Bill Russell: 00:10 Welcome to Influence a Production of This Week in Health IT where we explore the influence of technology on health with people who are making it happen. My name is Bill Russell. recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to training the next generation of health leaders. Today, Matt Hawkins, CEO of Waystar joins us. Waystar provides cloud based RCM solutions that serve 450,000 providers, 5,000 health plans and over 2 billion transactions. Waystar with birthed from a strong technology foundation with NaviCare and ZuriMED coming together and this past year they added Connance and Ovation to build upon their platform. In this episode Matt and I talk about modernizing healthcare experiences with the consumer at the center and Technology as the foundation. This podcast is brought to you by health lyrics We help you to build agile, efficient and effective health IT. Let’s talk visit healthlyrics,com to schedule your free consultation. And now Matt Hawkins, CEO of Waystar. I hope you enjoy our conversation.
Bill Russell: 01:07 All right, so here we are from the, here we are from the HIMSS event. We’re here with Matt Hawkins, CEO of Waystar. Thanks Matt for meeting with us. Appreciate it. I’m grateful to be here. Um, so Matt, give us a little background on a Waystar. What do you guys do? Where’d you come from and those kinds of things.
Matt Hawkins: 01:24 Waystar is a cloud based technology company that is the combination of Navicure and Zirmed two market leading revenue cycle management businesses. that was put together in November of 2017. About the time I joined the business. And today, we are a business that has evolved and grown to not only include NaviCare and ZuriMED but also, two more acquisitions of business called Connance and another business called Ovation. And we now proudly and gratefully serve a nearly 450,000 providers that use our technology every day in every care setting. So from a physician office to a physical therapy practice, a skilled nursing facility to the largest health systems in the country, in hospitals as well. The folks who use our technology the Waystar platform to perform a revenue cycle, work to process health payments and to take care of the needs of their patients.
Bill Russell: 02:30 it’s interesting. So I’m going to come back to that in a second. So what we’re gonna do is we’re going to, we’re going to march through it. We’re going to talk about the community industry providers and technology. We’re going to talk wide ranging on this, but I want to come back to this. You identify yourself as a technology company, but the two companies you talked about coming together, we’re really revenue cycle services companies. So why, I mean, so you’re leading with technology. Technology is sort of the backbone for this. It is.
Matt Hawkins: 02:53 So I’m actually NaviCare and ZuriMED Were both revenue cycle technology businesses that were well recognized in the industry. They both offered Sass based solutions. Uh, ZuriMED had been invested in a, uh, a west coast venture capital firm called sequoia and they really did an incredible job investing in ZuriMED’s technology stack. We took that technology stack given its modern cloud based architecture and with the, at the outset of, of putting NaviCare and ZuriMED together, we said, let’s take this technology, unify every user on the, uh, a platform leverage this technology called the way star platform. And, and we’re, we’ve done that. So now we’ve United, uh, more than 2 billion healthcare administrative transactions, claims, remittance as eligibility is, et Cetera, onto this platform. We’ve also, uh, United, uh, all of the ZuriMED users. And now several, you know, increasingly every week we had more of the NaviCare side users to the Waystar platform.
Matt Hawkins: 04:02 And we take a tech first approach. So our, the way star platform today leverages predictive algorithms to prioritize revenue cycle workflow tasks to eliminate those tasks because we automate them, um, and, and make it easier for end users to use our technology. So that’s a stark contrast bill from, you know, someone who had just employed a services organization to replace the service work that’s going on in their, in their clinic or in their hospital or practice.
Bill Russell: 04:37 Well, it’s a difference between using technology and architecture really. I mean, what you’re describing is if you can put the right architecture together, you can, you can move a lot quicker, you can integrate a lot quicker. And that’s one of the bigger pieces, right? So if I were going to do revenue cycle, a lot of services companies were coming in and say, look, here’s what we’re going to do. We’re going to do Citrix sessions, we’re going to do whatever. We’re going to be looking at your screens and you’re whatever. And I think what you’re saying is, hey, we integrate directly and we bring it onto the Waystar platform. And then we put our, our RPA and our machine learning and our algorithms on top of it on your platform. Is that pretty accurate?
Matt Hawkins: 05:10 You just said it really well. Perfectly great. And, and in fact, um, we work with every, uh, you know, health information system vendors. So we work with epic and Cerner and Meditech. We work with the practice management vendors as well and we do in bed nicely with their technology so that, um, anyone who’s using those solutions can interact with our technology as well as there’s, we’re not forcing the end user to make a choice. We think that when they, when they step into using our solution, it’s a very elegant, uh, technology experience and gives them a lift, so to speak. It helps them a supplement, the work that they’re doing within their own systems. And so we like the approach. It’s bi directional integration. Absolutely.
