PriorAuthNow Sees Cloud Technology as the Future of the Heathcare Space
Bart Murphy - Columbus Tech Power Player Honoree
Previously CTO for PriorAuthNow
Now Chief Technology and Information Officer for OCLC
Director of Market Strategy - Central Ohio
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CTO for PriorAuthNow, Bart Murphy, discusses cloud technology and automation in the future of healthcare.
Hello, and welcome to the ComSpark podcast, where you will get to meet today's technology thought leaders. To learn more, visit comspark.tech.
SG: We're here today with Bart Murphy, who is the Chief Technology Officer at PriorAuthNow, an organization based right here in Central Ohio. My name is Steve Gruetter with Expedient and I'll be your guest moderator today. Bart, let's get started.
BM: Thanks for having me.
SG: Absolutely. So, you’ve been in the space here in Central Ohio. Been seeing the changes come through the community, how do you see technology with what you're doing at PriorAuthNow changing in the next three years?
BM: Well, hopefully, it changes the healthcare landscape. When you talk about PriorAuthNow, we're really spending a lot of time normalizing the workflow and creating electronic means for the provider to automate the Prior authorization process. The intent and goal of that is to limit the friction on all parts of the lifecycle of that authorization, both from the payer, the provider, but the ultimate goal is to get a patient their desired procedure in a very fast, efficient fashion. So, that's what we're focused on and we know the technology and the modern ways of running technology can help solve that problem over the next three years.
SG: So, what is the outcome for you, for the patient here – is it going to be speed of service, quality of service, what's the outcome?
BM: All those, but certainly speed to service right now. Some of the biggest limiters as it relates to a procedure being completed or the approval process from the insurance company. And in many ways, any one hospital system or provider office has to deal with one of 50 payers that day to get that appropriate approval so that when they conduct the procedure, they'll be paid from the insurance company for that procedure. So, our goal is to decrease that cycle and ensure that the proper protocols are followed to ensure that we're saving,, you know, controlling the cost of healthcare, but also getting the patients the procedures that they need quickly and efficiently so that they can improve their own health and move on with their day versus waiting two weeks for a procedure.
SG: Makes plenty of sense. So, as you are incorporating technology into your overall solution, what aspects of technology do you view as most important over the next three years?
BM: Well, I mean, I think that the world's becoming more connected in general. So, whether it's the cloud, private cloud, a modern infrastructure like APIs, I think that's where you're going to see a ton more connectivity in the healthcare space alone. And with other organizations, you see more and more electronic data coming in. So, healthcare in this example, more and more organizations have EMR now, that they're creating the electronic health record, what are the other ancillary services around that process that can be made electronic versus fax, email, phone? You see that in with how service now grew extremely fast, right? Because there was a ton of unstructured data that was done manually, wasn't done in electronic means and once they got it into one system of record, they were able to explore tons of connectivity with other systems to automate workflow.
Well, we sort of see ourselves that way related to the PriorAuth, the healthcare space. If we can get into an electronic workflow, there's a ton of capability out there as a relates to interfacing with the appropriate entities to get that work done. So, I mean, I think technology will continue to grow. That connective component will allow you to do all kinds of things with unstructured data, with structured data, go down the list and in with the abilities of, you know, more processing power, you know, the ease from the cloud perspective, the ability to mine through the data, make decisions based upon that data, create algorithms based upon that data.
I think you'll see a lot of progression and automation and growth in the spaces where people can truly then focus on your end customer. Maybe in healthcare that as your patient, maybe it's the doctor that's interfacing with the healthcare, with the payer as an example, the insurance company, but for other organizations could be automating things so that you can spend more time with your customers and solving their problems versus doing manual processes that just end up taking a lot of cost in your organization.
SG: And right there you talk about where you're going to spend your time, where you're going to spend your dollars, which makes sense in something like that. What do you do? How do you measure the success of the technology that you are changing, that you are creating for PriorAuthNow? Where are you finding the margins to make it a better solution for your organization?
BM: Well, sure. I mean one automation is the key, right? So if you're looking from a business perspective in any environment, automations help improve margins and it's not a cost reduction strategy, it's just a way to take on more volume with less people, right? And that's what IT people have been doing for the past 30 years, right? I don't think that certainly there are industries that get impacted through that automation and, but you know, as you see today, there's a very robust job market, still even with those automations in place. So, I think you're going to continue to see a lot of automation and that's certainly how a lot of IT organizations are judged as it relates to a measurement of success, but that's just not good enough anymore. Now, you need to do it with speed, you need to be extremely flexible and it needs to scale extremely fast.
SG: And be secure every step of the process too.
