HIStalk Interviews Clay Ritchey, CEO, Verato

Clay Ritchey, MBA is CEO of Verato.

Tell me about yourself and the company.

I’ve spent the last 20 years in healthcare technology. One of the things that strikes me is that over that 20 years, we as an industry have spent billions of dollars digitizing healthcare and investing in digital transformation with the promise of having liquidity of healthcare data – getting it to the right place at the right time to improve outcomes and efficiency of care — only to realize that one of the biggest blockers of the success of that investment is identity. Being able to trust who the data belongs to and knowing who is who.

I got excited about joining Verato four years ago because we think of ourselves as the identity experts who enable better care everywhere by solving this problem that we believe drives everything else in healthcare, which is knowing who is who. We provide organizations with the tools to have a single source of truth for identity that enables this complete and trusted longitudinal view of the person, that single pane of glass that allows you to take all this data in your enterprise, make sense of it, and be able to trust who it belongs to so that you can get insight from it.

What is the business case for reconciling multiple identities of patients, members, and consumers?

The business case used to be around this idea of clinical interoperability. We had clinical systems, EHRs, that weren’t able to do a very good job of resolving identities, so that you had duplicate medical records, or maybe even overlays. The harm of that was either significant increased cost of things like doing duplicate procedures that you don’t need to do, or even worse, some type of sentinel event because you charted somebody else’s information on a patient record.

But as you think about 2024 and the challenges of the modern healthcare organization, we see that the business case is even more strategic. Most of our customers work with us because they’re trying to figure out how to plot a course for growth. Healthcare is just starting to think about consumer-oriented strategies and how they think of that.

A customer told me recently that they had a strategic offsite, where they decided that it is OK to call their patients consumers. That struck me since it gives us a sense of of how healthcare has had this challenge of thinking about investing in the types of tools and technologies that would enable them to understand the complete consumer experience. Tools that help them engage the consumer better, help them change their behavior, and help them consume the right services that they need for better outcomes. That’s where we see the biggest business case.

We’re in a world in 2024 where only one in four of those in the younger generations have a primary care physician. Primary care physicians historically have navigated patients into our into providers for referrals and high-value services. The emergency room is no longer a significant referral source, as urgent care pop-ups are taking more of that market share. We see more savvy consumers who want to search the internet for options for care and self-diagnosis. In that environment, we’re seeing this need to be better than ever at engaging consumers, and to do that, you have to know who is who and you have to do a better job of connecting the dots between all the engagement that you have with your consumers at all your touch points. That allows you to curate the best experience and the best care for them.

A lot of our customers think about, if I have a goal to double my revenue in five years, what infrastructure do I need to build to do that? That’s where they turn to Verato to help them figure out how to double their volume. If they don’t know who is who, they can’t engage consumers, retain them, and acquire them in a more frictionless way.

How is consumer identity management different from just matching up multiple sets of a patient’s records on internal systems, and how is healthcare different from other industries?

We’ve learned that historically, the problem that we have with consumer data and identity is that it’s often thinner information than you have for your clinical data. What you don’t want to do is pollute your clinical match by using less trustworthy data that you’re getting from marketing or consumer sources.

What we have done at Verato to solve that problem is that we have multi-tiered matching, which allows you to have different tiers of matching based on the trust level of your source. That allows you to associate these identities at a consumer level with maybe a clinical-grade identity that you have in your census, but without impacting  the way that you think about identifying that patient in a clinical way. You get the benefit of being able to associate the consumer data with somebody who you believe it belongs to, but at the same time, it doesn’t impact the quality of that match where you really have to get it right on the clinical side. That technology has allowed us to help organizations do a better job of landing consumer information and associate that consumer engagement with the patient with whom they already have a relationship.

How well are organizations using that type of technology?

We still see the industry as laggards when it comes to embracing and investing in modern technology that solves the modern problem of identity matching and resolution. The problem is no longer just about helping manage clinical identities inside of your clinical system. 

