Oh, absolutely. So, you know, one one thing that we did, a study we did a couple of years ago, I’d be a tie and there are several others doing that. You know, there’s there’s a concept called low value care. And what that means is that we are providing care, a certain type of care that could actually end up harming a patient. And at the same time, we’re spending more. And so, you know, so we have actually triangulated and said, OK, these eight or 10 low value care items and we run those numbers and the dollars you can save are staggering. And so to give you an example of low back pain, you know, you know, or headaches that are not and you know, you’re getting all kinds of tests done, imaging done, you know, is that necessary? And and, you know, you’re exposing somebody, your patients to radiation. So things like that. And, you know, there’s several of those categories that we looked at and said, you know, should we be providing now, you know, the question there becomes a clinical judgment of the clinician, the judgment, but at least you shape that, you know, shine a light on these issues. I’m not saying that, you know, we’re forcing you or not covering, but to shine a light on issues. Do you really need this step? And, you know, things like that. The other thing that I think is really interesting is that we’ve done is, you know, a lot of times when people have, let’s say are osteoarthritis, they may go in and get a knee replacement or a hip replacement. Well, the appropriate protocol should be, did you get physical therapy? Did you try alternative methods of trying to remedy the issue before you just jump into a joint replacement, which is expensive and could have complications? So those are the types of things that, you know, data can shine a light on. And then it tells you, you know, yes, let’s consider this or let’s look at a policy where we provide alternative care before we jump into surgery.

Saul Marquez:
Yeah, I think those are some great examples. And, you know, as we think about the the journey of, you know, a patient within the health care system, when they walk into your your doors, you know, if you’re a provider. Now, what exactly are we doing here and how are we being stewards of the of the resources within our system? I think it’s a super important question to ask. And how are you empowering those decisions? And so we’d love to hear from from you, Swati, how you guys are using technology to improve outcomes and improve that spend.

Swati Abbott:
Right. I mean, there’s multiple ways we do that. One is, like I said, we frequently do studies based on news and things like that when we had the opiate use. You know, we did a study saying, what are we seeing? What are the patterns? What’s leading to it? Or, you know, if we’re looking at, you know, typically the largest spend a few years in a row was a joint replacements was one of the top few. So we looked at and did a study to say, you know, is that is – was that appropriate? And and so those type of things, we shine a light and we share that with the Blue Cross plan. So what you know, and so we try I just so, you know, is owned by 18 Blue Cross plants throughout the country. Yeah. So that gives us a wonderful platform to do these studies and then go back to our investors, all 36 blues and say this is what we’re finding out. So I have a newsletter that I send to all my CEOs and say I wanted to shine a light on this issue for you. So we do that to share some of these findings. And then that individual plan, if they think it’s appropriate, may do their individual study or set a policy saying, you know, we really think that providers, before you recommend this, you should look at this. So it’s totally up to the individual blue how they want to do it. But our job is to shine the light. The other way we do it as we have a solution that is, you know, that we’ve taken a benchmarking opportunity for saving solution. And what we do is we can work with any individual Blue Cross plan and show them what are the top 10 drivers of spend. Let’s say in the inpatient area hospitalizations, etc. And a physician office area and drugs. And we showed them the top 10, the top 20 for that particular Blue Cross plan. And then we compare that on that same chart with benchmarks, regional and national. So it’s immediate to shine the light. So if you can see that, oh, I and we found one plan a while ago who was spending twice as much on a basic service like colonoscopy twice as much as any other Midwest plan. And they were like, why is that? You know, and we dug in and we found that they didn’t have a policy in place that said, you know, if you’re getting a colonoscopy try to go to a freestanding ambulatory surgical center. The cost is less than half as opposed to going to a hospital. But the other thing is they found a particular contract with a hospital where they had 99% of room and board. What that means is that hospital was keeping people overnight or billing the insurer that the 99% of my people getting colonoscopy are staying overnight. And you know, so that was so far away from our benchmarks that we immediately flagged it and they fixed the contract and they got back in line, saved 12 million dollars.

Saul Marquez:
Oh, my goodness. That’s incredible.