Bill Russell: 05:52 We can talk about the technology all day. Yup. All right. So what are the couple of things I want to talk to you about is we’re seeing a lot of, I think the trend I’m going to talk about in Hims 2019 is social determinants, right? So very hot top. Uh, we’ve, we heard it from a Karen DeSalvo this morning, heard it yesterday at the chime conference. Vivek Murphy, a former surgeon general talked about loneliness and he said, you know, the impact of loneliness and isolation is a more impactful than a obesity on a person’s health. And so we’re s we’re seeing this whole idea of health and yet 80% of health outcomes or nonmedical. How do you think that’s, I mean, how are we going to get our arms around all this data that lives outside of the, I mean, we used to say we need all of all the information at the point of care. Um, but the reality is if 80% is genetic and other things, how are we going to, how are we going to start creating this entire record for people so that we have all that information. Do you think that’s going to, that seems like a big lift.
Matt Hawkins: 07:02 It’s a, it’s a monumental lift, but one that will transform healthcare in ways that need to be transformed. I think the phenomenal realization is that, uh, with social determinant information we can add so much context to how to care for patients. Um, you know, it’s in ways that are not easily discoverable or not necessarily self identified by the patient. Um, uh, the, the simple example I use when I, when I think about social determinants of health is when a patient discloses their Physical Street address. Uh, that’s interesting. But when you add a little bit of a social determinant context around that street address, for example, they may say, I live on 150 west and main street. Well, 150 west main street by itself is nice to know. But when you realize that that’s a third floor walkup that doesn’t have an elevator. Right, and we can add that contextual information to the and present it to the carrying a provider who’s looking after the patient.
Matt Hawkins: 08:12 We can learn a bunch of interesting things about that, that patient that would help us create better care plans, help us create better engagement with the, with the patient in their own healthcare and make for a better experience. Uh, and I, I think that that has to come about, you know, when you look at the current practice management solutions and the current Ehr, electronic health record solutions there, they’re mostly provider centric today, right? I think the breakthrough technologies will become much more patient centric. And so this patient record will include social determinant information as well as other clinically valuable that the patient is in essence owns. Providers look in at that information and can then care for the patient in new novel ways. And I think that’s the promise of the future and we’re just working to realize that sooner or later
Bill Russell: 09:10 it’s going to be interesting. I mean, one of the things I heard from providers when I was a CIO and some of the clients I work with is they have too much information today. Sure. So how are we going to, I mean, how do we get beyond that? I mean, so now you’re saying, hey, you should look at their education data. You should look at their housing data. You should look at their family history. You should look at, they look at some of these things today, but, but let’s just assume we start getting housing data and then you realize, hey, they probably don’t have an air conditioner. They’re going up three flights of stairs and those kinds of things. Um, I mean, that’s a, that’s a different set of services than traditional providers.
Matt Hawkins: 09:45 That’s a lot of data to process. And to be able to process that information while you’re with a patient is near impossible. So how do we create algorithms that can basically capture that information and create a industry standards that, that would, uh, help dictate, you know, green, yellow, red, easy dashboards or easy monitors for a provider to then, you know, look across maybe a certain set of, of, uh, factors to say, here’s how I need to engage with this patient in order to optimize their care based on geography, based on family history, based on diet, based on education levels. And that’s what’s going to lead us to offer better care to the patients in the net.
Bill Russell: 10:34 It was almost might lead, it almost might just be simple things like alerts, you know, the health system alerts, the community services that’s going to provide another service and those kind of thing. Great example. It’s interesting. Well, let’s, you know, you have a, you have a m and a background and those kinds of things. So let’s talk a little bit about that. So let’s talk about the industry. Um, one of the things we’re seeing a lot of mergers and we’re seeing some mergers fall through. I, I haven’t confirmed this but I heard yesterday at the Baylor Scott and white and memorial Hermann, uh, fell through a, which wouldn’t be a surprise, they’re complex deals to put together. Um, I’m actually a displaced CIO from a merger that, that was successful and I think is going pretty well. Um, the question I hear all the time is, has this been good? Is this good for healthcare? Is this creating the kind of outcomes we want for, well, let’s, let’s take it from two perspectives. Is this good for health care from a patient perspective is one of the questions. And then the other is, um, how to scale benefit these large health systems to be able to provide, I don’t know, better services for the community.
