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Availity allows transparent exchange of information among health plans, providers, and tech partners
Steven Loeb speaks with Russ Thomas, CEO of Availity, a company that creates a transparent exchange of information among health plans, providers, and technology partners.
Our goal with this podcast is to understand how technology is radically changing healthcare: the way we screen, treat and measure progress and outcomes. Whether tech is helping or hurting our well-being physically and mentally. And whether we’re creating productivity that drives economic costs down while improving are overall health.
Highlights from the interview:
- Thomas has been in healthcare technology now for 22 years, and in that time he has seen a lot of changes and improvement, though sometimes he believes that healthcare is a story of the more things change, the more they stay the same. While we've absolutely seen rapid adoption of technology and a lot of really cool new capabilities come out in the market, we're still trying to solve issues that we've been talking about for two decades. A lot of that comes down to the underlying complexity of the system, and a willingness to accept things as they are, as opposed to really driving towards change.
- Availity is in the administration of healthcare, meaning how to get from the point where people consume healthcare service to how the providers bill for that service and are ultimately compensated; the company manages that administrative process. We still have a long way to go, which Thomas sees as an opportunity to drive to a truly transparent, interoperable, real time health care system.
- Data is a tool to implement and leverage in delivering solutions to the problems, but access to actionable, real-time, quality, reliable data is critical to driving this transparent, real-time system. There's still data that we need, data that's missing, data that's siloed in areas where we can't get at it as quickly as we need to, while, in other areas, there's an overabundance of data that hasn't been rendered in a way that can be usable in a workflow application.
- Availity will transact 13 billion healthcare transactions through its network this year, the vast majority of which are structured, standardized kinds of transactions, but not all standard transactions are created the same. What historically has been missing has been clinical data; there's a lot of it in a lot of different places, and the vast majority of it remains unstructured, non-standard data types. That’s why the company bought Diameter Health, to standardize that data so that it can be consumed in machine learning and a software application and in a programming language that is consistent and repeatable and can be automated in the end through a workflow.
- Thomas is a big fan of value-based arrangements if we can get providers the information they need to take that risk. Some of the early programs struggled because providers were asked to take on financial responsibility for the holistic management of a patient, and yet couldn't tell them in real-time when that patient has gone to the emergency room, or when they haven't filled their prescriptions, or when there's a visit to another physician office or when they're going out on network, which is what drives a lot of cost in those programs. If you're asking them to take risk for something, they need to make sure that I can understand and manage and mitigate that risk as effectively as possible and efficiently as possible in the workflow.
- From a pure business, financial perspective, COVID didn’t have a material impact on Availity. The silver lining on COVID may be that it really forced legacy thinkers to get out of their mindset and be open to adopting technology as a solution to things that, at the time, were very manual. COVID really helped people change their way of thinking about things.
Thank you to our sponsors: Advsr; a boutique M&A advisory firm. They wrote the book on startup M&A called "Magic Box Paradigm: A framework for startup acquisitions." Go to Amazon.com to get your copy. Also thanks to Stratpoint, an outsourced engineering firm and Scrubbed, an online bookkeeping firm. If you need affordable and quality engineering and bookkeeping, check them out. We highly recommend them!
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