Swati Abbott:
So that is a power of you know, every blue plan or every payer would have their own issue, something they do really well. Some things they need to improve on. And this in five seconds can shine the light. Say here things you should be focusing on specific to your business. And so that’s another way we help. A third way we work with a lot of the Blue Cross plans or of our clients is, you know, a lot of times large national employers. Let’s say you have the Walgreens, Wal-Mart, last large national employers who have, you know, employees all over the country. They want to. They want to test that, you know. But, you know, if we believe that if you, you know, cut out the bottom 5 percent provider in the country, you know, because they’re providing such bad care, we may be able to improve and lower our costs and improve our employees health. And those kinds of questions come to our clients and we sit down with them, look at the data. And so at this particular opportunity came to me. I looked at their data and I was able to sit down with them and say, you know, I looked at your total spend. The top area where you’re spending is for this large national employer, Right.. And I said, the top area you’re spending is pregnancy deliveries, which, you know, you have a younger population. The second is joint replacement. So let me drill down into joint replacement. Take an example of a knee replacement and tell you really, are you going to save the money before we go and make all this change et me at least test your hypothesis.

Saul Marquez:
Yes.

Swati Abbott:
So we did the analysis and we pointed out to them that, you know, in fact, all you would do if you eliminate bottom for some providers is save five hundred thousand over three years. Is that worth it? However, if you tear your employees to the best providers in your area, in wherever they’re living, the best provider, you could actually save two hundred million of that in just one…

Saul Marquez:
Like it.

Swati Abbott:
And so we totally turn the conversation based on the fact that we were providing them inside. And so that is really where when I say make data driven decisions, it becomes so essential to look at the data to analyze, pause. Test the hypothesis and then execute.

Saul Marquez:
I think it’s brilliant. And, you know, for for a large employer providing those types of services. This is the type of insight that you want. So, Swati. Tell me. So you’re you’re working with the blues, you’re working with large employers for the listeners thinking, man. You know, am I somebody that they would work with? I mean, tell me a little bit more about customer profiles and the type of people that you work with.

Swati Abbott:
Sure, we definitely have two aspects to our business. One is we work with the blues and their customers and all providers. So it’s a collaborative. We like the collaborative approach as opposed to working with one versus the other. We also have several clients we work with who are providers of services. Let’s say we have you know, we work with IQVIA that has a lot of data licensure with pharmaceutical companies on effectiveness of drugs, etc. So we work with them and we provide our data to them. We also work with several providers of services to, for example, providers, hospitals, etc. And there again, we have a data collaboration where our data powers, their solutions. So they are able to bring meaningful insights to providers on, you know, where they’re offering their services. Are they doing the right thing or are they effective in their care? Those type of things. So, you know, we we work with a multitude of customers that way.

Saul Marquez:
It’s great to know that for the listeners wanted to potentially engage and learn how to how to leverage some of this, shed some of this light on potential opportunities for savings and outcomes improvement. So appreciate you sharing that. Swati, tell us about a a setback that you guys have had and what did you learn from that setback?

Swati Abbott:
So I can talk through about being try and give you an example, but I can also tell you my own personal experience. Let me start there. When I got into health care as a very, very young executive early on in my career, I have a very left. I was very left brain. I was a physics major and a programming expert and technical I.T. base. And I was in charge of this product line where we were providing services to hospitals for different clinical and non-clinical areas. And I was so focused on process and organization and development and somewhere on my radar. Just coming from my inclination, right. We all do what we were comfortable doing and I was comfortable on the process, the organization being a great manager and building great products technical and totally lost the customer along the way. And you know, did not really understand what we’re building and why and was so busy on the technical to build and stand it up in a lot of as I go through even at the try, I hire young executives and I love that coaching. Always think of what your customers, what they want. Why are you building it? Questions. And how can we solve the problem? You know, we all owe it to ourselves and our companies to do that. And it’s, you know. So when that company brought in an expert on that, I was like, oh, my God, I felt like I’ve failed. And I reflected on it and I realized I was so busy and process and tasks that I forgot my customer along the way. I have to understand what they need. Why am I building this? What can I do better than what they already have today? And that’s the part that you can’t leave behind. And I think that that message stays with me even today.