Matt Hawkins: 11:39 I think if you look at other industries where, uh, m and a work has occurred in consolidation, has occurred, in some cases it has been beneficial for patients or consumers in those industries, if you will. It’s not always clear that it is. And so, uh, and I think you see evidences of that in healthcare. I believe that the, that most, uh, m and a work in healthcare today, especially on the provider side is driven by the belief that consolidation will enable scale and will enable providers to leverage their knowhow across a broader network. There’ll be able to serve a broader population of patients and deliver them more services or offer them more capabilities or direct them to the best sources within their network. Um, that will over time ultimately lead to better care and also kind of a better financial profile. Uh, and I, I do think there are some evidences of that, uh, beginning to succeed, but I do also at the same time see that, um, that the, that the health system providers side mergers that take place, that don’t keep the patient front and center in their, in their investment thesis or in the reason why they do these deals, that it’s, it’s subject to kind of not have the impact that they’re hoping to achieve.
Matt Hawkins: 13:05 Uh, and, and I think, you know, if you kind of then kind of helicopter back just a little bit and say, well, look at all of the other m and a work that starting to take place around the providers that are doing their own MNA to serve those providers more effectively. I think that’s interesting as well. Right?
Bill Russell: 13:25 Uh, the, uh, but you know, when you have the m and a and you have the big players, sometimes they don’t do not move as fast as they used to. And so then you have new entrants, right? So we, this is a couple, couple of interesting entrance, not necessarily a small player, cvs, Aetna. And when you look at that, I think what I’m hearing their play is, and I could be wrong on this, but it’s really to disintermediate, um, the patient from the health system in terms of care navigation. Yes. So they, they want to step into that role and help them with everything from handling their bill to where they should direct them to, to get care. That’s interesting. And I guess that speaks to your consumer centric. So if you are a CEO of a, of a health system and you saw the CVS Aetna thing, how would you maybe adjust your strategy to make sure that nobody could come in between you? What are some areas that you would work on?
Matt Hawkins: 14:19 Yeah. So when you look at what is cvs good at, they are good at understanding the consumer as a retailer and offering services and products around that. What is Aetna good at? Well they’re good at health plan administration. And so if, if I’m a modern, you know, decision maker in a health system, I would take note in, in those, in those areas I would say and I think, you know, many are that how do we offer more consumer like experiences within our health system and how does that drive or give us conviction to acquire a physician network or an additional hospital or a surgical center or a, you know, minute clinic or some type of uh, easy access care site. And, and not only acquisitions, but how do I invest in more consumer like experiences in either care settings or in the ways I engage with the consumer.
Matt Hawkins: 15:16 The patient as a consumer, uh, patients like web experiences, they like streamlined bills. They, they, they like, uh, things that are easy to understand and intuitive. And so if I were a decision maker today in, in healthcare, in a large health system watching cvs and Aetna, I’d be paying extra attention to those types of capabilities so I could, if I could offer them to the consumers.
Bill Russell: 15:40 I saw a presentation to three years ago, and it was cvs, I think it was a CMIO, and he was talking about, you know, what they’re doing and they’re implementing epic. And finally, you know, one of the providers to the microphone and said, uh, my question to you is, what makes you think you can compete with us? He said, parking. Ah, that was it. That was his whole answer. And everybody laughed because it was like, oh yeah, that’s really true because parking is horrible at a hospital.
Matt Hawkins: 16:05 It’s great at CVS. Yeah. Um, it’s, it’s free in their parking lot and most places. And you know, in a recent hospital visit, I went to visit a friend who, uh, was in the hospital. And had to pay $10 to park there for an hour. Um, you know, and, and so you start to think about things like that that are really not healthcare delivery related but their experience related and how do we create experiences for consumers. I think another really important factor is quality. Um, in health care you haven’t necessarily seen patients vote with their pocket books yet because they’re for the most part directed to where they should go receive care even with high deductible plans, they’re still directed into a network of, they’re still directed into a network in some or most cases, uh, when you, so if I were a healthcare decision maker today in a big health system, I would say, how do we ensure that we have quality measures in place that don’t necessarily measure just clinical quality, but experiential quality to say that I’m creating a, a, um, a trusted, a unique experience for the patients in my community and I’m treating them in a modern and contemporary way.