BM: That's just a given, right? So, if you're not secure, then then that's a whole different set of challenges, and then you need it, you know, so there's things like the cloud that help with that from a scale perspective. There's newer models out there as it relates to how you do your software development, how you architect your sell your solution so that you can scale and so that you can, you know, have those type of margin so that you can reinvest and things like your product, a product development companies need to drive that level of automation so that they can keep reinvesting in their product and bringing that more and more value to the customer that they serve.
SG: When you're talking about the scalability, that's one of the numerous challenges, but what are the challenges that as PriorAuthNow is deep into development? What are the challenges that you're seeing in designing of applications?
BM: Sure. I mean, I think anytime you're attacking a new market, and certainly a market where there's a not a ton of products out there, you're really defining the market from a product development perspective that brings its own set of challenges. Certainly, I think a part of that is ensuring that your product and development teams are in lockstep as you're working through and solving that problem goes back to a little bit of that speed and agility that I answered just previously, You to have processes in place to be able to adjust to feedback. The feedback could be coming from product, it could be coming from a current implementation, it could be coming from market, you know, factors that we were unaware of, you know, a month ago.
So, I think those are very important things when you look at the challenges of designing an application, especially when it's sort of greenfield development. And then you have to look at how do we ensure that when we design a product that we know needs to scale significantly from not only a business perspective, but to meet the market demand, how are you going to build that? And that's where you start looking at microservices architecture. You start looking at not really being tied to a transactional database, whether you're doing stateful service versus stateless services – where does that make sense?
How can I run my data and memory, but then get it into a data stream that goes into a data lake? So, I can do all my data warehouse reporting, but I'm not tied to a tightly coupled system that can scale as good as my transactional database and that's where you're seeing a bunch of improvement on large scale systems where this new architecture along with, you know, the cloud and the ability to bring in infrastructure to scale it versus code and more database power to scale it is really key when you're designing a new product, if you have the chance to design a new product, you know, starting today versus migrating something that may be potentially a legacy into that type of architecture.
SG: Well, with another, there's a myriad of challenges on that. Though, what we're seeing on our side is very few organizations or even talking hardware infrastructure anymore. It's generally the conversation leads with what type of cloud, private cloud, hybrid cloud, whatever it might be. A multicloud is big. So, we’re seeing that quite a bit.
BM: But, they may be using the cloud in the abstract sense if you don't understand the infrastructure that's supporting that cloud and how that infrastructure interacts with architecture. Some type of service fabric as an example in order to scale and you don't develop in a manner that can self-fill or even scaled by nodes, whatever the term is for that cloud, then no matter what you do, you won't be able to leverage that cloud to scale your system. So, they may not talk about infrastructure, but certainly there is an infrastructure architecture component that you need to understand how that interacts with your platform, so that you can do the things that are using the cloud, which is I can go, you know, within minutes hours, add more resources to my cloud and that will help either horizontally or vertically scale on my application as it relates to performance.
SG: When you're coming into performance, what are you doing? Any steps in that you're taking to balance the quality versus the timeline?
BM: Well, I mean, that's always the challenge. I mean, from a quality perspective, you can't give on quality for the timeline, because even one transaction that can’t process, especially when you're talking about Prior Authorizations as somebody who can't get a procedure, so you can't really give them quality. It's not a matter of a numbers game as it relates to performance.
SG: Healthcare is one of these industries.
BM: Yeah, and I would argue that I think everybody takes their business extremely serious as well. And, you know, impacting a customer, whether it's, you know, not being able to buy something on a site for an hour, I think they'd probably see that as a pretty big challenge as well, because of the revenue loss or even the customer loss. So, although healthcare does have some more dire consequences as it relates to performance and quality, I would argue other companies feel the same. So, there's really not an ability, at least in my view, in today's environment to sacrifice for timeline. You have to figure out, you know, ways to ensure.
And that's why scale becomes so important as long as you can scale the system and you can actually hide some sins, even from a development perspective with some level of infrastructure scale. This is not an uncommon practice. It's been done for years, right? You go in through a huge server at it or a huge database server at it and you buy yourself some time to take care of that technical debt as it relates to potentially the bottlenecks that have been created either in the code and slash or in the architecture.
The same applies in the cloud. I'm sure there's some laws of diminishing return at one point, but it certainly gives you the flexibility and you always got to stay ahead of that. So, when I hear time on, I hear, is there a combination of resources that we can throw out this in order to give us the appropriate time to ensure that we have that scale? But then you have to have really good vision into how you're scaling the business to timeframe so that you can buy that time and properly invest at the right time to go to a million transactions. 10 million. There's no reason to build that up front. It's a huge investment, a so you just need to be really in tune with your sales and your product and everything else in order to make those investments at the right time and ensure the levers that you can pull are available to you to, you know, be more than your capacity at any given moment.
SG: Bart, outstanding information today. Thank you very much for your time. This is Steve Gruetter and Bart Murphy, CTO at PriorAuthNow. To learn more, please visit comSpark.tech. Goodbye. Until next time.
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