Sam Maule and Maia Bittner have invited Boe Hartman, the CTO and co-Founder of Nomi, to pull up a chair again at our virtual table to share insights on the repercussions rippling through the healthcare payment systems, laying bare the stark financial and personal implications for providers and patients alike.
As we navigate the turbulent waters of a $4 trillion industry caught in the throes of a major claims processing shutdown, we uncover the unseen winners of this crisis and confront the startling differences in regulation when comparing healthcare to the banking sector. The conversation pivots scrutinizes the antitrust landscape and its potential effects on healthcare competition and innovation. Tune in for a thought-provoking exploration into the intertwined worlds of healthcare policy, economics, and the cutting-edge efforts by companies like Nomi to forge a more direct and efficient marketplace for us all.
Boe Hartman article: Why Healthcare Needs a Crash Course from Banking Now!
Hosts: Sam Maule & Maia Bittner
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
This is Essential Audio.
Speaker 2 (00:11):
Hey everyone, I'm Maya Bittner and I'm Sam Maul.
Speaker 1 (00:14):
Welcome to Artificially Intelligent brought
to you by Money 2020.
Speaker 2 (00:17):
So on today's episode we're doing a follow-up on the
change healthcare hack thathappened on February 21st and is
still ongoing.
We're going to discuss what'sunfolded over the past week, the
impact from a paymentsperspective and how we think
this is going to unfold from aregulatory perspective.
Speaker 1 (00:34):
This story is absolutely crazy, Maya.
I missed you last week when werecorded this, but as soon as I
sat down with you and we kind ofcaught up a little bit, this is
amazing, isn't it?
I mean, I really don't haveanother way to describe this
other than the word amazing.
Speaker 2 (00:53):
It's so and I am still you've talked about this
can't believe it's not on thefront page of every newspaper I
saw.
It was on the front page of theWashington Post March 4th and
it's being picked up, but it ishaving such a huge impact on a
critical part of our economy andI actually, sam, I don't know
if you saw this, but I tweetedabout this on February 22nd and
(01:16):
the reason I tripped over thiseven and I was like why is this
not all over my Twitter feed?
Is because, you might know, Irecently had a baby and one of
the things that you do when youhave a baby is they're like they
advise you to get the Tdapvaccine for anyone who's going
to be visiting the baby, right?
So grandparents and things likethat make sure you're up to
(01:36):
date.
The important part of that isthe P, which covers whooping
cough, which is very dangerousto newborns.
So I asked my mom to go get theTdap vaccine and she went into
the pharmacy and the pharmacysaid sorry, there's been a huge
nationwide hack that's affectingalmost every pharmacy and we
(01:58):
cannot tell you if my mom isunder Medicare, if Medicare will
cover this vaccine or how muchit's going to cost for you.
And my mom is very costconscious and so she said I'm
not going to get it, like if Idon't know how much it's going
to cost me, I'm not going to getit until you guys figure it out
and so this is such a tiny,minor thing.
It's just a tiny minor vaccine.
(02:20):
Whooping cough is very rareanyway, but I was affected by
this on day two and I tweetedabout it.
I was like my local pharmacysays there's a nationwide cyber
attack on pharmacies and my momcan't get.
Now can't is an exaggeration,but my mom doesn't want to risk
having to pay the potential fullretail price of a vaccine and
(02:42):
and so she's not getting it.
And then I've started to seethings pick up since then.
But I really feel like thisshould be everywhere, and I
think the reason it's noteverywhere is, in general, most
patients are getting the carethat they need, they're getting
the drugs that they need,they're going to the doctor, and
so, fortunately, though it'scausing a lot of harm, most of
(03:03):
the harm is not on the endcustomers.
Speaker 1 (03:06):
Yeah, it's going to be.
Just to frame this out forthose that listened to the last
episode.
We've asked Bo Hartman, theco-founder and CTO of Anomi, to
come back on.
Bo, how are you doing?
You've had quite the week, andI think it was just yesterday.
You were actually quoted in apiece that Axios wrote around
(03:29):
this.
You want to kind of give us aquick update on?
We can talk about that piecebut also kind of where we're at
now.
Speaker 3 (03:39):
Right.
So yeah, as you guys are saying, and we all agree, this is a
piece that is just running underthe radar Since we've talked.
Last week, we are now gettingpolicymakers who are actually
coming alive on these topics.
The White House had the CEO ofUnitedHealthcare, who is the
parent company of ChangeHealthcare, yesterday in DC to
(04:01):
go over that Providers arefiling for bankruptcies.
Yesterday in DC to go over thatProviders are filing for
bankruptcies.
The loan programs are beingrolled out, which I think we
should discuss.
The money flow all around thatas well, because that makes my
head explode.
Payments still not flowing andwe're starting to get our heads
wrapped around what theoperational hurdle that is
(04:24):
speeding at us that will be outthere.
Young companies that arealternatives to change are
actually starting to gethundreds of thousands of
transactions which are puttingtheir infrastructure at stress.
So it's actually reallyinteresting unfolding and I'm
starting to put some of my mindto what I think the future steps
(04:47):
are, the steps to go forward.
How do we unwind this dangerousrisk to its critical
infrastructure?
Speaker 1 (04:54):
I'll give you one quote out of the piece that you
said.
That I still love is that thishas punched a hole in 20% of the
US economy and appears at themoment no one's being held
accountable.
Speaker 3 (05:07):
Yeah, actually, on the other map that we did, it's
nearly 5% of global GDP.
So think about that.
Think about that for a second.
And the reason why I think thatfolks aren't screaming yet is
because it's not affecting youropportunity to go get care.
But, like I said on the lastsession, providers are getting
(05:30):
0% of revenue and 100% ofcaseload and they're running out
of money to pay their staff.
So there is a timeline that isquickly approaching us to where
they won't be able to pay staff.
They won't be able to payvendors.
Speaker 2 (05:43):
Well, I saw that is having an impact.
So there's a nursing home inNew Jersey that just closed down
temporarily.
But they said, hey, we can'tpay our staff.
Our staff is not going to comein if they're not getting paid.
So we can't take care of peopleif we can't submit the claims
and get paid for them.
And so the nursing home rightshut down.
People got to be taken care ofelsewhere.
Speaker 3 (06:05):
While this is ongoing , and just under the waterline.
That's happening all over theUnited States and you're
definitely seeing that.
So, yeah, so it is fascinating.
And what's interesting is theseproviders are owed money for
care they've given and we canmeasure that for care they've
(06:28):
given, and and we can measurethat we can use the metrics to
where a uhg can pay them, likewhat their normal flow would be
right to, to actually make surethat these critical, critical
parts of our health care andeconomy stay alive there's a
great blog post by a doctor,jared deshetsky.
Speaker 1 (06:42):
I slaughtered your name.
I apologize.
I'm sure we can provide a linkto this in the show notes.
He said you got to think aboutthis change Healthcare processes
$2 trillion worth of claimseach year, 2 trillion and it's
literally shut down everybody.
I just can't stress it.
Speaker 2 (06:59):
Yeah, and think about that 2 trillion.
Speaker 3 (07:01):
It's not just the 2 trillion, it's the three and a
half trillion we talked aboutbecause, just like the Visa
MasterCard rails, you might notbe connected to change as part
of the exchange, but there's aparty in that flow of that
transaction.
That is right.
