HIStalk Interviews Josh Schoeller, CEO, LexisNexis Healthcare

Josh Schoeller is CEO of LexisNexis Healthcare.

Tell me about yourself and the company.

I’ve been in the data and analytics space for over 25 years, the last 15 in healthcare. At LexisNexis Healthcare, we use data and analytics to help healthcare operate better and to create healthier communities. That’s front and center right now, given that we spend 18% of our GDP — over $11,000 on every man, woman, and child — for healthcare, yet we don’t even rank in the top 10. We have a lot of work to do, and our data and analytics can help us get better.

How are providers using third-party socioeconomic data of patients, either for care improvement or for their own business outcomes?

They are starting to use it more. I would say that we were pioneers in the SDOH space when we launched our product a little over three years ago, so we have spent a lot of time educating the market. We did some work last year with industry leaders across payer, provider, and health tech on defining the ethical uses of social determinants of health. There was a lot of consternation around how this data should be used.

At the end of the day, it is proven that health outcomes are driven just as much by your social factors as they are by any clinical conditions. It’s critical, if we are going to move to a value-based care system, that we treat people holistically. Their health, not just their clinical conditions. That’s what SDOH is for.

On the provider side, they are using it more from an HRA, health risk assessments, perspective. When you are signing in for your appointment, they’re utilizing information that they give you. They’re not using third parties as much. Some of the cutting edge systems are. We are seeing the third-party use more on the health insurance or the payer side, probably because of the scale. They are not as connected to their members, so they use that third party to get broader insights around population health for larger populations.

To what extent are health systems using outside data?

More and more. That is one of the great areas that we impact today. There isn’t a shortage of data, there’s a shortage of usable data. It is disconnected, siloed, and not standardized. That’s a big piece of what our business does, to help do that data standardization, data transformation, and the linking of that data to incremental data assets to help make better decisions in healthcare.

What are the challenges and imperatives around provider data management?

I was one of the founding members of Enclarity, a company that LexisNexis bought in 2013. We started in 2006 to try to solve provider data quality issues for the industry. Everybody is trying to keep that data up to date, and if every organization is trying to do the same thing, it’s terribly operationally inefficient. If we could do it in one place and leverage that across the industry, then we could do it better, faster, and cheaper for the industry.

We have been successful in being able to roll that out. We have large provider data management businesses across healthcare in health systems, hospitals, health insurance companies, life science institutions, and retail pharmacy.

The challenge is that providers move around a lot. US consumers move on average once every seven years, but the rate of provider change that we see in our MD and DO database is more like 24% per year. To keep up with that, you need to have systems that allow you to monitor, because providers are busy and they are not going to self-report in any meaningful way. We need to be able to monitor and use analytics to track and keep key demographics and key credentials up to date, which then allows us to process claims and have accurate directories for people to find their providers.

Provider data management and the resulting directories have turned into a consumer-facing tool that delivers competitive advantage.

Absolutely. You saw a couple of years ago that a lot of the attorney generals started making regulations around the accuracy rates of provider directories. They were saying that almost one out of every two providers listed weren’t accepting new patients, were no longer at that location, were no longer in network, or had a phone number listed that was no longer correct.

People were going on the exchanges to purchase their insurance, and the #1 driver of choosing an insurance plan outside of price is, do I get to stay with my provider? Almost 50% of the time, they were going to see their provider and finding out that they couldn’t. Then they had to choose between paying out-of-network rates or being disrupted by having to choose a new provider. In California, the AG likened it to a cereal company that lists false ingredients on the box. They put these regulations in place for consumers, not only for their access to care, but also for general continuity.

How are health systems using your systems and data in new ways, especially around the pandemic?

All of our solutions revolve around our three core data assets. They are differentiated proprietary data assets.

First is our provider data, which is the most correct current and comprehensive provider profiles in the US.

The second is the largest de-identified medical claims repository, about 2.2 billion medical claims. You can imagine not only being able to understand where a provider is and what their profile looks like, but now understanding what procedures and what diagnoses they’re doing at what location and who they are referring to, with all that transactional detail being linked. 

The third is more on the consumer side. LexisNexis is one of the largest aggregators of public and private data sources. We utilize that to create a large consumer data asset. That’s a highly regulated data set, but we can utilize it for patient safety. Linking data together from different data sites, making sure that we have high precision, and linking consumer health information together. 

We utilize it for protecting access to data. We do consumer authentication. Health data is yours. As a consumer, you own it. The hospital system doesn’t and the health payers don’t. But for you to get access to it, the covered entities need to make sure you are who you say you are. We have a sophisticated technology to be able to do that identity authentication.

Third is the profile enhancement, like you mentioned before, which is social determinants of health. I’ll give you one use case. During the pandemic, everybody needed to get tested, and now everybody is getting vaccines. We are at the front lines of that, doing the identity authentication. When you log in to check your test results, we’re authenticating that you are who you say you are. When you log in to make an appointment to get your vaccine, we’re doing instant identification of you to make sure that you are a real person so you can then log in to make that appointment.

You mentioned de-identified claims data. The trend is toward drug companies using real-world evidence and performing virtual clinical studies using provider EHR data sold them by third parties, which brings up challenges of data quality and ownership. What challenges do you see in the sudden rush to create a business of selling research data to drug companies?

