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- [00:02]
A
This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.
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B
Hello, everyone, and welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by Jay Nakashima, President of eHealth Exchange. Jay, how are you doing today? Thanks so much for joining us.
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C
Yeah, hey, thank you for having me. I'm doing great.
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B
Excellent. It's a new year, but some of the same kind of trends and topics in healthcare and with health plans and so maybe some new ones to address. So we'll dive into all that. But Jay, before we get started on the topics, I'm just wondering if you could please share a little bit about your background and career journey, please.
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C
Yeah, you bet. So I've been working in the health IT space for over 30 years. I spent about 10 years, my first 10 years with health plans as they were merging and acquiring others every other day and was ultimately the CIO of an HMO ppo. I then moved over to the clinical IT space. So I worked for a couple of large EHR vendors that helped out hospitals and health systems. I then went to work for a large national provider again on the clinical IT strategy side. And then I've been running eHealth Exchange, which is a nonprofit data exchange network. And I've been doing that for the past eight years.
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B
Well, thanks for sharing your career journey, Jay. So much great experience in there. First topic I wanted to get to, how are your relationships with providers changing as both sides face cost pressure and workforce shortages?
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C
Yeah, great question. So eHealth exchange was created about 20 years ago by the federal government, as strange as that sounds, as a nonprofit health tech company, another strange concept. But at any rate, eHealth exchange was originally founded to help healthcare providers exchange rich clinical information, so patients electronic medical records, and to exchange those among health care providers and with federal agencies. So when I mentioned federal agencies, you might think of like the Veterans Administration, the largest health care provider in the country, and the Department of Defense, who has army hospitals, Navy hospitals, etc. But at any rate, it really took us, it really took us a good 10 years to get health Care providers to exchange data at scale and with trust and that was for the HIPAA treatment purposes. And you know, got to the point where we were exchanging, you know, over 20 billion health care transactions annually of course in all 50 states and up to 25 billion. But the vast majority of those electronic medical records being exchanged are still being exchanged for the HIPAA treatment purpose. So think of a clinician at the chair side, bedside tableside, whatever, about to prescribe a medication or order a surgery. And we've shifted over the past five years to also focus on payer provide exchange and provider to public health exchange. So we're really excited about reducing the burden that both payers and providers have when exchanging patients electronic medical records.
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B
I appreciate you shedding a light on all that wonderful work there, Jay. A lot of the progress has been made and certainly a lot of growth there. Next question I want to ask you. Where do you see the biggest gap today between payer strategy and operational execution?
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C
I think it's, you know, in my mind it's really in the, it's really in the lack of understanding of, of how inefficient the current processes are. So you know, when I speak with providers, you know, from large sophisticated health systems, you know, they often tell me oh, you know, we don't share patient records payers and as nicely and tactfully as I can, I say well of course you do. You know, you've been doing this for 30, 40 years. It's just been a behind the scenes operation that number one is required in your payer provider contract but might be also happening in an unscalable, unscalable fashion. So it might be happening via and sorry for the non techies, it might be using an old school HL7 version 2 interface or it might be someone swapping Excel CSV files or it might even be the dreaded fax machine. But regardless that data is being exchanged today. But it's, it's, it's expensive and clumsy and, and so that's what ehealth Exchange is trying to tackle. We're trying to number one demystify process, use national standards and apply modern technology so that it's easier and less expensive to exchange the medical records.
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B
Are you surprised that there has to be efforts to kind of get people to adapt to pretty basic modern tech at this point?
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C
Yeah, you know it's, yeah, it's, it's really surprising, you know, that, that fax machines are, are not only alive and well but they' at such tremendous volume currently. And so you Know, when we speak to payers and providers about this and we explain the possibilities, they really do get excited.
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B
In terms of possibilities, what's one investment or initiative you believe will most reshape how health plans operate over the next two to three years?
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C
Yeah, great question. So you know, so we use the national standards which have been, you know, government endorsed and it's called HL7 and we're using modern APIs. So think about the programming framework used in your mobile phones for social media, to deal with your bank, to order coffee at Starbucks, whatever. And so we're leveraging that same technology. We're actually using the healthcare fhir fhir technical specifications to facilitate the movement of electronic medical records. And of course we're not using mobile phones to do this, but we're installing these apps on health plan and providers large institutional computer servers to facilitate the exchange in a scalable, standardized, trusted fashion.
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B
Yeah, you know, I know we just kind of touched on being surprised that people are still using, you know, fax machines for a lot of these records. But I've also heard, you know, particularly at our conferences from payer leaders that they're surprised how many seniors are utilizing these apps correctly and efficiently. Have you seen that?
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C
You know, I haven't seen it personally but. But it's something that ehealth Exchange definitely supports you, I think. I really haven't seen it just because our scale is so big. Again, 25 billion records annually and the percentage of that that's facilitated by individuals is still relatively small. But to your point, as consumers and individuals become more and more tech savvy and unfortunately as healthcare costs and as patients become more vested in their clinical health care outcomes. Yeah, I see them absolutely using technology for electronic medical records. I personally use it myself and it's really helpful because like most people, I see more than one healthcare provider in more than one setting and I like to have all of my data consolidated in one place that I can access via my phone or via my, my laptop.
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B
Absolutely. If you could change one regulatory or industry practice tomorrow to improve affordability and access, what would it be and why?
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C
You know, there's something in HIPAA called the minimum necessary rule. And you know, this was written back, you know, in the previous century, before, before computer systems in the Internet were really deployed widespread. And so what this rule is, is currently interpreted to say is that is that HIPAA covered entities, so including payers and providers can only exchange the minimum necessary for quality purposes. And question is, what's the minimum necessary? And you know, computer systems be it at 2 in the morning or 2 in the afternoon, have a hard time interpreting that. So I'd love on the policy side to have the government publish an interpretation of what is the HIPAA minimum necessary? Yeah, I think that'd be fantastic.
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B
I certainly think you'll have some support there.
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C
Yeah.
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B
The last thing I wanted to ask you, Jay, what issue is putting the most pressure on health plan margins right now and how will you respond differently in 2026?
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C
Yeah, so the biggest pressure for health plan margins right now, I mean, it's got to be, you know, of course there's, of course there's the medical loss ratio, but the administrative costs are really getting a focus and the in, in the media as well as from investors and, and so we're really excited to help reduce the administrative cost via electronic medical exchange.
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B
Jay, thanks so much for joining the podcast and for a great conversation. Look forward to working with you again soon.
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C
All right, thank you.