So to complete that transactionas we know it in payment and
(07:23):
banking, you have to have ahealthy, robust rail contract.
So even if you are notconnected to the exchange
platforms, a counterparty inthat flow could be, and it has
stopped those as well.
So you've done it.
I mean, do you guys think thisis a place where you talk about
(07:47):
the other side of who gets who'smaking real big money right now
?
Well, what I?
Speaker 2 (07:52):
was going to ask.
You know, whenever something'shappening that I don't
understand, right, when this is,it's going on three weeks of
billions of dollars in impact, Ialways say, well, what are the
incentives?
Right, like, who's making moneyhere, who's not making money
here?
When I think about so Facebook,right, also of a massive scale.
If Facebook goes down, facebookstops making money, and I think
(08:15):
that kind of lights a fireunder people's asses to go fix
it, you know.
And so I'm curious.
I mean, yeah, bo Sam, right, sochange is down.
Who is making money?
Who is losing out in thissituation?
Speaker 1 (08:30):
Everybody strap in for this next answer that Bo's
about to give, by the way.
Speaker 3 (08:35):
Yeah.
So if we think about theconstruct of money flow right in
this world.
So you have United Healthcarethat has its subsidiary that's
transacting this.
As I described, people areconnected to it in varying
different ways to make thesetransactions take place.
The transactions, as Maya said,aren't flowing, but companies
(08:55):
are still paying their premiumsto United Healthcare.
So the premiums are stillflowing into their coffers.
They're also sitting on themoney that already exists, that
hasn't flowed out, that aresitting there, so they're making
float.
One of the weird things aboutthese payers is that they're
quasi shadow treasure banks.
Speaker 2 (09:13):
is what they are right.
Speaker 3 (09:14):
Because they're sitting on float and they manage
float as part of that.
So they're getting inflows ofpremiums, they're not paying
claims out and they're makingfloat, so they stand to make a
massive windfall as a part ofthis.
Now, as Sam and I were talkinga bit earlier, if this was a
(09:34):
banking situation where it wasdown, that money would be
earmarked to pay out at a laterdate and the bank would be held
to account of how much moneythat they were sitting on and
how much they were making basedon this event of accountability.
So again, this is another placewhere we need to separate the
care from this conversation andfocus on the economic impact of
(10:00):
this payment situation.
Speaker 2 (10:02):
Well, and so I mean, when you're talking about this,
this is kind of the classicinsurance business model, right?
You get paid premiums and youdon't pay out.
I do think we tried to regulatethis to limit the extent to
which insurance companies can dothis.
And health insurance companiesIs that gonna play into effect
here?
(10:22):
Is there?
I know they have to pay outsome percentage of premiums they
receive, but I don't know thedetails of that regulation.
Is there a time frame?
Speaker 3 (10:29):
Yeah, yeah, I mean, in this case it's fairly silent.
I mean, you know again, and Ithink we touched on it last time
and I definitely have touchedit with other reporters last
week and I had a very seniorhealth reporter agree with me on
this, on this aspect of thisindustry the regulation is very
(10:50):
thin compared to what Sam and Iexperience at banking.
Not even close, right, it's noteven in the same ballpark.
And so it's fairly silent.
Because I'm not like.
Ok, the premiums are thepercentage of premiums that have
to go.
Well, they can't push them likeright now, as far as they claim
.
But what about the float?
What about the interest of thatmoney?
You know, right, like again,and it's silent on that topic.
(11:14):
And we're talking hundreds ofmillions of dollars.
This is not insignificant.
And again, because it's soopaque and because, unlike banks
, they are not required toreport this in the same manner
that you would inside of thebanking construct, no, it's so
(11:35):
hard to determine what it is.
I mean, it's taken us threeweeks and you know we're now
starting to get numbers wherepeople are actually quoting
numbers, and even those numbersaren't right.
You know the one person quoted,you know two trillion through
change, right, but it doesn'tcount for the other trillion of
other parts.
So it is so opaque in thisdomain that we actually have to
make it transparent so that wecan make it better, so we can
(11:58):
put good policy in place.
Speaker 1 (11:59):
What's even funnier, if you really want to geek out
on payments and Maya Beau andmyself we are payment geeks this
is what we do.
We know within payments that asfar as how you communicate,
there's ISO standards.
There's standards set onpayment flow for this.
What is fascinating with thisis that a great string on
(12:23):
Twitter from an account, zachCantor, talking about the impact
HIPAA has Of all things.
I think we're all familiar withHIPAA, but HIPAA actually set
and established a standard forthe electronic transactions when
it comes to insurance and thismoney flow.
You know what 99% of theinsurance companies use for the
flow.
Who set the standard for thisis change healthcare.
(12:44):
So if you're trying to get offof change, you're looking at
months worth of programmersgoing in and rewriting these
standards because there's not aset standard for this.
The industry set comes fromchange.
This is the most circular snakeeating itself thing I've ever
seen in my life and if this wasbanking, we would all be in
(13:05):
front of Congress right now.
Speaker 2 (13:07):
Well, I wanted to ask how much of a free market is it
?
You know, I understand thatchange is a clearing house.
Can you choose whoever it is?
I was, you know.
I was talking with my friendEllen DeSilva.
She's at Summer Health and shesays most of these small
practices don't even pick aclearing house, it just gets
bundled in with their electronicmedical record system.
Speaker 3 (13:27):
That's a that's a hundred percent correct, right?
So you go, epic, cerner, oreven some of the smaller ones.
They're already bounded tochange and if you look at the
history of what change did,change went around and they
bought up all these little tinyexchanges way back when and then
they became a patchwork.
And we saw this in banking whenbanks got rid of other banks.
(13:48):
The systems weren't integratedand they were these patchworks
of connections.
Again, there was no oversightor policy to give good guidance
on this aspect.
Cms, hhs this is kind of a weirdspace for them.
They really are not experts inthis domain.
This quasi or this shadowbanking industry grew up on top
(14:11):
of it.
You have the smaller ones, likewaystar and alibon um, they're
sending, um, they're sendingcontracts out to provider groups
and the contract uh, theproduct group is sending unread
lines back to them in fiveminutes and saying, yep, let's
get on it.
So you have these smallerorganizations who are getting
stretched way beyond theircapabilities and the operational
impact is going to hit themsoon too.
(14:33):
Right, because what's going tohappen is they're going to get
huge transaction volumes.
They're going to be stressed,they're on modern architecture,
but when you go from a couplehundred thousand to a couple
hundred million transactions,it's a different ballgame
completely, and so it isdefinitely not a free market.
And again, the mind-blowingthing about it is definitely not
(14:53):
a free market.
And again, the mind-blowingthing about it is folks don't
realize how much of amonopolistic situation creates
this risk.
The UK chairman letters fromthe 2012 NatWest collapse of
technology.
It actually sets a greatframework to allow you to say
(15:15):
how do you actually create good,solid infrastructure like this
in an open free market.
That is the UK bankingecosystem.
Speaker 2 (15:25):
So, and I was going to say you know tech, bring it
back to Facebook, bring it backto technology.
Like tech also operates at hugescale, like this right, there's
so much of tech and fintechthat's doing trillions of
transactions and I don't know.
I mean not to brag, but like Ifeel like we've kind of figured
it out, like we know how tobuild resilient systems.
(15:46):
Right, you do redundancy bydefault.
You've got multiple databases,multiple database backups.
You have your servers indifferent regions, use multiple
banks.
