Revolutionizing Healthcare: Exploring the Cutting-Edge Trends and Innovations with Julie Lambert, President & General Manager at Inovalon

Today, we're talking to Julie from Inovalon about the digital health care market of the future. You're listening to Joel Beasley, Modern CTO.

So could you tell me a little bit about Inovalon?

Yes. So Inovalon, really the vision and why Inovalon is in business is to improve and advance the economics and quality of health care, and it's made up of four different divisions. There is a payer division that supports health insurance, health plans, Medicare, Medicaid. There is a provider division, which is what I lead, and that is supporting different hospital systems, home health agencies, skilled nursing facilities, clinics, different areas like that. And then we have a pharmacy business that supports our customers using our pharmacy platform to process prescriptions and do the care that goes with them.

And then we also have an insights area that really takes a lot of the data that we collect from payers, providers, and pharmacies and aggregates it into a format that can be used for different analytics, machine learning, and providing just really good insights to different areas across the health care ecosystem.

How did you get into this business?

I started about three years ago. Throughout my career, I've always been in health insurance. I did start in property casualty, and then I moved into pharmacy benefit management. Then I worked for a large health plan, and then I worked in a pharmacy with the large health plan. And about three years ago, I had an opportunity to really move into the technology side of it, where Inovalon is really a cloud-based SaaS software solution.

And it was really exciting because it really touches all areas. Just about everyone has an encounter with health care, and it is an area that's behind. I mean, it's hard to believe in some cases, there's faxes still going back and forth to submit prescriptions or request information or documentation. So it's really perfect timing to get the digital side of things more advanced.

100%. My brother is a general physician, like family doctor. And my stepmom, she owns a clinic that has about 10 doctors, and they do your best performing self. They're not an insurance type one or a cash type one and help people achieve their best health type deal. And so I get to experience it by both seeing them run their business and then my brother, and we all talk about it, of course, the intersection of health care and technology because to your point, I actually had a conversation with my brother two nights ago, and he was telling me about how they are still getting faxes because I was telling him, I said, hey, what do you think this GPT thing's gonna do for you as a physician? And he hadn't looked into it a whole lot, and he was like, I don't know, dude. We're still getting faxes of patient information.

Great. It's amazing. And even the prior authorization process, whether it's precertification for a medical procedure or it's to get prescribed a medication, it's still really antiquated. Each health plan has their own algorithms and their own way to identify when it's needed, get the forms filled out, and then check the status.

I was having this conversation with my brother, and he was saying how annoying it is that all these things get injected into his workflow. Like, why isn't that? And he's like, well, obviously, they just didn't have that data point. How do you manage the—you obviously you have to push this forward, and this tech—I'm a technologist. Right? I'm pro. This is going to get better. I understand it's going to get better. I understand what the amount of data and the sets and the feedback you get from the physicians. It'll only get more accurate, more informative, and ultimately result in a productivity gain and a better course of care. How do you handle the in between when they're upset about it or they get frustrated with it?

You're absolutely right because there's only—you know, there's a lot of data, but the data is telling us what it's telling us. We're not—they're meeting with the patient, or if they have something that's within their own notes or not within the system, then, you know, obviously, that's not something we can see or look at. So it is definitely a collaboration and figuring out what is the right method, what's the right timing, what's the right reimbursement. And even if it's just a response to say, hey, got this alert. Thank you for sending it. Just responding back that X, Y, Z because it's okay or this has been addressed or it's really not an issue. I think it's just that feedback loop and then over time can continue to get better and better with it.

I think that the medical billing and coding is going to get reduced through technological efficiencies by up to 90%. Like, you're just gonna need less of these people in your physician's office.

Right.

