Thought Leaders in Healthcare IT: Pareto Intelligence CEO John Steele (Part 2)

Sramana Mitra: I’d like to do some use cases across those two different bodies of problems and solutions. Help me out with a few use cases.

John Steele: I’ll start with revenue integrity. We take and analyze our client’s data. We identify where there are gaps in that data whether supplemental documentation needs to be received to support it or it’s missing.

Our analytics looks at all those data, scores them, and then we drive interventions to close those gaps. Some of those gaps could be for getting more information out of a patient’s existing medical record. Some of those will actually be looking at transformation of the data that happened as it got processed.

The information was there at one point. But because there are so many systems that touch this information, it got transformed or didn’t make it through. We identify all of those and then we feed the tactical interventions to be able to close those gaps.

When we’re submitting it for reimbursement, we have the most complete picture for a patient or a member. That can include their enrollment data, the clinical data, or quality factors. We try to make sure that all that information is complete.

That’s what our revenue solution is doing. It’s being able to identify the gaps and address them. 

Sramana Mitra: Let’s do another one.

John Steele: There’s our health data integration which addresses the increasing volume and velocity of health data. A payer gets a lot of information from different sources whether that be from labs, providers, or hospitals.

One of the use cases that we have is try to make sure that the most informed information is provided to the provider for them to make the most informed decisions on behalf of their patient. We have developed an intelligence router where as information comes in, we can route that back to the primary care’s EMR if a patient is being discharged.

Now they know that that person was discharged. They might be able to schedule a follow-up visit. In the past, a lot of that feedback loop wasn’t necessarily happening.

In the past, having information such as admissions, discharge, and transfer wasn’t necessarily used to match that up with other data we have on that patient and trigger an action to flow back to the decision maker.

That’s one of the ways we’re trying to bring all of these data together. That improves the outcomes of the care delivered.

Sramana Mitra: How many insurance companies are using your technologies for these kinds of use cases?

John Steele: We have about 45 health plan clients, and about five or so risk-bearing entities.

Sramana Mitra: You are in touch with lots of clients and open problems. What are some of the open problems that have caught your attention? If you were not doing this company and if you were looking for a problem to solve to start another company, what problem would you go after?

John Steele: One of the big problems out there is the interoperability of systems. There is a technology that can be used but trying to solve that in a more meaningful way than the lighter integrations that are happening would be a big problem to solve. It’s not just the care setting but also bringing together the social determinants that people talk about that drive health outcomes. That would be an area I’d look into.

Sramana Mitra: Thank you for your time.

This segment is part 2 in the series : Thought Leaders in Healthcare IT: Pareto Intelligence CEO John Steele
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