Svb Bit you in the ass if youweren't doing that.
We've got all of the differentpieces and I feel like I might
have an idea what's actuallyhappening right now at change,
(16:07):
which is, something went down.
Speaker 1 (16:10):
They paid the ransom A naive perspective is
everything should be back onthat unconfirmed but you know
that you can build it.
Speaker 2 (16:23):
It's like you're gonna have a set of cascading
failures.
It's gonna affect stuff.
As they bring things online,they're gonna realize not
everything is working asexpected.
Speaker 1 (16:40):
And I really think it's like.
I feel like there are a lot oflessons that could be learned
from the way that tech operatesat a scale like this.
I mean we talked about thislast week, though that we've
been if you're in banking andpayments, you've been through
the crucible, we've been throughthe fire, and there's a ton of
lessons that can be learned fromthere.
When it comes to the regulatoryside, when it comes to the
redundancies that need to bethere, right, maya, we talk
about stress tests all the timewith banks.
If you look at the US bankingsystem, you know it's kind of
(17:01):
hard to argue that we're notstronger than ever Right Over
here and from a, from a standard.
So the lessons are all here.
It's just.
You know, beau, I mean, that'sthe question I would ask is so
where do we go from here?
I mean, I know there's a lot oftalk going on in DC.
(17:22):
There was a I saw on Twitter.
Dan Diamond, very good reporter, said he spoke with Barry
Sanders yesterday.
Senator Sanders, who's alongtime critic, by the way, of
UnitedHealthcare Shocking.
He also sits on the Senate'shealth panel, by the way.
He called the spiraling crisisa very important problem and
told me he's considering Senatehearings.
It's just a question of how wefit it in.
I think they're going to fit in.
(17:43):
I think it's safe to say yeah.
Speaker 3 (17:45):
Well, I was going to say Barry Sanders loved him when
he was running back.
Speaker 1 (17:49):
Oh no, sorry, Detroit , everybody the greatest running
back of all time, and we shouldactually do a show on that.
I'm sorry, bernie, with yourmittens.
Speaker 3 (18:03):
Yeah, it's good.
So about a year or so ago, Iactually authored an article
with just exactly what you'resaying, maya, is that the health
industry can actually take thelessons from banking.
So, for example, when I landedin this industry, I started
looking at it.
This industry looks likebanking from the early aughts
(18:25):
into the early teens and thenwhen the fintech wars took place
around that 2011, 2012, 13, 14,15, right that this industry
can actually take that roadmapfrom the fintech banking era and
learn so much.
To skip to your point, skipforward and actually improve the
(18:48):
way that I'm thinking about itright now when we're speaking to
some policymakers one is Samone let's take the lessons from
banking.
Two, this is an economic andnational critical infrastructure
topic.
This is not about a doctorcaring for a patient.
We do that pretty well.
This is about how do weactually protect and create to
(19:10):
Maya's point, the resiliencythat we already know how to do
for our nationally criticalprocesses.
Right Three, we need to holdthe participants who are engaged
in this to a higher level.
Right, we need to create theincentives to actually open this
market up so that not onesingle model player who can be
(19:31):
taken down with a golden BB forthose of you at my age will know
that reference and actuallycreate an environment where
these other players can come in,help reduce the cost, increase
the efficiency and thetransparency.
And then, lastly, this needs tobe a joint hearing between
(19:53):
finance oversight and thehealthcare oversight, because
the committees that overseehealth are not equipped for this
topic.
They just don't have the back.
When I talk to them, I have towhiteboard it very basically so
that they can go oh, weunderstand.
Okay, now we see the problem,right, and so we need to
actually do that.
And incentives could be taxdeductions for provider networks
(20:15):
that actually do the ITinvestment on their EHRs to
connect into multiple exchanges,right?
Those are the sorts of thingsthat we need to create.
Speaker 1 (20:27):
And Bo, when you and I were talking I think it was
yesterday or the day before thata couple of things we want to
flag.
We said it on the last show.
Please understand this was agovernment-sponsored attack.
This hack was governmentsponsored, so you can go and
read about that everybody.
So that's one.
So when you talk about criticalinfrastructure, it shows you
(20:47):
how susceptible we are for anentire system to be taken down.
Half of this is you don't wantthe pendulum to swing too far,
right?
We've all come out of banking.
We all survived 2008.
And what typically happens withsomething like this is a
(21:08):
pendulum swings the full arc,right?
So this is a chance to go inthere and do this right.
When we're talking from aregulatory standpoint, we're
coming from a standardstandpoint and the lessons
coming out of banking andpayments the roadmap is there
for this.
Speaker 3 (21:23):
The roadmap's there.
And then, maya and Sam, as youguys know from last time we
talked, when UHGUnitedHealthcare through Optum,
spent $12 billion on changehealthcare $12 billion and the
DOG stepped in to say let'sreview it for monopolistic
practices and it was struck downby a federal judge, right?
(21:46):
This is exactly what thatoverview would have hopefully
surfaced up that we injected amassive amount of risk into the
environment, right?
Speaker 2 (21:59):
That's what I'm saying Talking about regulation.
Now, I think it's important,but it's kind of like closing
the fence after the horse hasescaped.
Should we have just blockedthis in the first place?
And I think United knew howmuch they had to gain, which is
why they defeated that's whythey spent $12 billion.
Speaker 1 (22:17):
Exactly.
Speaker 3 (22:20):
And people go.
Well, didn't the risk existwhen change was out there?
Yes, but if change during that,that trans transaction, we
could have had the conversationsof how do we put a competition
and how do we help you know, thecompanies, like the nomies and
the elevants and everyone thatare that are trying to create
diversity in the market, right,yeah?
Speaker 1 (22:37):
let me get not to outrage everybody a little bit
more.
But why not A great article onprospectorg that talks about an
Oregon medical practice that,again through this, basically
had zero funds to operate.
I mean, the doctors pulledtogether to be able to pay staff
to keep this going.
(22:57):
Their only option that theyhave was to push a sale to
anybody want to guess to whom?
United Healthcare.
Speaker 2 (23:07):
That's I was going to ask.
I mean right, because it's thisvertically integrated monopoly.
Are they picking up thesestruggling they 100%.
Speaker 3 (23:15):
Yes, one of Optum's practices is they go in and they
purchase providers that arefailing.
That's actually part of aplaybook that they do If we
could do a screenshot of Maya'sface right now.
Speaker 2 (23:28):
I would.
I mean, this is so nasty.
Speaker 1 (23:35):
United Healthcare comprises of 2,642 separate
companies, collectively rankedat $371.6 billion.
The federal government could beall over this.
Speaker 2 (23:45):
They're the only ones powerful enough.
Speaker 3 (23:47):
And if you look at Raytheon, raytheon's massive
defense contractor, right, theyhave oversight, they have
detailed oversight.
And again, I'm not calling formassive regulation.
To Sam's point, I'm saying goodpolicy, right, there's good
roadmap, and but as well as wealso have to to create it so
that uh, that these innovatorscan come in like like an omni
(24:09):
health and actually uh, create adiversity that would create a
quasi exchange competition likewe have, that, for example, we
have providers scrambling to geton these new exchanges.
Right.
If we would have had a contractlike we have with the credit
(24:32):
bureaus, like we talked lasttime, or the different payment
rails that we have across theUnited States, all they would
have to do is say, okay, we'regoing to increase traffic to
these other channels, and theprocess would still be you sound
like you worked in the UK,though you really do, or yeah
around the globe Right.