Saul Marquez:
And they’re both so important. Right. You know, I appreciate that message that you’re leaving here with with us. And it is you know, they’re both so important Right. keeping close to the customer and delivering a high quality solution. What do you do to stay balanced there? Right.

Swati Abbott:
Yeah. And you know, and I’ll give you an example of what we’re doing at BHI now, right? Sure. I came to be BHI from a company called MEDai where we used artificial intelligence to really go through a mine healthcare data and predict. So, you know, I’ve talked about descriptive analytics, which is you’re looking back in the rearview mirror and saying, this is what happened. This is what you need to do right then. And then we did a lot of predictive, which is OK. You know, we know, for example, let’s take my name, Swati Abbott, you know, and you could look at and say, oh, Swati may have diabetes and she has hypertension and she’s not very good about taking her drugs. So we predict she’s going to cost you fifty thousand or above. Next to you, she’s right now at five thousand. But based on her profile, we predict this. So that was very essential. And and so at BHI, we do that, too. But then, you know, when my team was working on it, I said I worked at MEDai I nine years ago. We can’t come back and be a try and do what we did nine years ago. There are many companies who are doing that. What else is needed? Yeah. So we went and talked to our customers and understood their need and really came back and said, what we really need is once you predict what these members are, who these people are, who need extra care so that you can truly provide better care and prevents them from becoming the train wrecks that they’re on a path to. What do you do if you as a health plan or a provider or call that person you call Swati Abbott? What are the three things you need to tell me to do? So now we’re looking at prescriptive analytics and I’m so excited about that. We’re mining our data and we’re going and saying, OK, how do we create personas of members who are the two people who are diabetics and who are the same age group and who have the same profile? Why did one become really sick and cost a lot? And really, it’s a turmoil on that patient’s family as well as the health care system versus the other who stayed healthy. And then we come down with what are the five things this one did that the other didn’t. And so by machine learning, we can give you prescriptive analytics, which means what do you do about the predictions you made? So that is, you know, where I’m heading. And you have to understand the need, not just put a solution and then advance. To keep ahead of the health care.

Saul Marquez:
I love it. I love it. You’re not stopping at hey, here’s your potential problem. But here’s a set of solutions that have worked.

Swati Abbott:
Right..

Saul Marquez:
You can try them. You can. You can start a, you know, a program, a policy. Love this enhancement for sure. And so you’ve had a lot of success too, Swati. I’d love to hear from you what you believe is one of your proudest moments to date.

Swati Abbott:
You know. The one that that that does. Oh, you know, when I was joining BHI, as I mentioned, you know, we had 18 investor plus the Blue Cross Association as an investor. So 19 investors. BHI was actually formed as a division of Blue Cross Association because the association works with all the individual blue plans. And then Scott Sirota, their CEO, decided in 2010 that the best approach for this would be to spin it off as a for profit standalone company and and get a CEO who could then give it direction. And so they hired me as the first CEO and I joined in 2011. You know, I talked to a lot of blue CEOs. I talked to several people in the industry. And everybody was like, this is going to be very challenging. How do you know when you have that many investors? How are you ever going to get consensus? How are you ever going to be able to lead this? And you know, my answer was, I have to understand what they’re trying to achieve, because the problem is pretty universal. And I have to try to create solutions that can adapt to their individual market. And you know, and some of it is a trust and it’s a challenging environment. But I believe that if we can start showing small successes, we will get people to believe and join. And so and when I was able to and I when I joined BHP, I laid out a five year business plan on what level of adoption I would have with the solutions we build, what solutions would I build, what would be the revenue and what would be the expense. And and, you know, and I have to say, I have a wonderful team. And we were able to beat all our goals five years in a row and now going on 8 – 9. So and it was just because we kept our ears to the ground. We listened to our customers. We didn’t let one customer drive the whole agenda. We were looking at customers. We have constant meetings. And we created solutions that were more universally appealing and could adapt to a local plans, needs as well as the overall system. And and I think that that is a message, you know, that a lot of people have an investor or two. And, you know, let’s always think of the broader market. Let’s always think of what is a problem we’re solving and that’ll lead to how you do it.