You nailed the two challenges with it. They call it tokenization of the data. The de-identification of the data needs to meet statistical standards so that it cannot be re-identified. Certainly the SMART on FHIR HL7 standards will help create a better standardization of that data to make it more usable, but we are on the cusp of getting into that with the interoperability rulings coming into play.

Once it is de-identified, you don’t have the consent issue because it is no longer identifiable. But if the entity that is utilizing the data has identified information and they’re trying to link it to it, that can create some concerns as well.

From a hospital system perspective, there’s the new revenue stream of creating real-world evidence, real-world data assets, and leveraging them for life science companies. But I think that the next evolution is even greater, which is not de-identifying it, but  instead the hospital system, as a covered entity, is using it for real-time clinical decision support and clinical health pathways. We need a broader learning and research capability around how we are treating our patients. De-identification allows us to use data for clinical trials, but it’s even more valuable to be able to use it in interacting with our patients on the hospital and health system side.

Are providers using the “patients like this one” model to tap into broad evidence similarly how Amazon recommends an additional item because other customers like you bought it?

Absolutely. The cohort management of the like, I guess I’ll call it, is not only important for providers, but you are starting to see consumers want to be a part of that community and to understand that data.

I run the LexisNexis Healthcare business. Our sister company is Elsevier Health, one of the largest health content companies in the world. We have been doing a lot of work with them to  look within hospitals and health systems to see how they are using content related to those clinical pathways that you described for treatment, as well as for patient engagement. Upon discharge, how are we enabling those patients to understand more about their current health condition, how they should be treating it, and motivating and engaging them to be more in tune with their own health?

How widely are health systems using multi-factor authentication for security and applying technology to positively identify patients?

It’s going to be more and more of a concern. As interoperability enables the rate of health data exchange to go up, up, up, we are going to see the need for tighter data security and identity authentication go up, up, up as well. Some of the regulations have the NIST IAL criteria for authentication. Some of that requires biometrics, which we call TrueID on our side. It uses a driver’s license or a passport photo to verify.

There’s always a fine balance between compliance and enablement of the consumer. You don’t want to put them through such a security gauntlet where 50% of them give up and don’t end up logging in and getting access to the health information that they access. It’s that fine line. As a technology company, we want to enable it to be less abrasive to the consumer, but at the same time, enhancing the overall risk detection on the identity side.

You have seen that we’ve acquired several companies over the last few years, ThreatMetrix being the largest. ThreatMetrix is the largest digital identity network contributory database in the world that understands the IP address of your laptop and your phone. As you are logging in, we can say, “that phone belongs to Josh Schoeller” versus seeing that it’s routing through Eastern Europe. Doing bot detection, checking that the keystrokes are at the speed of someone typing instead of the same individual doing 136,000 transmissions in the last 30 minutes trying different access codes. All those things need to happen behind the scenes and in real time to help with security and to enable consumer access to their health.

How will vaccination passports work?

Every state has their vaccine registries. We work with several partners that interact with them and help them in various ways. All vaccine locations are required to submit to the federal registry.

The question is, will that become a consumer asset? We are seeing apps and companies pop up, saying that you can have your vaccines documented on your phone and pull it up when you want to go to a concert, get on an airplane, or send your kids back to school. There is definitely value in that utility, but the question is, what’s the commercial model? Will people actually pay for that access? If not, what’s the commercial viability of that space? Certainly this pandemic gave us all new kind of understanding. It changed the game as far as the importance of vaccinations and people’s access to them.

How has the pandemic changed the company’s business?

When the pandemic hit, we got together to say, what are the risks and what are the opportunities? We are a health business, and this is a health pandemic, so it’s going to be more impactful to us than other industries or other areas of the broader business.

We were able to look at how we could pivot into the needs that the pandemic created. Within three weeks of the offices shutting down last, almost a year ago this week, we created the LexisNexis COVID data resource. We put that out on the internet for free. That tracked every day all of the people who got COVID, using the Johns Hopkins data. We overlaid that with our claims data to understand hotbeds of comorbidities. We then overlaid that with our social determinants of health to understand other impacts to those communities. Finally, we overlaid it with our provider information. Where are the pharmacies, where are the hospitals that need to treat all these people? You could start to see hotspots of where we needed more resources. That was put out there to help the research community. Out of that, we interacted a lot with our customers around how they could utilize their data during COVID.

On the broader industry side, we were already moving rapidly towards digital healthcare, the digitalization and consumer-driven healthcare. COVID probably moved us five years ahead in that area. We saw a 400% increase in the use of telemedicine. That’s not going to go away. Consumers, because of all the news and all the information that was out there, generally got more engaged, and they did that in a digital way. That’s not going to change.

Our business needed to pivot to help both the consumer-patient-member as well as our customers, who are payers, pharmacies, and hospital systems. How we can help that digital experience — from a data security, compliance, and operational efficiencies perspective — improve health and healthcare delivery in the United States?

Do you have any final thoughts?

We are on the cusp, and we are seeing it every day, of healthcare transforming. It is consumer driven and digitally driven, but at its roots, it will be driven by the use of data and analytics to help drive better health care outcomes.

LexisNexis and other companies are in a unique position to help both public and private sector healthcare improve healthcare outcomes. That’s our mission and goal over the next several years. I’m bullish on us being able to improve healthcare delivery, as well as health outcomes, to create healthier communities across the US and being able to have the data and metrics to track that from an ROI perspective for our customers.