So again, I really think, andsame with Maya we need to use
(24:57):
your platform.
We need to bring the thoughtleaders together in your
audience and audience, and weneed to actually say here is the
plan, this is where we're goingto go right, because that's
what nomi's trying to do iswe're trying to say like this is
you know, this is a crisis, uh,and here's the plan and here's
how we're approaching it, here'swhat we recommend, so we can
actually get exchanges of ideasthat we can, that we can
(25:18):
approach the, the differentcommittees, and we can approach
the different policymakers andsay this is so important, this
is the things we have to go doand, to the point, you both made
the roadmap's there Us bankers,we've seen it, we've been
through it, we've done it.
Speaker 2 (25:34):
And it does feel like right.
Increasing competition wouldhelp mitigate how vulnerable we
are to things like thishappening.
It'd help reduce the risk.
I saw Health and Human Serviceswrote a letter pleading
healthcare leaders to help makeit easier to switch
clearinghouses and it does seemlike there's been a little bit
of work there.
But, like Sam said, it's hardto move that type of standard
(25:56):
quickly.
But even backing up a littlebit I mean, of course this is
top of mind because this must bethe know me mission but it's a
little crazy that we needmiddlemen to know how much
providers are going to get paidin the first place.
So yeah, having more middlemenas options and a free
marketplace to choose betweenthem is a more reliable system.
(26:18):
But part of my brain is like tochoose between them is a more
reliable system.
But part of my brain is like,well, could we cut them out
entirely?
Like, do we need to rely on amiddleman for our healthcare
system to function?
Speaker 3 (26:29):
Right.
So you know, nomi stands for nomiddleman, right, and some
people go but hey, aren't you amiddleman?
No, we are about creating theefficiency of the market, of
what you're talking about, right?
So you know you're going tohave to have third parties in
the flow.
Whatever it is, the problem isthe market itself is just not
efficient, right?
The market has all thesemiddlemen in the way.
(26:51):
That is actually buildinginefficiency, because it creates
their opportunity of revenue,right?
So the thing we didn't talkabout last time 40% of every
dollar that is spent on caredoes not make it to the end
provider and it's picked offalong the way by administration
(27:13):
organizations and that sort ofstuff.
And that's actually on the goodside.
That's the upside, right?
And that 60 cents doesn't makeit to the provider for like nine
months, and then what willhappen is someone will come back
later and they'll claw it back,right?
And so each of us have all ourhorror stories about this
industry and how it's soinefficient, massively
(27:34):
inefficient, right?
And so our big mission is howdo you make it efficient?
Because the real cost ofhealthcare in the United States
states is about 30 to 50 percentless right.
Speaker 1 (27:45):
It is mind-boggling like the only thing I can equate
this to is doing your taxesright guess how much you owe?
Speaker 2 (27:50):
how about you tell me ?
Speaker 1 (27:51):
I guess you know if you get it wrong you're in a lot
of trouble and when it comes tohealth care, as as somebody who
has four kids and is pushing 60and everything else, that's
that's always the fun part.
Right when you're going intohalf procedure you're like
what's it going to run me?
I have no idea you have no ideaWe'll.
We'll let you know.
Yeah, it's the most amazingindustry I've ever seen, yep and
(28:15):
and so yeah, so I think this isa monument.
Speaker 3 (28:17):
I'm so glad you guys are giving me the opportunity to
engage with your community.
You know I come from thiscommunity and we really.
There's opportunity for us tolead and be thought leaders, and
we need to be.
This is so monumentallyimportant because we're losing
providers on a daily basis.
Insurance commissioners acrossthe states are having to say,
(28:41):
hey, how do we actually give theloan to keep a provider in
place?
And I'm like but there's $4trillion flushing around this
market and we know how much aprovider made on a monthly by
monthly basis.
Why don't we actually give themthat?
Speaker 2 (28:54):
Right, and when the reconciliation is over, right.
It seems like we're so good atcash flow forecasting and we
know that, right, like, loanpayback rates are really high.
When it's caused by somethinglike this, which is not the
fault, it's like they're stillproviding the things.
It's almost like earned wageaccess, but for medical
practices and for physicians,it's like we could look at what
(29:15):
are you doing for people?
We should be able to know,looking at historical records,
and we should be able to lendpeople the money they need
accordingly, but the impact toindividuals' lives.
Speaker 1 (29:25):
I'll keep coming back to this.
There's a cancer clinic inArizona that serves 16,000
patients.
That said they had three weeksworth of operating income.
That's it, 16,000 individuals.
So again, criticalinfrastructure, right.
It's not that the care can'ttake place, it's that the back
(29:46):
end of this, that payout nothappening.
So again.
I'll keep saying it how thisisn't front page news is
backflip.
Speaker 3 (29:57):
Yeah, so yeah, and that's why I said, wow, this is
an economic issue that we haveto pound on.
So yeah so that's why it'slooking like, the more we get it
out, it's starting to getpicked up.
Like I said, my calendar isstarting to fill up with
interviews so we can get themessage out.
And it's funny, all theinterviews start the same,
especially the health carereporters.
Yeah, this is a big story.
(30:18):
We're also shocked about how noone's really picking this up.
But yeah, it's the monopoly andyou can't fight them.
And I said, but that's theproblem, that's the problem.
Speaker 2 (30:28):
Right, I mean Sam was talking about its critical
infrastructure.
Some people would argue suchcritical infrastructure should
maybe not be run by privatecorporations and it's a setup
that's not really destined forsuccess.
Speaker 3 (30:42):
And you know private corporations, I think the
private industry has to beengaged with it.
But just like theclearinghouses, right, the
clearinghouses are guaranteed bythe government and everybody
pipes into it, right?
And then that creates a marketto allow the market to function.
Speaker 2 (30:56):
Exactly.
Speaker 3 (30:57):
And every participant is held to a standard.
Speaker 1 (31:08):
And that's what we need, that we need to move in
that direction, right.
So I feel that that's wherethis message is, maya folks that
have built systems that alignto this so well, folks that know
you know that understandpayments inside and out.
But unfortunately we're out oftime here, maya you want to
(31:35):
close this out?
Speaker 2 (31:35):
Yeah, you know, that does it for this week's
Artificially Intelligent Podcast, though United needs to do
better, I have to admit.
So, personally, I actually lovedoing incident response, and
part of me is kind of jealous.
Speaker 1 (31:44):
I'm serious, I love.
Speaker 2 (31:46):
Well, it's like being an early stage startup.
Everything's on fire.
I love it, so I'm a little bitjealous of the incident response
team at United, though theyneed to pick up their game.
Hey, we love hearing fromlisteners.
Go out and give us a review,preferably five stars, wherever
you listen to podcasts.
This helps us grow our audienceand, hey, you can reach out to
(32:07):
us too.
We love the conversations.
We love the feedback.
We'd love to hear your ideasfor how to make this system
better.
The best place to find me is onTwitter.
I'm at M-A-I-A-B and if you canhear Aria, my new daughter, in
the background, beau, where'sthe best place for our listeners
to engage with you?
Speaker 3 (32:26):
So I think engaging Nomi Health, you know, on the
web, at nomihealthcom or on allsocials, I think, is the right
way.