Matt Hawkins: 17:28 It’s interesting, I’ll pass three cvs pharmacies before I get to my provider. And so the question becomes how do they compete with that? And I guess if you’re thinking experientially you, you say, okay, well we’re not going to put three locations between here in his house, but we can do telahealth. Sure. And so, you know, you have your first consultation is via telehealth and now you’re, you’re, they’ve actually jumped cvs and gotten closer to the patient.
Matt Hawkins: 17:55 Yeah. But what are health systems get at? Well, they’re good at delivering clinical care. Can we deliver that clinical care via video, a video consultation or a telephone based consultation? Absolutely. Can we deploy apps that, um, you know, measure heart, deploy or give people the vices that measure other vital statistics that could be meaningful in a dialogue with a provider and health systems could leverage those types of capabilities to stay relevant.
Bill Russell: 18:26 So let’s, let’s talk a, yeah, so experience is interesting because yesterday I was talking to a CIO and he, he mentioned that they have a team working on a single bill, so it gets closer to where you’re living right now. Um, do you find that systems that have spent that time to simplify the billing process, that collections are better, easier? People understand it, fewer phone calls, fewer, those kinds of things? I mean, I would think, I would think that’s absolutely true. I mean,
Matt Hawkins: 18:53 well, patients, uh, increasingly equate their clinical experience with their financial followup from the doctor’s office or the hospital or health system. So we know that a simple experience wins every day. Um, and at Waystar, our, our mission is to simplify and unify the healthcare payment process using modern technology for every care setting. And, and so our belief is that there’s a lot of folks that are probably very interested in and what you could call the holy grail of, of, of healthcare financial responsibility, which is really the payment estimation piece, right? If you can get that right, think about all the work that you save downstream, all the hassle and headache that you also save for, for both those that are following up on the administrative side and ultimately those that are consumers and receiving bills and trying to make sense of them. So this, this idea of a single bill is powerful.
Matt Hawkins: 19:57 It’s even more powerful if you can estimate that bill based on insurance eligibility based on preauthorization informed by patient propensity to pay their bill, um, and, and, and, and then present that to a patient at the outset of their experience, not 90 days after their service episode. So, um, that’s not easy to do. And at WayStar, you know, we’re processing about 2 billion healthcare administrative transactions a year. So we’ve got a lot of rules that govern and automate and streamline that process and we’re helping to make that possible with the clients that we serve so that truly they can present estimation, um, payment estimation up front. And I think that will be in the and months and years ahead if we can, if we can drive more of that information forward and create this single, the single bill like you, you, you know, you mentioned, um, that becomes empowering and will unlock a lot of dissatisfaction, um, uh, at the, at the patient level.
Bill Russell: 21:04 So that’s a lot better. Well. Okay, so the intent of the CMS and onc price transparency was what you just described. I mean, so that people could know that hey, this is what it’s going to cost now that the practical, I’ve gone out onto a few of the websites and looked at the, there’s no, I mean the one of them had a spreadsheet. I think it had, I dunno, like 1800 columns. So I would have to figure out which Mri I got. And I mean it was very hospital centric language around it. Um, but that gets closer to the, to the spirit of it, right? Of people want to know what they’re going to, um, what they’re going to be charged and how much it’s going to cost, what their experience is going to be. So what would be, what do you think would be better than just, hey, here’s, here’s our, here’s our price list.
Bill Russell: 21:55 Would it be, you know, some sort of way of calculating and how are we gonna, how are we going to get from where we’re at from a policy standpoint? This is what they, this is what they said, um, to where we need to get, or is it just, we’re now looking at, um, uh, consumer centric focus and that’s going to drive us to different kinds of solutions. They’re going to look at a health system and go, I can’t understand, you know what, this is going to cost me. And they had to find another one that you just pull up your app and go, Oh, you’re doing this. It’s probably going to be around 2,500 bucks.
Matt Hawkins: 22:29 Yeah. Yeah. I, I, you know, I think CMS is intent is, is very good. So drive price transparency. Absolutely. But to your point, the price lists are long and there’s lots of ways to kind of obfuscate what the real price is and, and that’s part of the age old game of payer provider interactions, um, that impact patients. And so I think it’s going to be a combination of several things. First, we’ve never been able to do more with technology than we can do right now. We can process technology, we can leverage algorithms that be, that create rules that govern technology, that govern data and the use of that data. So really we using eligibility information using preauthorization information. You know, in the case where a patient has some form of, of insurance, we can get pretty close to determining a patient estimation, uh, or excuse me, payment estimation for payments.
