Nate Maslak on the Empowered Patient Podcast: the provider data problem, price transparency in healthcare, and more
It’s a hot topic these days: price transparency in healthcare. Ribbon Health CEO and co-founder Nate Maslak recently sat down with Empowered Patient Podcast show host Karen Jagoda to discuss the importance of price transparency in healthcare and how Ribbon is working to deliver industry solutions. The two dive into issues like inaccurate or missing data and duplicate provider records, and discuss how machine learning and predictive analytics can close the gap to increase transparency of healthcare costs and improve quality of care.
Price transparency in and of itself is not a solution. It's a part of the solution, and must be shared in context of all the other important data points someone needs to make a decision about a provider. The data needs to be turned into actionable information that is easy for patients to understand, instilling the confidence they need to make the right decision. Nate shares more about Ribbon’s intention of empathy for patients – especially those who are most vulnerable, why the goal is to fit into the current system rather than rebuilding it from scratch, and how he really feels about fax machines.
Listen to the Empowered Patient Podcast episode, or read the full conversation below.
Karen Jagoda: Welcome to the EmpoweredPatientPodcast.com show. I'm Karen Jagoda, and my guest today is Nate Maslak the CEO and Co-Founder of Ribbon Health, RibbonHealth.com. The topic today is price transparency, a topic we've spent a bit of time talking about. So Nate, I appreciate you taking a few minutes to be with us to continue that conversation.
Nate Maslak: Thank you for having me.
Karen Jagoda: Let's start with addressing some of the key needs in the healthcare industry that Ribbon Health is addressing.
Nate Maslak: Our reason for existing as a company is to help power every care decision to be affordable, accessible, and high-quality. And specifically, for us, what that means is making sure that whenever anybody needs to make a care decision, focusing on those high-stakes, high-importance moments like a referral or a patient seeking care, that they have the information that they need to make the right care decision for them. Or if they're making it on behalf of somebody else, then they can help empower that person to make the right decision.
Nate Maslak: Our view is that provider information and access to providers are absolutely critical. That's where we exist. We're a healthcare data platform that focuses on powering other healthcare enterprises with that type of provider information. Price transparency is definitely a big piece of it.
Karen Jagoda: Give us an example of some of the customers that you work with.
Nate Maslak: We work across a few different customer segments. We work with health insurance companies, so think of the large national health plans, as well as some of the new disruptive models. We work with innovative primary care models, usually focused on the value-based care space or anything that's more consumer-driven or, on the topic of our conversation, more focused on patient empowerment. So, think of the Oak Street Healths of the world.
Nate Maslak: And then we also work with digital health and care navigation solutions where we're helping power a consumer to be able to find care. So they could range anywhere from large direct-to-consumer apps that have a doctor finder all the way to really high-touch care navigation offerings that somebody might get through their employer.
Karen Jagoda: Tell us a little bit more about Ribbon Health's technology and the kinds of gaps in the overall solution that you're filling.
Nate Maslak: The overall technology focuses on being able to provide the right information on a provider at the right moment in time, so whenever/wherever somebody's seeking care. And the number of problems that exist in provider data is shocking, and sometimes I feel like they are infinite. So just starting with something as basic as the provider directory, so phone numbers, addresses. What is the specialty of this provider?
Nate Maslak: That information out there today is about 45% accurate, which is terrifying because that doesn't even start to hit on some other elements that are hard to get across. So Ribbon helps solve that. We're also then enabling other solutions to be able to show which insurance plan a given provider accepts down to the plan name and network level. And then, we layer on provider performance and cost-effectiveness, and price transparency.
Nate Maslak: And the way that we're able to do this is by taking a unique technological approach in which we're seeing data come to us across the entire healthcare ecosystem. We see over 1000 different data sources and counting, on a given provider. And just to give you a sense of what's out there, we see 50 phone numbers per doctor in our system. And again, that's phone numbers. Never mind things like, "How much does a given procedure cost? Or an episode cost to a patient?" And our technology is able to make sense of all of that.
Nate Maslak: By leveraging predictive analytics and machine learning, we're able to process that information and predict what is right and what is wrong. Because Ribbon is the only platform where the customers are actually contributing data back in. So when somebody's making a referral, we get confirmation that that provider is seeing patients at that location for that procedure.