If folks want to interact withme, the easiest way to do it is
at Twitter, atB-O-E-H-A-R-T-M-A-N, also,
LinkedIn.
Speaker 1 (32:42):
some of the posts that we're making together and
that I'm doing with others caninteract there as well,
excellent, well, folks, you canhit me up on LinkedIn or Twitter
at Sam Maul.
I want to thank everybody forlistening for this incredibly
important, in my opinion,episode, and I want to thank you
all for listening.
Speaker 3 (33:01):
We'll see you next.
This is Essential Audio.
Speaker 2 (00:11):
Hey everyone, I'm Maya Bittner and I'm Sam Maul.
Speaker 1 (00:14):
Welcome to Artificially Intelligent brought
to you by Money 2020.
Speaker 2 (00:17):
So on today's episode we're doing a follow-up on the
change healthcare hack thathappened on February 21st and is
still ongoing.
We're going to discuss what'sunfolded over the past week, the
impact from a paymentsperspective and how we think
this is going to unfold from aregulatory perspective.
Speaker 1 (00:34):
This story is absolutely crazy, Maya.
I missed you last week when werecorded this, but as soon as I
sat down with you and we kind ofcaught up a little bit, this is
amazing, isn't it?
I mean, I really don't haveanother way to describe this
other than the word amazing.
Speaker 2 (00:53):
It's so and I am still you've talked about this
can't believe it's not on thefront page of every newspaper I
saw.
It was on the front page of theWashington Post March 4th and
it's being picked up, but it ishaving such a huge impact on a
critical part of our economy andI actually, sam, I don't know
if you saw this, but I tweetedabout this on February 22nd and
(01:16):
the reason I tripped over thiseven and I was like why is this
not all over my Twitter feed?
Is because, you might know, Irecently had a baby and one of
the things that you do when youhave a baby is they're like they
advise you to get the Tdapvaccine for anyone who's going
to be visiting the baby, right?
So grandparents and things likethat make sure you're up to
(01:36):
date.
The important part of that isthe P, which covers whooping
cough, which is very dangerousto newborns.
So I asked my mom to go get theTdap vaccine and she went into
the pharmacy and the pharmacysaid sorry, there's been a huge
nationwide hack that's affectingalmost every pharmacy and we
(01:58):
cannot tell you if my mom isunder Medicare, if Medicare will
cover this vaccine or how muchit's going to cost for you.
And my mom is very costconscious and so she said I'm
not going to get it, like if Idon't know how much it's going
to cost me, I'm not going to getit until you guys figure it out
and so this is such a tiny,minor thing.
It's just a tiny minor vaccine.
(02:20):
Whooping cough is very rareanyway, but I was affected by
this on day two and I tweetedabout it.
I was like my local pharmacysays there's a nationwide cyber
attack on pharmacies and my momcan't get.
Now can't is an exaggeration,but my mom doesn't want to risk
having to pay the potential fullretail price of a vaccine and
(02:42):
and so she's not getting it.
And then I've started to seethings pick up since then.
But I really feel like thisshould be everywhere, and I
think the reason it's noteverywhere is, in general, most
patients are getting the carethat they need, they're getting
the drugs that they need,they're going to the doctor, and
so, fortunately, though it'scausing a lot of harm, most of
(03:03):
the harm is not on the endcustomers.
Speaker 1 (03:06):
Yeah, it's going to be.
Just to frame this out forthose that listened to the last
episode.
We've asked Bo Hartman, theco-founder and CTO of Anomi, to
come back on.
Bo, how are you doing?
You've had quite the week, andI think it was just yesterday.
You were actually quoted in apiece that Axios wrote around
(03:29):
this.
You want to kind of give us aquick update on?
We can talk about that piecebut also kind of where we're at
now.
Speaker 3 (03:39):
Right.
So yeah, as you guys are saying, and we all agree, this is a
piece that is just running underthe radar Since we've talked.
Last week, we are now gettingpolicymakers who are actually
coming alive on these topics.
The White House had the CEO ofUnitedHealthcare, who is the
parent company of ChangeHealthcare, yesterday in DC to
(04:01):
go over that Providers arefiling for bankruptcies.
Yesterday in DC to go over thatProviders are filing for
bankruptcies.
The loan programs are beingrolled out, which I think we
should discuss.
The money flow all around thatas well, because that makes my
head explode.
Payments still not flowing andwe're starting to get our heads
wrapped around what theoperational hurdle that is
(04:24):
speeding at us that will be outthere.
Young companies that arealternatives to change are
actually starting to gethundreds of thousands of
transactions which are puttingtheir infrastructure at stress.
So it's actually reallyinteresting unfolding and I'm
starting to put some of my mindto what I think the future steps
(04:47):
are, the steps to go forward.
How do we unwind this dangerousrisk to its critical
infrastructure?
Speaker 1 (04:54):
I'll give you one quote out of the piece that you
said.
That I still love is that thishas punched a hole in 20% of the
US economy and appears at themoment no one's being held
accountable.
Speaker 3 (05:07):
Yeah, actually, on the other map that we did, it's
nearly 5% of global GDP.
So think about that.
Think about that for a second.
And the reason why I think thatfolks aren't screaming yet is
because it's not affecting youropportunity to go get care.
But, like I said on the lastsession, providers are getting
(05:30):
0% of revenue and 100% ofcaseload and they're running out
of money to pay their staff.
So there is a timeline that isquickly approaching us to where
they won't be able to pay staff.
They won't be able to payvendors.
Speaker 2 (05:43):
Well, I saw that is having an impact.
So there's a nursing home inNew Jersey that just closed down
temporarily.
But they said, hey, we can'tpay our staff.
Our staff is not going to comein if they're not getting paid.
So we can't take care of peopleif we can't submit the claims
and get paid for them.
And so the nursing home rightshut down.
People got to be taken care ofelsewhere.
Speaker 3 (06:05):
While this is ongoing , and just under the waterline.
That's happening all over theUnited States and you're
definitely seeing that.
So, yeah, so it is fascinating.
And what's interesting is theseproviders are owed money for
care they've given and we canmeasure that for care they've
(06:28):
given, and and we can measurethat we can use the metrics to
where a uhg can pay them, likewhat their normal flow would be
right to, to actually make surethat these critical, critical
parts of our health care andeconomy stay alive there's a
great blog post by a doctor,jared deshetsky.
Speaker 1 (06:42):
I slaughtered your name.
I apologize.
I'm sure we can provide a linkto this in the show notes.
He said you got to think aboutthis change Healthcare processes
$2 trillion worth of claimseach year, 2 trillion and it's
literally shut down everybody.
I just can't stress it.
Speaker 2 (06:59):
Yeah, and think about that 2 trillion.
Speaker 3 (07:01):
It's not just the 2 trillion, it's the three and a
half trillion we talked aboutbecause, just like the Visa
MasterCard rails, you might notbe connected to change as part
of the exchange, but there's aparty in that flow of that
transaction.
That is right.
So to complete that transactionas we know it in payment and
(07:23):
banking, you have to have ahealthy, robust rail contract.
So even if you are notconnected to the exchange
platforms, a counterparty inthat flow could be, and it has
stopped those as well.
So you've done it.
I mean, do you guys think thisis a place where you talk about
(07:47):
the other side of who gets who'smaking real big money right now
?
Well, what I?
Speaker 2 (07:52):
was going to ask.