When I—you described them way better than I know how to. But, essentially, these things that come up in the provider's flow of work, they have to respond often to them. From my understanding, you could tell me that that's not the case. But I was telling my brother that a lot of those are probably generated through AI type stuff or at least just an approved question set when two pieces of data line up. Right? And I asked him, hey, are any of your softwares able to respond back to them? So that way, it's essentially their AI arguing with your AI about payment. Because right now, it's their AI and some humans arguing with the humans at the provider. Do you think that we will get to the point where it's essentially one AI negotiating with another AI back and forth as humans have previously done with claims and processing? Do you think we'll get there? And if so, how long do you think until we get there?

I think that is definitely the ideal state. I don't think we're anywhere close to getting there soon just because there are so many different electronic health records that are used across different hospital systems, across different pharmacy practices, different clinics, home health. So they're not necessarily—the interoperability isn't quite there yet. There's been a lot of work and task forces that have been put together to say, let's really look at what could be the standardized format. So which the pharmacy side of things has come a long way because there's a standardized way to do an e-prescription. There is a standardized way to adjudicate pharmacy claims.

We don't necessarily have that on the medical side yet. There is really no standard for prior authorization to identify one or to submit one. There isn't a specific standard for claims. There's the ICD-10, of course, but each payer could say, here's how I want you to submit claims to me. And so there's a whole other set of AI that Inovalon provides to providers to say, okay, depending on who the payer is, we're gonna put these business rules in place so you don't have to touch these claims. We're gonna put it in the format. We're gonna put the information in and make sure that you don't have to redo it or get a rejection, and it goes through. So it's speed to your AR, your accounts receivable. But I think we're still a long way from all of these systems really talking together and being consistent. It's probably gonna take an act of Congress.

Which will happen first? Will the tech to consume unstructured data, things like maybe fine-tuned GPTs, right, will those advance first to consume unstructured data and be able to interact with it, or will a standard happen first? Which do you think would come first?

I think it's gonna be the first.

Me too.

That you mentioned. Yeah. I don't know. I mean, the standard to get—we've been working on standards for a while on and I don't know that we're anywhere closer. There have been a lot of organizations that have tried to even take all of the different pieces and parts. There's so many different contracts between providers and payers. They all have their own contracts. They all have their own fee schedules, the reimbursement rates. I mean, I think with Medicare and Medicaid, definitely, you know, that could come first. But with all the different payers, and we have so many different emerging disruptors coming into the industry as well, such as Amazon, as an example, that is really—you know, they have their own care clinics now that are online. They have their own pharmacy. They just acquired One Medical as a brick and mortar set of clinics for 65 and up consumers for the most part. So there's just a lot coming into the market.

Yeah. My experience with Amazon was three to five years ago, I got really excited because I remember some announcement happened where Amazon was gonna enter the market, and they were gonna, quote unquote, fix health care. They hired these executives. Some stuff happened. I think it was Berkshire Hathaway, Amazon, and someone else came together.

Partnership.

Then there was nothing. It sort of disbanded. Something happened. You didn't hear about it. And now all of a sudden, I'm hearing Amazon has care clinics, pharmacies, and just acquired One Medical. Help me understand what happened with their original thing and what's happening now.

Yeah. Great question. So my understanding is when they went into this at first, they were looking at selling to employers, so self-funded employer groups. And as they did that, the market didn't really materialize. And so they closed down that part of it. And I think it was more because they—even today, they don't take insurance with their care clinics, not yet. And the care clinics just turned over last late last year to be this virtual chat. I mean, from my understanding, it's all chat. So there's certain conditions or certain area of common treatments that you can, you know, select the tile and start your chat and you can get diagnosed, you can get prescribed a medication, and it's really—you're not even talking to anybody. It's all through chat.

And so now they've moved from marketing this to employers who, for whatever reason, it didn't take off to direct to the consumer. And at this point in time, from what I've seen, they don't accept insurance. So it would have to be—you're saying, hey, it's $24.07. I need the convenience. I just wanna know if I have, you know, an ear infection or whatever the case may be and can get prescribed a medication or pink eye or something like that where it's like it's probably worth just paying it out of pocket and not putting it through insurance. So I think that would be, you know, one part of it. The pharmacy they purchased in 2018, they bought PillPack pharmacy, really a not a brick and mortar type pharmacy, but more of like a centralized fill pharmacy. And that has been evolving as well, and I think they could—you know, it's really being able to then send out prescription medications and over-the-counter medications together all in one. So it's a nice package.