Matt Hawkins: 23:25 Now that’s complex. I think that can inform a simple bill, a simple bill that says this is what insurance will cover for this particular care, uh, this particular treatment and this is what your responsibility is. And, um, I think that’s what’s required for us to break through, uh, and, and, uh, really create a consumer like experience that we’re all accustomed to in other industry settings here. I don’t, I don’t pretend that it’s easy. Uh, and I think people, there’s a lot of talk about it, but it will solve a lot of issues if we can get to that point that we’re in a 40 year journey of we are instant transformation and every dev derivation of it with capitated plans and everything else and try to simplify things. We’ve got to crack the code.
Bill Russell: 24:15 So if I were to ask you to Sorta, you know, 10 years from now, 10 years from now, hopefully I’ll be re no I won’t be retiring, but if I were retiring in 10 years, a little more golf. Yeah, exactly. Then say, get out, get out to get back to pebble beach and do those things. But um, let’s assume I’m retiring in 10 years, hows healthcare going to look different? I mean, are we, how’s it going to look at social determinants, technology, uh, predictive algorithms? Uh, genomics? I mean, just dream a little bit about what you will, you think it might look like in 10 years?
Matt Hawkins: 24:49 I’m going to think big for a second. I think it’s totally consumer. Like I think most of my healthcare is consumed on my, by my choice that, um, and by that I mean I have a patient, a truly patient centered health record, not a health record that is about me, that exists on a provider domain, right? I want it to exist on my phone, my device, my own technology, and I want to take it in a very consumer like way to a provider, whether that’s in a retail clinic or it’s in a primary care physician or it’s for some complex case that re I and I, I’ll present that to any caregiver so that they can quickly learn about me within my own patient record.
Matt Hawkins: 25:40 That’s portable, truly portable, the design of HIPPA, right? That’s my record. That’s not, it doesn’t exist on the providers domain. I just want to underscore that one more time. Um, I have all my family history. I have that, that’s important to know when someone’s caring for me, whether it’s a car, it’s a flu shot or it’s something far more complex. Um, and, and then I understand, uh, where, what the payment requirements are in every single interaction and it’s simple. And I, I can see a single form of payment that I can make for any type of health care service I want to receive. And I understand what insurance will cover. Clearly from the outset, I understand what my copay or financial responsibility will be. If copays still exist. Um, and, and I’ll, you, I’ll have information that is pushed to me. Perhaps it’s on a phone. Perhaps it’s on another device, perhaps on a watch that will remind me or alert me to how I can day to day take better control of my health, walk more steps, you know, don’t eat lucky charms, eat the, eat the wheaties sort of the Cheerios, uh, you know, whatever.
Bill Russell: 26:51 Yeah, absolutely. Well, that’s a good vision. I look forward to a retiring in 10 years. We’ll play some golf at Pebble. That would be great. Yeah. Matt, thank you for your time. I really appreciate it.
Bill Russell: 27:10 I hope you enjoyed this conversation. I had a great time with, uh, with Matt. We got to talk golf before the conversation and then afterwards we had a conversation about the future of payment models within healthcare. I wish I could have, uh, had the foresight to record that. It was just sort of a spontaneous thing after we got done and we got out pieces of paper and we were drawing out the future of healthcare and, uh, when we got down and we thought, man, I wish we had captured that. But, uh, maybe, maybe for another show at another time. Uh, I hope you really appreciate it. The conversation that I, that the thing I love the most about it, it’s just the concept of we don’t have to replace the old systems that are there. Sometimes we just have to get the data out, put it onto a platform that has access to modern and new technologies so that we could do the things we need to do on top of it.
Bill Russell: 27:56 And then once we get the results, we could push it back down into those transactional systems. And I think that’s one of the things that they have done in order to really transform the experience of the consumer around the bill, which we know is extremely important. Anyone who’s had to deal with that understands that there’s a lot of frustration that comes with people trying to figure out, uh, you know, copays and and uh, and reimbursement and all those other things. Not for the faint of heart and definitely not for something we want a consumer to try to figure out. And I appreciate the work that Matt and Waystar team is doing to make that a better experience for everybody. That’s all for this week. The show is a production of this week and health it for more great content. You could check out our website thisweekinhealthit.com or the youtube channel at ThisWeekinHealthit.com/video is the easiest way to get there. If you’re interested in becoming a sponsor for this week in health it. We would love to talk with you. You can reach out [email protected] we were looking for, four sponsors to cover the costs for this year. We believe it is a great way to maximize the value for a few organizations who share our commitment to training. The next generation of health leaders. That’s all for this week. Thanks for listening. That’s all for now.