Nate Maslak: We can close the loop with our customers and with our partners to understand how closely predictive the price transparency offering was. And through that, our models are constantly getting retrained, and the product that we can deliver to our customers then ends up being that much better. At the end of the day, it comes back to better, more accurate, more comprehensive information for patients, who can now better find the care that they need.
Karen Jagoda: You sure have opened up a big can of worms. Would you say that you're able to address the challenge of coding errors and duplicate records?
Nate Maslak: We absolutely can help to focus on duplicate records, which I think are a big part of the problem of other coding errors and a lot of other downstream repercussions that happen for a given patient. Just to give you an example, one of our health plan partners shares their entire provider data asset with us, and we help clean it up and normalize it before it goes out back to the patient for their provider directory.
Nate Maslak: And there was one provider at one location that had 1000 different records, and they were slightly different. The address was spelled a little bit differently. The name was spelled a little bit differently. But when it comes to a patient experience, patients were seeing providers show up 1000 times in a search. And when it came to billing and claims, the same thing was happening.
Nate Maslak: So that provider, in certain instances, could have been viewed as in-network. Then others could have been viewed as out-of-network, even though it was the same provider, same location, and same network contract, just because of some of these data problems that are so pervasive across the industry.
Karen Jagoda: When we think about transparency, we think about lowering costs and giving more transparency for the patients, as well as the providers. But when I'm listening to you talk, it seems to me you're also in a position to help organizations untangle the mess that their legacy systems created by all the layering-on that's gone on over the last 20, 30-plus years. Would that be fair to say?
Nate Maslak: I think that's fair to say. I don't think you can have price transparency without having just a strong foundational understanding of who the provider is and those affiliation relationships. But then, by being able to build a strong foundation and improve what we have already today, then this new information getting released by the price transparency regulations, then it becomes really powerful. Then it's actually actionable for a patient or for a provider to make a care decision.
Karen Jagoda: And it is data that you can trust. You're not wondering whether it is accurate or not.
Nate Maslak: That's right. Hopefully. And I have a lot of empathy for the position that health insurance companies and provider organizations, and hospital systems are in. I think you said it well that information has been layered on top of each other over the span of decades. And, like the rest of our healthcare industry has come from this point of natural evolution and decisions that probably made sense at that moment in time.
Nate Maslak: And really, our role is being able to play within that, not to come in and say, "Let's blow everything up completely." Because we know that's not going to work. There have been real infrastructure investments made to be able to enable what is ultimately, I think, existing to help patients and help providers. We want to make sure that we're playing within those confines and making what exists that much better as seamlessly as possible.
Karen Jagoda: So, what are you doing about getting rid of fax machines in this space?
Nate Maslak: I think we will never get rid of the fax machine in health. No. I'm just kidding. My hope is that we can help enable referrals to be sent digitally and more automatically and also really focus on booking availability and scheduling so that we can move as many of these transactions and interactions to be digital via our API. But I do think that we're still probably some time away from the fax machine disappearing from the doctor's office.
Karen Jagoda: I admit, that's one of my favorite questions to ask people like you, and I always get the same kind of answer. So thank you for confirming it's not going anywhere any time soon. Tell us more about how AI plays a role in personalizing the patient's experience with your technology.
Nate Maslak: We think about AI in a couple of different places. The first one is just being able to find the most accurate, most comprehensive provider information. So just fixing what is out there and what's broken. I'll give an example back on price transparency. While the new regulation and the amount of data it's created has been incredible by way of what we can do with it, that is not accessible to the patient. And the machine-readable files are machine-readable to an extent, but it requires a certain amount of technology and AI to be able to process them.
Nate Maslak: But even after that, as a patient, I'm looking for a knee replacement surgery and I want to know how much it's going to cost. I don't care how much the screw replacement as part of that surgery is going to cost in a fee-for-service environment. I want to understand the bundle. I want to understand the episode of care and really what it is going to cost me as a human being if I go and get this procedure at point A or point B.
Nate Maslak: And I believe that AI is absolutely critical for that because there's so much information that is out there. So first, we have to use AI to be able to unwind some of the problems that we've created, just understanding where this doctor practices. And then second, applying all of the new movement, all the new information that we have getting released to make it digestible and accessible for the patient. And then combining the two so that we can have in healthcare what we expect to see in any other industry, like if I look for a restaurant near me. I want to understand where I can go and how I get there.