And then recently with the One Medical, it's primary care clinic. So now this gives them a footprint not just online, but in neighborhoods. And it's really—and as I mentioned earlier, it's 65 and up is—and they will take Medicare insurance. So they're now starting to dabble in the insurance side of things with Medicare and the clinics that they just acquired.

Are they doing any major medical emergency type stuff or no?

I mean, I suspect they would because, typically, you know, any clinic would do that and look for, you know, some form of payment on a—you know, if they're probably would be out of network, but there could be an opportunity to still provide that service and bill for it.

We need to all get on the same page in this country about health care. Of course. Because, I mean, it is funky. Right? There are so many different ways to look. Like, I went—our son, we have a six-month-old son, Atlas, and he got pneumonia last week. And we went—it got bad enough to where, you know, we're calling, you know, mom and brother and everything because they're the doctors and sending pictures and all that. It got bad enough. They're like, okay, take him into the urgent care. Because he needs some amoxicillin. And so we said, okay. So we took him to the emergency care, and they said, okay, well, you're gonna have to—well, the first place turned us down because he was six months and four days old, and they're like, we can't see anyone under six months. So we're like, oh, okay. Bureaucratic stuff. So we went to the next one. We're like, they'll treat infants under six months. So—

Wow.

They did an X-ray. They did all of that. They had us—you know? We don't have insurance. We have Medi-Share, like a Medi-Share thing, and then we self-pay. And so they said the bill is if you pay this part of it today, it's 80% off. And then you'll get a bill in the mail in, like, three weeks. And if you pay that within, you know, five business days, you'll get another 20% off of that amount. And I was just like, what? Right. How does this make—I'm an entrepreneur. I own a business. We've got 20 employees, Julie. I know we're really small compared to your company, but, like, I understand a P&L, and I understand that you have cost to provide services and then, you know, what you charge to get paid for them. My mind just hurt a little bit. And so when I see things like Amazon, I'm secretly, like, hoping that they win because someone needs to fix this, but there's enough money interest. I know what I'm talking about. I'm sorry. But there's enough money interest in the insurance world. Shouldn't they be figuring out how to play nicely together and get this thing solved before these startups come and just boot them out entirely?

Yeah. I think you're absolutely right. I mean, it's just amazing to see not only the startups, but just other nontraditional but familiar names. Like, Best Buy is now doing home health, hospital at home. So they go out and use their Geek Squad to set up home monitoring devices and therapeutic monitoring. And so that's, you know—getting into health care is just spreading across what you traditionally see. Weight Watchers just purchased a virtual care platform so they can prescribe weight loss medication and so they can provide a full package of services to their constituents, which, you know, another easy thing. So instead of saying, well, we'll just send you—we'll refer you to a doctor—it's we will just do it ourselves and take care of the whole package for you. So I think it is very, very interesting.

And to your point, traditional insurance, it just keeps getting more restrictive and more expensive. Deductibles increasing, out of pockets increasing, more places that are out of network, and you have higher co-pays if it's an emergency room. It's—

Well, it's great if you're poor, and it's great if you're ultra rich because you just don't care. You're like, I don't care. Write the check. You know? But what sucks is middle class because they're paying the bill for everything.

Yeah. Exactly. Exactly.

I saw, to your point of Best Buy, when the pandemic and everything was happening, I started noticing a new end cap next to the Amazon Alexas and all those. It wasn't Amazon, but it was an end cap that had these oxygen, pulse ox, and they connect to your app, a thermometer, pulse ox. You could buy this package for, like, $89 that had these remote tools, and then they incorporated with, like, a Teladoc or something, like, one of the remote type services so they could read your vitals and read these things from your home. And so I'm assuming that that was the beginning, and now Best Buy is actually going and setting these up?