Saul Marquez:
I love it. Yeah, it’s it’s a great pathway to to get things done. Doesn’t matter how many investors you have, if your focus is so clear and so Swati, tell us, what’s the most exciting thing you guys are working on today?

Swati Abbott:
Well, I am super excited on, number one, the prescriptive analytics that I’ve told you about that that, you know, nobody in the healthcare industry has really quite nailed it. And a machine learning. Yeah. Clinicians can give you that. So I’m very excited about that. But I’m also very excited to say that, you know, we already have over 190 million lives going back 9 – 10 years. And the greatest database, as you mentioned. But we have now been approved by CMS as a qualified entity. And what that means is that we will be able to tie our I mean, we have the largest commercial database, commercial insurance database in healthcare in the U.S.. And when we get Medicare data, which is what we will get from CMS. Then we will pretty much have almost one in, you know, 150 or, you know, a unique members in the United. So we’ll be covering pretty much half the population between the blues and CMA. And and and also be and the other relevant thing that I am excited about this opportunity is that we can actually and CMS wants you to be a qualified entity so we can improve care in a provider setting. We can give providers feedback on their, you know, on the performance and what are opportunities for improvement. And think about it. Typically a provider, if you look at a provider, they work with so many insurers, they work with Medicare, CMS. They work with United. They work with the blues. So it becomes you know, it’s hard for them to be able to streamline their efforts because everybody’s saying something different.

Saul Marquez:
Right..

Swati Abbott:
But without having this much data, we pretty much would have about 70% on average because the blues are so dominant locally. Some providers experience and that can really, I think, forward our goal of really collaboration with the providers and being able to give give them good feedback and information. So I’m excited about that.

Saul Marquez:
That’s very exciting. And congratulations to you and your team. That’s an incredible milestone, I’d say.

Swati Abbott:
It really is. And thank you. Yes, we’re very excited.

Saul Marquez:
You know, just just thinking through that, that the potential benefits. You know, just outside of, you know, the provider space and, you know, outside of payors, you know, being able to also work with them – the government data you’re capturing so much.

Swati Abbott:
And you’ve seen when people before retirement their journey. And if you can, you know, after retirement, what are the patterns? What what other trends? I mean, those are very useful insights. If we, you know, towards the goal of improving health care.

Saul Marquez:
Yeah. And Swati, you know, I kind of think of it as as mapping like you guys. There are data mapping. What hasn’t been mapped before, kind of like when you you know, before we knew the the world was round and and, you know, people were mapping the geography. Right.

Swati Abbott:
Right.

Saul Marquez:
That’s really nice.

Swati Abbott:
It’s very exciting. It’s very inviting. And they’re also collaborating with several partners in this space who can do a lot of research. So we have an analytic council that we’ve established with several academic researchers from Harvard, Grace University, etc, Stanford and all, so that we can we can get their insights into this, too. So it’s an exciting moment.

Saul Marquez:
I would definitely agree with you. And and so getting close to the end of the interview here. Swati, I wish we had more time. We’re going to do the lightning round. So I got a couple questions for you and then you could share a book that you recommend to the listeners. You ready?

Swati Abbott:
Yeah.

Saul Marquez:
All right. What’s the best way to improve health care outcomes?

Swati Abbott:
I think understand that stock with data and then analyze that data and then make sure that you have a good execution plan, your findings are what you know, they’re actionable.

Saul Marquez:
What would you say is the biggest mistake or pitfall to avoid?

Swati Abbott:
I think, number one, when you get results, when you analyze data, question them, you know, and say, does it make sense? Review it. But then I think the biggest pitfall is also sometimes when we do research, we tend to get too much on the data and analytics side and don’t think other executable are that actionable. So make sure that whatever the findings and research we’re doing is actionable so we can actually do something with it.

Saul Marquez:
I love that. And it goes back to your your prescriptive analytics. I mean, I had one. I Right. those actionable insights.

Swati Abbott:
Absolutely.

Saul Marquez:
How do you stay relevant despite all the change?