Karen Jagoda: It seems to me this challenge of the interface to the data is really addressed well by thinking about artificial intelligence and having it be more of a dynamic real time environment as opposed to sort of a set menu kind of approach. Is this just generally making it easier for patients to get access to their information like they are Googling other information? Doctor Google's always the fallback in so many cases.
Nate Maslak: That's right. We believe that patients should have access to the most up-to-date and most relevant information all the time, wherever they're searching for it. So 80% of care searches still start at the health plan website, and I think, increasingly, that's changing. There are thousands, if not hundreds of thousands, of digital solutions where a patient can engage with their healthcare.
Nate Maslak: I believe that AI is really powerful, probably most powerful in just processing massive amounts of information and then doing something actionable with it. And that's the opportunity that we're sitting in front of as an industry right now is what do we do to actually apply this for good for the patient. And then from there, also thinking about personalization.
Nate Maslak: So I think of a world in which when I go to my health plan website, and I'm one of the 80% of people who start there. If I'm seeking care from a gastroenterologist, I might have to go through 5000 records and hope that I find the right phone number, the right address so that I can call them and book them. We can first show the patient a curated set of information that is, one, just accurate, and second, make sure that those doctors or providers are onlinebookable. So I don't have to sit on hold.
Nate Maslak: And then third, to your question around personalization, really getting to the point where, based on all the information my health plan already has on me, I like to see two or three doctors. I can choose from that, not a page of 100 that says, "Go from page one to page two to page three," and me having to make that choice. We want to empower them. But I think the best way to empower patients is to give them a more curated set of information and help them make that decision in a way that's easier and more digestible.
Karen Jagoda: Especially as we gather more data, this becomes really a challenge to figure out what the signal is with all that noise. But of course, this could be a lot of valuable data. I really appreciate folks like you trying to make sense of it in a more digestible way. I'm wondering what do health organizations need to know about price transparency?
Nate Maslak: There's so much, I think, we're still learning as an industry about it. But my personal view, and what I hope folks are thinking about, is that price transparency in and of itself is not a solution. It's a part of the solution. And I think it's been a necessary unlock to be able to provide this information for patients and for healthcare organizations to make the right care decisions. But again, the data in and of itself is not enough.
Nate Maslak: We need to be able to take that data and turn it into actionable information, and that is tied not only to understanding the cost of a given CPT code but then tying it back to a procedure or bundle procedures in a language that patients can understand. And then, most importantly, and where I want to see us as an industry spend way more time than we're spending today, is making that information actionable. What do I, as a patient, do with this data and with this information so I can go and find the right care for me, or I can help somebody that I'm a caretaker for find the right care for them? Tying everything back to action, to patient impact, and remembering that price transparency is the means to an end of empowering their patients.
Karen Jagoda: So, before we run out of time today, how does your background in consulting inform your ability to think about patient needs in the way you've just described?
Nate Maslak: Well, I've been a patient, and I've been a caretaker. And so, for me, a lot of that is tied back to empathy. I think one of the things that it's helping teach us is how to have empathy for whomever you're working with. And one of the things that I was really lucky with was that even with my very early clients, they were very patient-centric. And I was focused on basically starting to build new value-based care models in health plans and in large provider organizations, and it always came back to, "What does this actually mean for the most vulnerable communities and the most vulnerable patients?"
Nate Maslak: And that was really eye-opening for me and, honestly, quite refreshing to know that the folks that are making these decisions, I think for the most part, really do have the patients' best intent in mind and are really doing their best in a system in which it's hard to make massive changes. It's hard to make massive changes quickly.
Nate Maslak: So I think without that experience in consulting, I probably wouldn't have gotten that exposure as quickly as I did. It's really shaped how we think about building Ribbon as a company that builds empathy for the patient and that thinks of other customer needs first and humbly takes on the responsibility of fitting into the system. Changing from within as opposed to claiming that we can just blow it up and rebuild it, because I don't think that that's how it's going to work.
Karen Jagoda: Thanks to my guest today, Nate Maslak, CEO and Co-Founder of Ribbon Health. Ribbon Health.com. Follow them on Twitter @RibbonHealthAPI. I'm Karen Jagoda, and you've been listening to the EmpoweredPatientPodcast.com show. Follow me on Twitter @KarenJagoda. Like us on Facebook at Empowered Patient Radio. Thanks for listening, and we'll see you next time.