Yes.

Wow. How do you talk about that amongst your executive peers? Like, when you guys are seeing this happen in the marketplace, what type of conversations are you having?

(Julie at 00:17:12) I think it is more opportunity. As more and more get into this market, we have data. I mean, we have real world primary sourced data that comes from the traditional sources. And as we could work with and partner with these emerging, like if it's a Best Buy, Amazon, or Weight Watchers, to give them the—to take in the data that they have and give them the data that they need, we just become more and more of an aggregator of data to provide that interoperability and to really do the AI and figure out what's the best way to improve the economics of health care and improve the quality.

(Joel Beasley at 00:17:59) So I look at you less of a software vendor and more of a data infrastructure. Right? Do you think that's where it's going?

(Julie at 00:18:05) It's a data infrastructure, but there's also the software. So our core businesses are software SaaS solutions that do provide the platforms to providers for revenue cycle management, workforce management, clinical care management, pharmacy platform. And then we have platforms that help payers just manage their risk and population health. But, yes, with all of that data, it just gives us a whole new avenue to provide opportunities and ways to improve health care.

(Joel Beasley at 00:18:39) You do workforce management, like hiring people, things like that?

(Julie at 00:18:43) Yeah, it's for scheduling. And so it's targeted to hospitals, and we're actually really excited because we have a huge enhancement coming out for agency staff. And it's for scheduling nurses similar to any type of workforce application where you schedule somebody, they can swap, they can clock in, clock out, keep track of their certifications, hours worked when they might time out from being on the clock too long, and it also applies to physicians as well.

(Joel Beasley at 00:19:21) I saw that first in the restaurant service industry, and I was blown away when I saw it. It had to be five plus years ago. I was hanging out with someone. They were a waitress, and she opened up her phone and she swapped something. And then she had like three different restaurants that she worked between. She was almost this freelance waitress thing that just took these gigs that popped up. It was amazing to see how the technology has changed. It makes sense for you guys to be doing it for scheduling. Nice.

(Julie at 00:19:51) Right. Exactly. Exactly.

(Joel Beasley at 00:19:53) So with that product, is that something you would oversee? Your team would oversee the creation of that product? Tell me about what your team does specifically.

(Julie at 00:20:00) So I'm over the provider software applications. So that does include checking eligibility of a provider, checking eligibility, finding coverage, whether it's primary coverage, secondary, tertiary coverage, assessing, determining benefits, how much is where the patient's at with their deductible and out of pocket, looking at what the procedure is likely to cost or what the patient payment amount would be. And then that works all the way through getting the claims in the right place to get them submitted to the different payers and then get the payments or the remittances back. And any workflow that goes with that that can be built in based on the needs of a clinic or a hospital or a home health agency. And then also being able to process payments through a portal, take credit cards, even take credit cards in person on-site, and then also to submit bills.

(Julie at 00:20:59) So similar to what you brought up earlier, where a lot of facilities do want to collect upfront and give a discount because they're more likely to get paid faster. It's better to get paid faster than to have to wait.

(Joel Beasley at 00:21:14) I think we paid $250 walking in or something and then the balance when we walked out and then some other bill that came later. All to be said, for my family, where we're at currently, we look every year at the insurance rates, and we make our decision on what we want to do and what our past costs are. And for us, the Medi-Share thing makes the most amount of financial sense just based off of where we are with income and all of that. So you're the president of this division, so you're overseeing everything. You're overseeing product. You're overseeing sales. Is that correct? Customer success, all of that?

(Julie at 00:21:47) Yep.

(Joel Beasley at 00:21:48) And you're head of product. Let's just call them head of product. There's a lot of those types of people listening. Right? And they report up to a president like you. What do you look for when you're bringing on a new head of product? What's important to you?