Swati Abbott:
Yeah, I joke about this, you know, predictability in an unpredictable and unpredictable times, right.. And I think that’s where it ends. What you can do is anticipate stay curious and don’t don’t get stagnant. Always anticipate always up. You know, a part of my business as we do it is we always have an R&D area where we’re always trying to do some research, test some hypotheses. And I surround myself with curious people who love doing that.

Saul Marquez:
I love that. What’s an area of focus that drives everything at your organization?

Swati Abbott:
Data. Data. Data. How do we. And you know, we have the data. We talked about the CMS and our data. We’re also expanding that data source. We have claims right now, medical pharmacy. We’re expanding it to social determinants of health. Are you? What is with which geography is this member or patient and, you know, other geographical or community based factors? They don’t have a grocery store. They don’t have a drugs pharmacy. Are those impacting their care? So if you understand, all your prescriptive analytics need to reflect that. Your solution needs to be when I say actionable solution, you need to look at a person in their geography, in their setting and apply a custom sort of personal solution. You can’t just have one size fits all. And so that is why I think data and different sources of data is critical.

Saul Marquez:
I love that. What book would you recommend to the listener, Swati?

Swati Abbott:
I go back to a very simple book Who Moved My Cheese? I read it so many years ago as a young executive and and it’s like, you know, it’s so true. Your cheeses don’t get moved. Something is going to happen that will drastically change your life, your world, your business world. In fact, I read it even to my son when he was like 7 years old. I’m like, everybody needs to know that, that your cheese in life is always going to move. And and what do you do about it? And if you’re an executive, you absolutely need to understand that should be like you. Your question Right. constant change.

Saul Marquez:
Swati. I love it, you know. You know what’s funny is I was actually thinking about that book the other day. You know, it’s like there is so much change happening right now. It’s awesome that you mentioned that. I actually don’t even have it on my bookshelf anymore. I want to buy it today after we’re done.

Swati Abbott:
Oh, you can come to my office. I have it in my reception.

Saul Marquez:
Do you have it in your reception? Oh, my God. That is so good. I am. I’m so glad you have it there. That sends a message, right?

Swati Abbott:
Yeah, absolutely.

Saul Marquez:
Love that, Swati. So here we are. I mean, we reached the end. I wish it wasn’t over yet. Maybe we’ll have to deal part two. But I really appreciate the insight, insights you shared with us today, Swati. Leave us with the closing thought and then the best place where the listeners could engage and learn more.

Swati Abbott:
Absolutely. I think, as I would say, healthcare is at a, you know, rapidly changing, a lot happening. There’s an aging population that’s hitting healthcare. Consumerism is here and health care is woefully inadequate in handling consumers. As you all know, transparency, there are all kinds of care models, we’re saying working with providers and payers. There’s disruption from technical giants like Google and Amazon. They want to be in healthcare. They understand they could help solve it. And in all this, I think what we what I think we need to understand is data will be the critical currency in healthcare. We have to understand and make right decisions and navigate these changes and these times the right way. And we have to keep in mind, like I started, we have to keep in mind that our goal is to improve the care for every individual receiving care in the healthcare that the United States today and to contain costs without impacting care.

Saul Marquez:
Love it. What a great closing statement there. And for the listeners to learn more. Swati, what would you say they should go?

Swati Abbott:
I would love for you to go to my website as well as if you have any questions. Please feel free to reach out to me at in info@BlueHealthIntelligence.com.

Saul Marquez:
Outstanding. There you have it, folks. Questions reach out to Swati’s team, the website. BlueHealthIntelligence.com will also leave a link in the show notes. You know where to go. outcomesrocket.health.. This has been brilliant. Really appreciate the time you’ve dedicated with us today.

Swati Abbott:
Thank you. I appreciate spending some time and would love to do a follow up.

Quickly and accurately convert audio to text with Sonix.

Sonix uses cutting-edge artificial intelligence to convert your m4a files to text.

Thousands of researchers and podcasters use Sonix to automatically transcribe their audio files (*.m4a). Easily convert your m4a file to text or docx to make your media content more accessible to listeners.

Sonix is the best online audio transcription software in 2019—it’s fast, easy, and affordable.

If you are looking for a great way to convert your m4a to text, try Sonix today.