You know, whenever something'shappening that I don't
understand, right, when this is,it's going on three weeks of
billions of dollars in impact, Ialways say, well, what are the
incentives?
Right, like, who's making moneyhere, who's not making money
here?
When I think about so Facebook,right, also of a massive scale.
If Facebook goes down, facebookstops making money, and I think
(08:15):
that kind of lights a fireunder people's asses to go fix
it, you know.
And so I'm curious.
I mean, yeah, bo Sam, right, sochange is down.
Who is making money?
Who is losing out in thissituation?
Speaker 1 (08:30):
Everybody strap in for this next answer that Bo's
about to give, by the way.
Speaker 3 (08:35):
Yeah.
So if we think about theconstruct of money flow right in
this world.
So you have United Healthcarethat has its subsidiary that's
transacting this.
As I described, people areconnected to it in varying
different ways to make thesetransactions take place.
The transactions, as Maya said,aren't flowing, but companies
(08:55):
are still paying their premiumsto United Healthcare.
So the premiums are stillflowing into their coffers.
They're also sitting on themoney that already exists, that
hasn't flowed out, that aresitting there, so they're making
float.
One of the weird things aboutthese payers is that they're
quasi shadow treasure banks.
Speaker 2 (09:13):
is what they are right.
Speaker 3 (09:14):
Because they're sitting on float and they manage
float as part of that.
So they're getting inflows ofpremiums, they're not paying
claims out and they're makingfloat, so they stand to make a
massive windfall as a part ofthis.
Now, as Sam and I were talkinga bit earlier, if this was a
(09:34):
banking situation where it wasdown, that money would be
earmarked to pay out at a laterdate and the bank would be held
to account of how much moneythat they were sitting on and
how much they were making basedon this event of accountability.
So again, this is another placewhere we need to separate the
care from this conversation andfocus on the economic impact of
(10:00):
this payment situation.
Speaker 2 (10:02):
Well, and so I mean, when you're talking about this,
this is kind of the classicinsurance business model, right?
You get paid premiums and youdon't pay out.
I do think we tried to regulatethis to limit the extent to
which insurance companies can dothis.
And health insurance companiesIs that gonna play into effect
here?
(10:22):
Is there?
I know they have to pay outsome percentage of premiums they
receive, but I don't know thedetails of that regulation.
Is there a time frame?
Speaker 3 (10:29):
Yeah, yeah, I mean, in this case it's fairly silent.
I mean, you know again, and Ithink we touched on it last time
and I definitely have touchedit with other reporters last
week and I had a very seniorhealth reporter agree with me on
this, on this aspect of thisindustry the regulation is very
(10:50):
thin compared to what Sam and Iexperience at banking.
Not even close, right, it's noteven in the same ballpark.
And so it's fairly silent.
Because I'm not like.
Ok, the premiums are thepercentage of premiums that have
to go.
Well, they can't push them likeright now, as far as they claim
.
But what about the float?
What about the interest of thatmoney?
You know, right, like again,and it's silent on that topic.
(11:14):
And we're talking hundreds ofmillions of dollars.
This is not insignificant.
And again, because it's soopaque and because, unlike banks
, they are not required toreport this in the same manner
that you would inside of thebanking construct, no, it's so
(11:35):
hard to determine what it is.
I mean, it's taken us threeweeks and you know we're now
starting to get numbers wherepeople are actually quoting
numbers, and even those numbersaren't right.
You know the one person quoted,you know two trillion through
change, right, but it doesn'tcount for the other trillion of
other parts.
So it is so opaque in thisdomain that we actually have to
make it transparent so that wecan make it better, so we can
(11:58):
put good policy in place.
Speaker 1 (11:59):
What's even funnier, if you really want to geek out
on payments and Maya Beau andmyself we are payment geeks this
is what we do.
We know within payments that asfar as how you communicate,
there's ISO standards.
There's standards set onpayment flow for this.
What is fascinating with thisis that a great string on
(12:23):
Twitter from an account, zachCantor, talking about the impact
HIPAA has Of all things.
I think we're all familiar withHIPAA, but HIPAA actually set
and established a standard forthe electronic transactions when
it comes to insurance and thismoney flow.
You know what 99% of theinsurance companies use for the
flow.
Who set the standard for thisis change healthcare.
(12:44):
So if you're trying to get offof change, you're looking at
months worth of programmersgoing in and rewriting these
standards because there's not aset standard for this.
The industry set comes fromchange.
This is the most circular snakeeating itself thing I've ever
seen in my life and if this wasbanking, we would all be in
(13:05):
front of Congress right now.
Speaker 2 (13:07):
Well, I wanted to ask how much of a free market is it
?
You know, I understand thatchange is a clearing house.
Can you choose whoever it is?
I was, you know.
I was talking with my friendEllen DeSilva.
She's at Summer Health and shesays most of these small
practices don't even pick aclearing house, it just gets
bundled in with their electronicmedical record system.
Speaker 3 (13:27):
That's a that's a hundred percent correct, right?
So you go, epic, cerner, oreven some of the smaller ones.
They're already bounded tochange and if you look at the
history of what change did,change went around and they
bought up all these little tinyexchanges way back when and then
they became a patchwork.
And we saw this in banking whenbanks got rid of other banks.
(13:48):
The systems weren't integratedand they were these patchworks
of connections.
Again, there was no oversightor policy to give good guidance
on this aspect.
Cms, hhs this is kind of a weirdspace for them.
They really are not experts inthis domain.
This quasi or this shadowbanking industry grew up on top
(14:11):
of it.
You have the smaller ones, likewaystar and alibon um, they're
sending, um, they're sendingcontracts out to provider groups
and the contract uh, theproduct group is sending unread
lines back to them in fiveminutes and saying, yep, let's
get on it.
So you have these smallerorganizations who are getting
stretched way beyond theircapabilities and the operational
impact is going to hit themsoon too.
(14:33):
Right, because what's going tohappen is they're going to get
huge transaction volumes.
They're going to be stressed,they're on modern architecture,
but when you go from a couplehundred thousand to a couple
hundred million transactions,it's a different ballgame
completely, and so it isdefinitely not a free market.
And again, the mind-blowingthing about it is definitely not
(14:53):
a free market.
And again, the mind-blowingthing about it is folks don't
realize how much of amonopolistic situation creates
this risk.
The UK chairman letters fromthe 2012 NatWest collapse of
technology.
It actually sets a greatframework to allow you to say
(15:15):
how do you actually create good,solid infrastructure like this
in an open free market.
That is the UK bankingecosystem.
Speaker 2 (15:25):
So, and I was going to say you know tech, bring it
back to Facebook, bring it backto technology.
Like tech also operates at hugescale, like this right, there's
so much of tech and fintechthat's doing trillions of
transactions and I don't know.
I mean not to brag, but like Ifeel like we've kind of figured
it out, like we know how tobuild resilient systems.
(15:46):
Right, you do redundancy bydefault.
You've got multiple databases,multiple database backups.
You have your servers indifferent regions, use multiple
banks.
Svb Bit you in the ass if youweren't doing that.
We've got all of the differentpieces and I feel like I might
have an idea what's actuallyhappening right now at change,
(16:07):
which is, something went down.
Speaker 1 (16:10):
They paid the ransom A naive perspective is
everything should be back onthat unconfirmed but you know
that you can build it.
Speaker 2 (16:23):
It's like you're gonna have a set of cascading
failures.
It's gonna affect stuff.
