Thought Leaders in Healthcare IT: Girish Navani, CEO of eClinicalWorks (Part 6)

Sramana Mitra: Is there anything else that you want to discuss?

Girish Navani: I think we will see a different healthcare system where the payer is not necessarily the one clearing a bill without telling you someday what it costs. I’ll tell you something new that we’re doing next year. We just went live with it inside our company. I think there’s a business model for it outside of eClinicalWorks. We mandated that our insurance company give us our claim files, which was a tough one to get. It got to a point where it was frustratingly being ignored. They would say, “I don’t have it today. I’ll give it to you day after tomorrow.” It went on for about four months until it came to a point where I said, “Either I get it or I’m going to another company.” We got our files then.

We built technology to allow each one of our employees to look at that data and see what it costs when they go and get a lab, a flu shot, or an MRI done. We have an employee who went for a brand name prescription. The doctor recently switched it to a generic. Her son didn’t react well to the generic, so she had to go back to the branded one. She asked the doctor if she could do anything to manage the co-pay because co-pays are different for branded and generics. One of the employees in the company who had watched this data point in claim files then told her that Walmart is cheaper than CBS. It turned out to be true. She now saves $20 on every prescription she fills.

Employers helping employees create wellness and visibility along with technology companies providing consumers tools at home can change healthcare. It’ll take time because it’s regulated. There’s a lot of bureaucracy.

Sramana Mitra: Some of this stuff does not really need a lot of regulation change like optimizing the cost structure of a patient, which you just talked about.

Girish Navani: It does not. What needs to change is price. The initiatives coming out next year, because of government mandate, are still not going to give you the exact price for care. It’s going to be a reference range. But I still think that’ll go a long way. Getting price visibility and preventing sudden changes where the status quo gets challenged and people start getting into network contracts are good signs of a big tidal wave coming in. It’ll happen a little bit slower than it happened in the cab industry because there were lesser regulations, but I think it’ll happen in two or three years.

Sramana Mitra: I think what’s very encouraging about healthcare IT right now is that we are well within striking distance of the whole system digitizing.

Girish Navani: Yes.

Sramana Mitra: We are also well within striking distance of the healthcare administration costs becoming optimized significantly. There has been a lot of wastage in that area. All those add to the healthcare system becoming more efficient and being able to deliver care at a lower cost.

Girish Navani: And then we have population health analytics. New York City is doing something interesting. New York City has technology that is allowing them to understand outbreaks every 24 hours. They’re able to push medication recalls into provider and patient inboxes. They’re also able to understand chronic care management matched up against social, economic, and ethnicity breakdowns. This was not doable before. We take credit for the technology side because we put it in. But when you combine whatever we just discussed – consumerism in care with population health- I do think we might actually live healthier and at a lesser price point than what it is today. That will be a fun experience in life.

Sramana Mitra: What is your perspective on end-of-life care because one of the big chunks of the cost structure problem is in end-of-life care?

Girish Navani: Personal experience tells me that I can say whatever I want today but if your relative or family member ever had to go through that, you would try everything to see if it can work.

This segment is part 6 in the series : Thought Leaders in Healthcare IT: Girish Navani, CEO of eClinicalWorks
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