Jaideep Tandon, MS is co-founder and CEO of Infinx.
Tell me about yourself and the company.
I come from a technology background in engineering, with a focus on doing back office work over the years in hardware and software. Our entry into healthcare happened by chance, where somebody we were talking to said, can you guys help us out on medical transcription? We said sure, why not? We’re enterprising. Let’s see what we can do.
That was the beginning of Infinx. We saw an opportunity around the overall burden that healthcare providers face when they are dispensing care. We started by providing back office help, but quickly realized that there’s an amazing opportunity here to reduce friction in overall RCM through the use of technology and trained resources.
That has been the journey that we’ve been on over the last 14 years since I co-founded this company. Today we provide a variety of RCM solutions to about 800 customers.
How has health system demand for RCM technology and assistance changed over the years?
Change is constant. It is inherent with the way that our health system is designed. It’s that principal-agent problem, where we’re all giving up some level of control to another party between patient, provider and payer. It is generally set up as a slightly adversarial system. As much as we talk about data interchange and things working smoothly, the incentives aren’t quite aligned for payers to share as much information with providers and vice versa.
There’s always this friction that has been created inherently in the system. That leads to constant changes in payer guidelines, denials going up, and increased requirements for authorizations. We see no point in the future where suddenly everything will be solved. It’s an environment of managing and continuing to get more efficient as things change.
What progress has been made in making the prior authorization process less frictional?
The prior authorization burden is tremendous on providers as well as payers. Patients are the ones who suffer, because their access to care decreases or gets more complicated.
The end-to-end solution probably doesn’t ever get solved. Payers will always want some level of authorization, which they should in terms of making sure of medical necessity and that providers aren’t overprescribing certain things. But even before you get to that aspect of it, a lot of information asymmetry exists as providers receive orders and submit prior authorizations. Missing information and incomplete orders are coming to providers, which can lead to denials on prior authorization.
There’s a lot of low-hanging fruit that can be addressed through technology, as well as better business processes and having tighter controls in the front end of your RCM. That can stop revenue leaking, and more importantly, get patients the care they need when they need it.
How are these capabilities being integrated into the EHR?
EHRs are definitely making a lot of progress in being that single source of truth. Sadly, we still see that fax is still the lowest common denominator of communicating, which is absurd because I don’t think fax machines actually exist anywhere now. It’s just the fax protocol of the thing, “Oh, I’m receiving an e-fax.”
We’re seeing a lot of interesting things happening in document capture. As much as we’re saying that paper has been or will be eliminated, that’s the primary form of information exchange that we see when it’s a handoff between a referring physician to a specialist, and then from that specialist to a hospital or a health system. Obviously there are exceptions, but the industry standard involves a lot of disparate systems, so faxes end up becoming the way of life because they are low cost and you can get work done. Perhaps not the most efficient, but at least things keep moving along versus burdening IT teams to build broader integrations.
What RCM opportunities might AI provide beyond the earlier phases of offshoring and robotic process automation?
We look at technology solutions as first line of defense across any of the business processes that we are addressing for our customers, but we don’t leave it there. Our view is that our customers should demand outcomes, and that’s what we should deliver to them.
For instance, in an authorization request, our customers and their patient customers don’t care how we get that authorization done. What they want is a clean authorization on file before date of service so that the patient can be seen in a timely manner and care can be dispensed as needed. Sometimes the ugly truth is that it will require somebody picking up the phone. It’s a stat requirement and you will need to talk to the payer and give all the clinical details about why the patient needs to be seen today, and we will support that.
But we see a lot of things that can be done from a technology perspective. That’s where early days we had machine learning and brought in RPA. Today we’re gradually bringing in AI agents to do more and more of those cognitive tasks that humans were doing. Reiterating the outcome-based approach, it doesn’t matter how we get it done, as long as we get it done with a quality output in a timely manner for our customers so that they can continue to focus on dispensing care.
Are health systems holding prospective vendors more accountable for outcomes that create measurable return on investment?
A lot of the technology spend these days in larger health systems is coming out of their innovation groups. Healthcare has been slow in technology adoption, but we are seeing more of a push to be on the cutting edge and not being left behind that is being driven by these innovation departments. But the folks who are actually driving the business processes, who have been living and breathing those inefficiencies, are pushing back about consuming yet another piece of technology. What is the value proposition that you are delivering to us? How will you ensure that we won’t increase our team size versus actually bringing efficiency?
A lot of creative things are happening, but more often than not, our customers are defining an outcome and a success metric and saying that we are both going to work towards it. Nine out of 10 times, we’re going to get to those success metrics. Sometimes there are inherent workflow issues or business processes that can’t be changed, and perhaps the technology can’t deliver the value that it promised at the outset. It’s a joint effort between vendors and health systems to better define the problem, because once that’s defined, the guardrail is established, and technology can work really well within those framings.
Will payers use technology that is compatible with that of providers?
With Epic and other EHRs, we are seeing payers coming to the table to support various data interchange standards such as FHIR or previously HL7. There’s more and more of that happening in our ability to connect with benefit managers to get automated responses, be it on claim status checks or prior authorization requests. All of those things are definitely leading towards addressing some of the low-hanging fruit around what can be done through technology and EHR integrations.
But again, we feel that there are a lot of long-tail problems here in healthcare, RCM as well, that going back to my example on prior authorization, we just have to get it done. Let’s not wait for a technology to be 100% effective. If it is 80% effective, it’s a lot better than where some of the health systems are today.
As someone who has started, run, scaled, and sold businesses, how would you assess today’s environment?
Had you asked me that question maybe 10 months ago, my answer would have been very different. The general geopolitical environment worldwide is creeping into business decisions. Organizations are not taking a long view on things because they don’t know what the world will look like 12 months from now, and that makes it difficult for them to get tied into longer term contracts or buying into certain things that then they have to unwind. Commitment levels are getting tested.
But by the same token, innovation is at an all-time high. In the 15 years that I have been doing this, this is the first time that I have seen the investor community, healthcare leaders, the vendor community, and everyone aligned towards making this time different, with healthcare leading the charge versus being stodgy followers that never change. That is refreshing and exciting.
How do those factors affect the company’s strategy?
As we look at our various lines of business, and as we are looking to make investments across the organization, we ask ourselves the question — is AI going to disrupt us as we go down this path? Is AI going to be an opportunity for us as we go down this path?
More often than not, at least for now, we are seeing that the answer is the latter. We can definitely co-opt AI in many aspects of our business, which we continue to do. But it’s not the one silver bullet that will solve everything. Healthcare is an extremely fragmented industry and RCM is extremely fragmented across various specialties and geographies, so M&A is a key piece of our overall growth strategy.
We feel that there is a lot of domain expertise that exists between various pockets around the country, whether it’s pathology billing, serving academic medical centers, or something complex like oncology billing. We keep looking at opportunities where we can partner with really smart people who have deep subject matter expertise in these specialties, then bring in our technology stack and our ability to globally scale to deliver value to our customers. AI continues to be a cornerstone of how we bring our solutions to market and how we service our customers, but domain knowledge will continue to exist and develop along with AI.
I have never been more excited about what we’re trying to do here at Infinx, along with the healthcare market in general. The ability to reduce friction between payers and providers, bring information to the forefront, and give agency to patients to better administer their own care is an industry opportunity. It obviously brings a lot of competition along the way, and a lot of noise as well, but we feel that we are well positioned. We are excited to be going forward and helping our provider partner customers across the board.
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"A valid concern..." Oh please. Everyone picks the software they like and the origin of that software is an afterthought.…