As they bring things online,they're gonna realize not
everything is working asexpected.
Speaker 1 (16:40):
And I really think it's like.
I feel like there are a lot oflessons that could be learned
from the way that tech operatesat a scale like this.
I mean we talked about thislast week, though that we've
been if you're in banking andpayments, you've been through
the crucible, we've been throughthe fire, and there's a ton of
lessons that can be learned fromthere.
When it comes to the regulatoryside, when it comes to the
redundancies that need to bethere, right, maya, we talk
about stress tests all the timewith banks.
If you look at the US bankingsystem, you know it's kind of
(17:01):
hard to argue that we're notstronger than ever Right Over
here and from a, from a standard.
So the lessons are all here.
It's just.
You know, beau, I mean, that'sthe question I would ask is so
where do we go from here?
I mean, I know there's a lot oftalk going on in DC.
(17:22):
There was a I saw on Twitter.
Dan Diamond, very good reporter, said he spoke with Barry
Sanders yesterday.
Senator Sanders, who's alongtime critic, by the way, of
UnitedHealthcare Shocking.
He also sits on the Senate'shealth panel, by the way.
He called the spiraling crisisa very important problem and
told me he's considering Senatehearings.
It's just a question of how wefit it in.
I think they're going to fit in.
(17:43):
I think it's safe to say yeah.
Speaker 3 (17:45):
Well, I was going to say Barry Sanders loved him when
he was running back.
Speaker 1 (17:49):
Oh no, sorry, Detroit , everybody the greatest running
back of all time, and we shouldactually do a show on that.
I'm sorry, bernie, with yourmittens.
Speaker 3 (18:03):
Yeah, it's good.
So about a year or so ago, Iactually authored an article
with just exactly what you'resaying, maya, is that the health
industry can actually take thelessons from banking.
So, for example, when I landedin this industry, I started
looking at it.
This industry looks likebanking from the early aughts
(18:25):
into the early teens and thenwhen the fintech wars took place
around that 2011, 2012, 13, 14,15, right that this industry
can actually take that roadmapfrom the fintech banking era and
learn so much.
To skip to your point, skipforward and actually improve the
(18:48):
way that I'm thinking about itright now when we're speaking to
some policymakers one is Samone let's take the lessons from
banking.
Two, this is an economic andnational critical infrastructure
topic.
This is not about a doctorcaring for a patient.
We do that pretty well.
This is about how do weactually protect and create to
(19:10):
Maya's point, the resiliencythat we already know how to do
for our nationally criticalprocesses.
Right Three, we need to holdthe participants who are engaged
in this to a higher level.
Right, we need to create theincentives to actually open this
market up so that not onesingle model player who can be
(19:31):
taken down with a golden BB forthose of you at my age will know
that reference and actuallycreate an environment where
these other players can come in,help reduce the cost, increase
the efficiency and thetransparency.
And then, lastly, this needs tobe a joint hearing between
(19:53):
finance oversight and thehealthcare oversight, because
the committees that overseehealth are not equipped for this
topic.
They just don't have the back.
When I talk to them, I have towhiteboard it very basically so
that they can go oh, weunderstand.
Okay, now we see the problem,right, and so we need to
actually do that.
And incentives could be taxdeductions for provider networks
(20:15):
that actually do the ITinvestment on their EHRs to
connect into multiple exchanges,right?
Those are the sorts of thingsthat we need to create.
Speaker 1 (20:27):
And Bo, when you and I were talking I think it was
yesterday or the day before thata couple of things we want to
flag.
We said it on the last show.
Please understand this was agovernment-sponsored attack.
This hack was governmentsponsored, so you can go and
read about that everybody.
So that's one.
So when you talk about criticalinfrastructure, it shows you
(20:47):
how susceptible we are for anentire system to be taken down.
Half of this is you don't wantthe pendulum to swing too far,
right?
We've all come out of banking.
We all survived 2008.
And what typically happens withsomething like this is a
(21:08):
pendulum swings the full arc,right?
So this is a chance to go inthere and do this right.
When we're talking from aregulatory standpoint, we're
coming from a standardstandpoint and the lessons
coming out of banking andpayments the roadmap is there
for this.
Speaker 3 (21:23):
The roadmap's there.
And then, maya and Sam, as youguys know from last time we
talked, when UHGUnitedHealthcare through Optum,
spent $12 billion on changehealthcare $12 billion and the
DOG stepped in to say let'sreview it for monopolistic
practices and it was struck downby a federal judge, right?
(21:46):
This is exactly what thatoverview would have hopefully
surfaced up that we injected amassive amount of risk into the
environment, right?
Speaker 2 (21:59):
That's what I'm saying Talking about regulation.
Now, I think it's important,but it's kind of like closing
the fence after the horse hasescaped.
Should we have just blockedthis in the first place?
And I think United knew howmuch they had to gain, which is
why they defeated that's whythey spent $12 billion.
Speaker 1 (22:17):
Exactly.
Speaker 3 (22:20):
And people go.
Well, didn't the risk existwhen change was out there?
Yes, but if change during that,that trans transaction, we
could have had the conversationsof how do we put a competition
and how do we help you know, thecompanies, like the nomies and
the elevants and everyone thatare that are trying to create
diversity in the market, right,yeah?
Speaker 1 (22:37):
let me get not to outrage everybody a little bit
more.
But why not A great article onprospectorg that talks about an
Oregon medical practice that,again through this, basically
had zero funds to operate.
I mean, the doctors pulledtogether to be able to pay staff
to keep this going.
(22:57):
Their only option that theyhave was to push a sale to
anybody want to guess to whom?
United Healthcare.
Speaker 2 (23:07):
That's I was going to ask.
I mean right, because it's thisvertically integrated monopoly.
Are they picking up thesestruggling they 100%.
Speaker 3 (23:15):
Yes, one of Optum's practices is they go in and they
purchase providers that arefailing.
That's actually part of aplaybook that they do If we
could do a screenshot of Maya'sface right now.
Speaker 2 (23:28):
I would.
I mean, this is so nasty.
Speaker 1 (23:35):
United Healthcare comprises of 2,642 separate
companies, collectively rankedat $371.6 billion.
The federal government could beall over this.
Speaker 2 (23:45):
They're the only ones powerful enough.
Speaker 3 (23:47):
And if you look at Raytheon, raytheon's massive
defense contractor, right, theyhave oversight, they have
detailed oversight.
And again, I'm not calling formassive regulation.
To Sam's point, I'm saying goodpolicy, right, there's good
roadmap, and but as well as wealso have to to create it so
that uh, that these innovatorscan come in like like an omni
(24:09):
health and actually uh, create adiversity that would create a
quasi exchange competition likewe have, that, for example, we
have providers scrambling to geton these new exchanges.
Right.
If we would have had a contractlike we have with the credit
(24:32):
bureaus, like we talked lasttime, or the different payment
rails that we have across theUnited States, all they would
have to do is say, okay, we'regoing to increase traffic to
these other channels, and theprocess would still be you sound
like you worked in the UK,though you really do, or yeah
around the globe Right.
So again, I really think, andsame with Maya we need to use
(24:57):
your platform.