(Julie at 00:22:16) You know, a lot of it has to do with—well, experience and background is really helpful. Having the product methodology. Having the health care background is really important. Really look for someone who has a lot of energy. Look for someone who is really passionate about this type of work, is really motivated to step into the mission, step into the challenges, and build a strong team around them and not be afraid to try new things. And that's what's nice about Inovalon is we're big enough, but we're small enough where we can try different things and fail fast if we need to and tweak and redefine and work with our different customers on just different product enhancements, new ideas, new ways of thinking, new ways of doing things. So really that innovation energetic type of person that shows up every day thinking about improvements.

(Joel Beasley at 00:23:29) What is the best leadership advice—here's the qualifiers—you've received, you put into action, and it's stuck with you?

(Julie at 00:23:39) I love that question. It really is being open to feedback and asking for feedback and reflecting on that feedback. A lot of times, it's hard to hear where your opportunity areas are or where you could improve, but I have been told to really embrace that, see that as a gift, and put it into action and then take it seriously. And so that has really been part of who I am, is constantly asking for, yes, thank you for what I did, but what could I do better next time? And it's asking anybody from those that report to me, customers that I work with and engage with, my boss, the president and CEO of our entire organization, always looking for that feedback.

(Joel Beasley at 00:24:27) What areas are you currently working on?

(Julie at 00:24:30) I am always working on trying to slow down. I want things to get done faster than the resources are available and really looking at, yes, the priorities are set, but wow, saying no to good ideas is a hard thing to do, but it is definitely something you have to look at every day because you can only do so many things at one time and still there's a finite number of change that you can instill at one time as well. So it's definitely keeping the pace that you're just don't—you're trying to do a little bit of everything versus really getting things to the finish line.

(Joel Beasley at 00:25:10) Patience is something I'm always working on. It is so tough.

(Julie at 00:25:15) It is very tough. It is very tough. Even for me, like, driving when, you know, being stuck in traffic or long lines, inefficient people at the grocery store when you're trying to check out or people in front of you.

(Joel Beasley at 00:25:26) Or it's like, sometimes I just wanna walk up there and be, hey.

(Julie at 00:25:31) Can I show you a better way to do this? Can I get you more organized? You have all these people here to move through.

(Joel Beasley at 00:25:37) You know what happens to me when I'm in those situations? I'll get frustrated. I'm sitting in TSA line, and I'll think, man, I need to make more money. I need a private jet. Or if I'm in the grocery store, I'll say, man, this is my fault. I need to make more money. I need a personal shopper.

(Julie at 00:25:53) Yes. Right. Because just think about all the other things you could be doing while you're waiting in line that you aren't doing.

(Joel Beasley at 00:25:59) I love some Instacart.

(Julie at 00:26:01) Yes. Right.

(Joel Beasley at 00:26:03) When we had our new son six months ago, Instacart was a lifesaver because it's tough to get out when you have a newborn.

(Julie at 00:26:11) Oh, I can see that. I can see that. And sometimes you just need something right away, and it's usually pretty fast.

(Joel Beasley at 00:26:19) Oh, yeah. I wanna talk a little bit more about feedback. So I have noticed that as a leader, I have to constantly remind people about feedback, trying to embed feedback into the culture because I have found, in general, more often than not, people are shy to give feedback because they've done it before and they got bit, and they're shy now.

(Julie at 00:26:44) I think it's definitely in the delivery. And I think if it comes across as sincere and from a meaningful way where it's not to be like a gotcha, but, hey, something to think about. And if I were to be giving you feedback, everybody has areas to improve. Everyone has things that they could work on or do better. Nobody's perfect. I do think a lot of it's in the delivery. And then, but you're right. Sometimes people just don't wanna hear it or they're very blind to it. And so I've seen that a lot too where then you have to come back and have the facts, the data to back it up. But like, okay, Paul, let me give you some examples. Let's look at the examples. I've had to even with staff members or peers that I've worked with where I've given them feedback. And they'll say, well, on the call, you know, I think things got a little off track when you said this. So when we went down this path. And they will say, I don't see that at all. I'm not doing that. And so I've said, well, let's record a couple meetings, not because I'm trying to pick on you or anything, but I just think it's a blind spot that would be really helpful for you to be aware of. And if somebody's not gonna tell you about it, then you won't be aware and you won't be able to do anything about it.