We think about three kinds of systems. One is systems of record, such as the EHR. Others are systems of experience, such as CRM, the marketing automation platform, or patient engagement tools or platforms. The third area is systems of insight that drive clinical and consumer insights around people, so things like cloud data platforms.

When you think about those very different systems, and you think about a modern platform or set of investments that you need to make sure that you’re able to share information across those different types of use cases, that’s where we think the modern investment needs to be made in a cloud-based tool that enables you to have a single pane of glass across all of these disparate sources of data and consumers of data. That’s where we’re seeing the marketplace, where provider health systems, payers, and even state and local governments are making investments based on this complexity of not just managing data internally in clinical systems, but also across these systems of insight and systems of experience. Then meeting the demands of all the folks who want to consume and share data outside of your organization.

There’s a whole different level of innovation required to understand and manage identities across that broader, more complex ecosystem. That’s where you’re seeing organizations start thinking about this next level of investment and data management platforms such as Verato’s.

Is there an opportunity to use AI to improve that process?

We are using AI in our platform today. We believe that AI can absolutely continue to help manage identity and identity attribution. We’re using AI today, for example, to make matches that we couldn’t have made otherwise. We are learning from the humans who are stewarding matches. We’re leveraging our AI to track and understand the behavior of humans and the matches that they are making manually. We have already been able to show 25% to 30% improvement on matches that we couldn’t make without AI based on that type of smart stewardship. That’s one area where we are seeing AI to be really, really helpful.

Second, we spend a lot of time making matches that aren’t intuitive, where it’s hard to see that these two records involve the same person. We are using AI also to explain to our customers how they can count on and trust that this match really is the same person. AI is being helpful of being able to connect the dots and show the breadcrumbs to those end users so that they can trust the match. It’s kind of counterintuitive, but we’re seeing AI as a tool to help provide more trust in these complex matches that we’re making by being able to help explain it.

Lastly, we think that AI more than anything is a great opportunity for us to drive a lot of productivity inside our organization in how we use AI to write better code and document that code.

With respect to identity resolution itself and how it might actually enable AI, that’s the other area we’re excited about. As I’m talking to a lot of our customers across the healthcare continuum, everybody has a strategic initiative around AI, mostly just trying to understand what their strategy should be and how can they thoughtfully and responsibly move forward towards that strategy. 

A lot of those folks are thinking about data fidelity being the starting point, because garbage in is garbage out, especially with AI. We’re all worried about about these hallucinations, and when AI gets it wrong, they really get it wrong and cause harm.  We are seeing an opportunity for organizations to first focus on the foundational elements of how to get high data fidelity so that you can train AI on data that you trust. That comes back to this basic premise of identity resolution, knowing who is who and being able to trust that the data set is longitudinal and accurate across all the touch points of that person.

What is the interest level in applying identity management to consumer-initiated inbound communication, such as calls to a contact center or conversations with a chatbot?

One of my favorite airlines is Delta. They do an amazing job in that when I call them, they know who I am, they know my history, they know my preferences, and they have already put me into a workflow that will most likely help solve my problem. Because they know who I am, they already know that maybe I just missed a flight and I need to have one rescheduled, and they have already started working on rescheduling that. 

How can you take advantage of a modern call center to not only improve outcomes, but also to become a source of revenue for your health system? We are seeing call centers leveraging tools like Verato to not only identify those who are calling or messaging, but to connect them accurately to their record so they can already be prepared to anticipate that customer’s call and help navigate them to help them where they’re going,

That can also address gaps in care. I call in today to deal with an appointment for myself. Wouldn’t it be great if that call center agent knows that I have three children in my home and two of those children have a gap in care? Maybe they missed their annual checkup. I would be able to close those gaps in care in one call while I have them on the phone. We think these are all great opportunities for identity resolution to be incorporated into the call center workflow experience so that we can better anticipate the needs of the caller and also better anticipate the needs of the other people in that caller’s household. That helps us drive revenue and close gaps in care.