We need to bring the thoughtleaders together in your
audience and audience, and weneed to actually say here is the
plan, this is where we're goingto go right, because that's
what nomi's trying to do iswe're trying to say like this is
you know, this is a crisis, uh,and here's the plan and here's
how we're approaching it, here'swhat we recommend, so we can
actually get exchanges of ideasthat we can, that we can
(25:18):
approach the, the differentcommittees, and we can approach
the different policymakers andsay this is so important, this
is the things we have to go doand, to the point, you both made
the roadmap's there Us bankers,we've seen it, we've been
through it, we've done it.
Speaker 2 (25:34):
And it does feel like right.
Increasing competition wouldhelp mitigate how vulnerable we
are to things like thishappening.
It'd help reduce the risk.
I saw Health and Human Serviceswrote a letter pleading
healthcare leaders to help makeit easier to switch
clearinghouses and it does seemlike there's been a little bit
of work there.
But, like Sam said, it's hardto move that type of standard
(25:56):
quickly.
But even backing up a littlebit I mean, of course this is
top of mind because this must bethe know me mission but it's a
little crazy that we needmiddlemen to know how much
providers are going to get paidin the first place.
So yeah, having more middlemenas options and a free
marketplace to choose betweenthem is a more reliable system.
(26:18):
But part of my brain is like tochoose between them is a more
reliable system.
But part of my brain is like,well, could we cut them out
entirely?
Like, do we need to rely on amiddleman for our healthcare
system to function?
Speaker 3 (26:29):
Right.
So you know, nomi stands for nomiddleman, right, and some
people go but hey, aren't you amiddleman?
No, we are about creating theefficiency of the market, of
what you're talking about, right?
So you know you're going tohave to have third parties in
the flow.
Whatever it is, the problem isthe market itself is just not
efficient, right?
The market has all thesemiddlemen in the way.
(26:51):
That is actually buildinginefficiency, because it creates
their opportunity of revenue,right?
So the thing we didn't talkabout last time 40% of every
dollar that is spent on caredoes not make it to the end
provider and it's picked offalong the way by administration
(27:13):
organizations and that sort ofstuff.
And that's actually on the goodside.
That's the upside, right?
And that 60 cents doesn't makeit to the provider for like nine
months, and then what willhappen is someone will come back
later and they'll claw it back,right?
And so each of us have all ourhorror stories about this
industry and how it's soinefficient, massively
(27:34):
inefficient, right?
And so our big mission is howdo you make it efficient?
Because the real cost ofhealthcare in the United States
states is about 30 to 50 percentless right.
Speaker 1 (27:45):
It is mind-boggling like the only thing I can equate
this to is doing your taxesright guess how much you owe?
Speaker 2 (27:50):
how about you tell me ?
Speaker 1 (27:51):
I guess you know if you get it wrong you're in a lot
of trouble and when it comes tohealth care, as as somebody who
has four kids and is pushing 60and everything else, that's
that's always the fun part.
Right when you're going intohalf procedure you're like
what's it going to run me?
I have no idea you have no ideaWe'll.
We'll let you know.
Yeah, it's the most amazingindustry I've ever seen, yep and
(28:15):
and so yeah, so I think this isa monument.
Speaker 3 (28:17):
I'm so glad you guys are giving me the opportunity to
engage with your community.
You know I come from thiscommunity and we really.
There's opportunity for us tolead and be thought leaders, and
we need to be.
This is so monumentallyimportant because we're losing
providers on a daily basis.
Insurance commissioners acrossthe states are having to say,
(28:41):
hey, how do we actually give theloan to keep a provider in
place?
And I'm like but there's $4trillion flushing around this
market and we know how much aprovider made on a monthly by
monthly basis.
Why don't we actually give themthat?
Speaker 2 (28:54):
Right, and when the reconciliation is over, right.
It seems like we're so good atcash flow forecasting and we
know that, right, like, loanpayback rates are really high.
When it's caused by somethinglike this, which is not the
fault, it's like they're stillproviding the things.
It's almost like earned wageaccess, but for medical
practices and for physicians,it's like we could look at what
(29:15):
are you doing for people?
We should be able to know,looking at historical records,
and we should be able to lendpeople the money they need
accordingly, but the impact toindividuals' lives.
Speaker 1 (29:25):
I'll keep coming back to this.
There's a cancer clinic inArizona that serves 16,000
patients.
That said they had three weeksworth of operating income.
That's it, 16,000 individuals.
So again, criticalinfrastructure, right.
It's not that the care can'ttake place, it's that the back
(29:46):
end of this, that payout nothappening.
So again.
I'll keep saying it how thisisn't front page news is
backflip.
Speaker 3 (29:57):
Yeah, so yeah, and that's why I said, wow, this is
an economic issue that we haveto pound on.
So yeah so that's why it'slooking like, the more we get it
out, it's starting to getpicked up.
Like I said, my calendar isstarting to fill up with
interviews so we can get themessage out.
And it's funny, all theinterviews start the same,
especially the health carereporters.
Yeah, this is a big story.
(30:18):
We're also shocked about how noone's really picking this up.
But yeah, it's the monopoly andyou can't fight them.
And I said, but that's theproblem, that's the problem.
Speaker 2 (30:28):
Right, I mean Sam was talking about its critical
infrastructure.
Some people would argue suchcritical infrastructure should
maybe not be run by privatecorporations and it's a setup
that's not really destined forsuccess.
Speaker 3 (30:42):
And you know private corporations, I think the
private industry has to beengaged with it.
But just like theclearinghouses, right, the
clearinghouses are guaranteed bythe government and everybody
pipes into it, right?
And then that creates a marketto allow the market to function.
Speaker 2 (30:56):
Exactly.
Speaker 3 (30:57):
And every participant is held to a standard.
Speaker 1 (31:08):
And that's what we need, that we need to move in
that direction, right.
So I feel that that's wherethis message is, maya folks that
have built systems that alignto this so well, folks that know
you know that understandpayments inside and out.
But unfortunately we're out oftime here, maya you want to
(31:35):
close this out?
Speaker 2 (31:35):
Yeah, you know, that does it for this week's
Artificially Intelligent Podcast, though United needs to do
better, I have to admit.
So, personally, I actually lovedoing incident response, and
part of me is kind of jealous.
Speaker 1 (31:44):
I'm serious, I love.
Speaker 2 (31:46):
Well, it's like being an early stage startup.
Everything's on fire.
I love it, so I'm a little bitjealous of the incident response
team at United, though theyneed to pick up their game.
Hey, we love hearing fromlisteners.
Go out and give us a review,preferably five stars, wherever
you listen to podcasts.
This helps us grow our audienceand, hey, you can reach out to
(32:07):
us too.
We love the conversations.
We love the feedback.
We'd love to hear your ideasfor how to make this system
better.
The best place to find me is onTwitter.
I'm at M-A-I-A-B and if you canhear Aria, my new daughter, in
the background, beau, where'sthe best place for our listeners
to engage with you?
Speaker 3 (32:26):
So I think engaging Nomi Health, you know, on the
web, at nomihealthcom or on allsocials, I think, is the right
way.
If folks want to interact withme, the easiest way to do it is
at Twitter, atB-O-E-H-A-R-T-M-A-N, also,
LinkedIn.
Speaker 1 (32:42):
some of the posts that we're making together and
that I'm doing with others caninteract there as well,
excellent, well, folks, you canhit me up on LinkedIn or Twitter
at Sam Maul.
I want to thank everybody forlistening for this incredibly
important, in my opinion,episode, and I want to thank you
all for listening.
Speaker 3 (33:01):
We'll see you next.
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