C-Suite Q&A: Health Fidelity's Chief Development Officer on NLP and More

Ryan Black
AUGUST 04, 2017
Let’s walk off into the uncertainty of healthcare for a second, since there’s just overall volatility regarding national healthcare policy. How (if at all) does it affect you as a company, and do these factors impact the client necessity for the work you do?

I think the biggest uncertainty right now is around the ACA, and the challenges for the market as a whole. Unless it is replaced by a robust plan, or unless it is shored up with certain changes, many health plans are actually choosing to leave the markets that they operate in for the ACA. Clearly, for us that means there’s fewer health plans and even providers that might need those services on the ACA side.

The good news is that that’s not a giant proportion of the market that we go after, the dominant programs such as Medicare Advantage aren’t going anywhere, and although Medicaid might shrink a little bit there’s still a pretty substantial number of lives in that program. Medicaid ACOs are only increasing as that program achieves more and more success.

For Health Fidelity, while we do pay attention to the political landscape and how the individual and small group health plans are going to be impacted by whatever happens at the national level, it doesn’t really impact the business much. I think the impact of those changes to our health plan customers’ business is very substantial. One of our health plan clients on the ACA side, due to the uncertain markets, lost a lot of money last year on their ACA products. We certainly see that, and we empathize, and we believe that our solutions can certainly help shore up some of the struggling plans, but we don’t have a magic solution for policy plans at the national level.

Is the move from “encouragement” to “mandate” of value-based care, thinking about how the real teeth of MACRA will come into play in a couple years, creating demand for your work?

I think the demand is really off the charts just because payer-provider collaboration is no longer a fancy term, it is real. As our outcomes, both financially and clinically, are tied to how well the plan and the provider work together to achieve better results of the patients, as that comes more of a reality based on the value-based care movement, it’s taken on a brand new sense of urgency. We are seeing more and more of these risk-based contracts and we are seeing our opportunity dramatically expand.

We couldn’t be happier in terms of where we are positioned to be successful in the market.

So 5 years down the line, what do you see your company doing, and what do you see happening in that market?

I’ll flip the question, let’s talk about what I think the market will be like first. We believe that in 3 to 5 years, you’ll see that it’s no longer going to be an option for payers and providers to not collaborate, it’s going to be a mandate that they do in order to be successful in a highly competitive healthcare landscape. How you work with your payer partners, if you’re a provider, and if you’re a payer, how you work with your medical network, both become absolutely crucial to improve your outcomes and get better results for patients.

We think that that’s going to be the state of the industry, and that we’ll be well poised to be one of the leaders helping these payer-provider relationships be successful in managing risk.

A final question I have is just for you about yourself, and what you enjoy about your work with Health Fidelity. What do you get out of each day?

That’s easy, it’s the innovation and the fast pace and the people. We are approximately 80 people right now, and I still know everybody individually. I love that, as opposed to being in Optum where I knew less than 5% of the company. Being able to innovate at a very rapid rate and deliver those solutions to our customers and see real value, helping them run their business better. Last but not least, seeing the technology impact the overall healthcare in the country as well as the individual improvements in patient’s treatments…all of that together is very satisfying.

I love the pace. It’s really great.

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