(Joel Beasley at 00:28:02) I learned really early on in my professional career that I am the guy that will—I don't want to because it's difficult—but I will tell you when you have lettuce in your teeth. Because the problem is so many people won't tell you.

(Julie at 00:28:16) Right.

(Joel Beasley at 00:28:17) And it's hard because you feel like as the person telling them, you don't want to. I don't wanna do that. It's gonna be awkward or whatever. But then I think it's in service to them because if it was happening to me, I would wanna know.

(Julie at 00:28:30) You'd wanna know. Right. Yeah. Otherwise, everybody else is just thinking about it and like, oh, look, it's distracting.

(Joel Beasley at 00:28:35) Yeah.

(Julie at 00:28:36) And, yeah, it's actually a nice thing to do to tell somebody. I think most people appreciate it, but not.

(Joel Beasley at 00:28:42) Right? I've never been upset at the—I'm embarrassed that I've got something in my teeth, and I try and get it out or worse. But I've never been upset at the person who gave me that information.

(Julie at 00:28:51) Right. You know? Exactly. I agree with you. Yeah. I agree with you.

(Joel Beasley at 00:28:54) Okay. For people who wanna learn more about Inovalon, where do they go?

(Julie at 00:28:59) They would go to www.inovalon.com, and there is just a variety of areas to dig into for providers, payers, pharmacies, anyone that wants to understand more about health care, how data is used and aggregated. The mission and vision of Inovalon is all right there.

(Joel Beasley at 00:29:23) And are you currently hiring?

(Julie at 00:29:25) We are currently hiring. We're hiring in all areas, so we're growing really, really fast. We're adding products. We're going into more markets. We are adding to our sales team. We're adding to our product team. We are adding to our customer success team. We are adding our engineering team constantly. So there's lots of opportunities and all available on the website as well.

(Joel Beasley at 00:29:50) We'll post links in the show notes to your hiring page and to the website so people can find that easily. You said earlier, good energy in your product leader or VP of product. What's another thing that you look for across all hires?

(Julie at 00:30:04) Just really looking for someone who is genuine and willing to put the time and effort into getting to know the company, getting to know the product, great with customer service. Very important for us to treat our customers as they would wanna be treated and really putting the customer in the center and thinking about how is this impacting the customer. Also making it easier for the customer to do business with us. So that's one thing I talk about all the time is if we're not making it easy to get a hold of us, easy to work through a tech support issue, easy to implement the products that we have and taking that burden off of the customer, then we're really not doing our full purpose of what we're doing. So it's very, very customer centric.

(Joel Beasley at 00:30:55) I love it.

(Julie at 00:30:56) Outcome driven.

(Joel Beasley at 00:30:57) Outcome driven, humble, customer focused. I like having people on, especially the leaders within organizations, because I found really early on in the interviewing of different executives that the culture comes from the leaders. You can't convince me it doesn't. It definitely trickles down from the leaders because what they determine is acceptable is standard for the company. You know?

(Julie at 00:31:23) Absolutely. Completely agree.

(Joel Beasley at 00:31:25) Julie, we made a podcast. How do you feel?

(Julie at 00:31:27) Good.

(Joel Beasley at 00:31:28) Thank you so much for listening. And if you found this episode useful, please share it with a friend or colleague who you think would get value from it. And if you have topics that you would like to hear discussed on the podcast, either add me on LinkedIn or send me an email, [email protected]. Every time I get an email or LinkedIn message, it absolutely makes my day and inspires me to keep going.