Website user tracking allows big companies and social media to target advertising based on the person’s broader identity or persona. Are there techniques or lessons learned that could be used more noble purposes?

I think yes, but we believe and understand that many consumers and patients are giving up privacy for convenience, along the lines of our policies around consent and preferences. How do we as a society do a better job of allowing consumers to give more granular consent and more granular preferences around how their data will be used, consumed, and shared? Then we can all do a better job of leveraging that information in the right way to create a better experience for them.

Second is that 85% of the US population was uniquely identified in Verato’s platform last year. Through those workflows and experiences, we see a lot of demographic information about these patients. We are continuing to look for ways to get more control to not only to our customers, but also the patient on how that information is used. We want to think about granular consent and how we can be a single source of truth and enable more control by people of how their data can be used for convenience measures, but in a way that they are comfortable with from a privacy perspective.

A hot topic is insures or health systems maintaining accurate and current provider directories, which is harder when clinicians work at multiple facilities or hold multiple roles. How are health systems using provider data management technology?

The current state is pretty sad, in the sense that we find this problem to be even more challenging than patient identity and consumer identity. The state of accuracy of provider directories, their affiliations, and their ability to have open census that’s available where they are available to see new patients hasn’t really improved in the last 10 years.

I saw that last week that 57% of patients who are consuming an inaccurate provider directory results in revenue leaving that payer or that provider into outside their network. There’s all these negative consequences that are associated with not only the patient experience, but also revenue capture and revenue leakage for payers and providers. The stakes are pretty high in getting it wrong, but we still see a scenario where there isn’t a good single source of truth for provider identities and provider information.

We are applying our expertise in patient identity resolution to this big provider problem. We are already seeing a lot of opportunity to do so, not only in a sense of being able to be a single source of provider data that sits inside of an organization, but also a lot of the 85% of the population who comes through Verato is coming through large HIEs that we have relationships with. Those HIEs often have accurate, real-time data around providers and their affiliations, where they’re practicing, and what patients they are are seeing. We are looking for ways to tap into that type of data so that we can get more real time, accurate provider data that can hopefully solve this problem that has been elusive historically.

What are the company’s priorities over the next few years?

I mentioned earlier that our mission is enable better care everywhere by solving this problem that drives everything else, which is knowing who is who. Where I see healthcare going in the next three to five years, and where we want to get there ahead of them, is along these lines of interoperability outside of our customer organizations. 

Most of our customers leverage Verato to help them do a better job of managing data as it relates to people inside their organizations so that they can deliver better services to those patients more efficiently. Where we’re starting to invest in is thinking how we can also enable those flows of data outside of the organizations as interoperability across the care continuum becomes more of a reality and more of a must-have with the requirements like 21st Century Cures, information blocking rules, and the requirements for organizations to create better experiences for patients that are having experiences across payers, life sciences, and providers. We see an opportunity for us to invest there. We are working really hard on finding ways to enable that ecosystem to do a better job of being able to share identity information across the care continuum so that consumers and patients want their information to be shared and have better tools to do so with better reliance.

One of our customers recently told me that they have a bridge that connects a children’s hospital that is not affiliated with them to their to their acute care hospital. They often have patients walking across that bridge to consume services in their hospital from the children’s hospital. Both organizations use the same EHR, but even though they are connected with their bridge, the EHRs are not connected in the same way. Even though it’s the same EHR, they can’t share records in a way that they can depend on. They worked with Verato to take that very simple use case, same EHR but in different organizations, and use Verato as the bridge to enable that interoperable connectivity. Now when that patient comes across the bridge, they already know their history, why they are there, and where the referral came from. They are already  running towards delivering services to that patient. That’s a good example of the beginning of what we see, that Verato will be a part of this bigger interoperability play across the healthcare continuum.