Automating Healthcare with Artificial Intelligence

In this podcast, we talk with Justin Adams, co-founder and CEO of Digitize.AI about his experiences in applying artificial intelligence to health care business processes. As a relative newcomer to healthcare Justin offers some fresh and astute observations about the current economic and operational state and opportunities to “stop putting band aids on problems and completely rethink them.” We get into the details of how his team is has applyed AI to automate the insurance prior authorization process for the benefit of patients, providers and payers. We also speculate a bit about what is coming next as these applications steadily grow more sophisticated. Justin and I agree: advanced AI and robots are coming which will create great opportunity and lots of disruption. Justin’s pet peeve relates to the need for more “forcing mechanisms” and concludes with some sage and moving advice about the benefits of being kind in our personal, public, and business relationships.

Dr. Dave Levin: Welcome to 4 x 4 health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I’m your host Dr. Dave Levin. Today I am talking with Justin Adams, Co-founder and CEO of Digitize.AI where he and his team are on a mission to use artificial intelligence to transform healthcare administer. Justin has more than a decade of experience working with artificial intelligence and automation. As practice leader for digital transformation, automation and AI at independence consulting group, he built a digital automation practice from the ground up. Prior to that he helped start and lead PriceWaterhouseCooper’s, AI and Automation Center of Excellence. Justin and has also worked in the intelligence community and has received numerous awards from the Government for his efforts. I’m not sure what he did but I suspect it’s the kind of stuff where he’d have to kill us if he told us what he really did. Justin earned a BA in Economics from wheaton College and an MBA from the University of Chicago Booth School of Business. Justin is also a Mentor at Urban Promise, Charlotte whose mission is to provide Charlotte’s children and youth with the spiritual academic and social development necessary to become leaders, determined to restore their communities. This previous community service activities include building houses in Mexico, tutoring at-risk teens in inner-city Chicago, and running a sports camp for homeless children in Kiev, Ukraine. Justin, I think we are gonna have you back for a second podcast just to talk about that experience in the Ukraine. Welcome to 4 x 4 Health.

Justin Adams: Thanks Dave, happy to be here.

Dave: Great! Let’s go ahead and get started. I’m gonna ask you a series of four questions and I’d like to take up to four minutes to answer each one. So, for the first question, tell us about yourself in your organization.

Justin: Yeah, thank you. So, I am as you mentioned Co-founder and CEO of Digitize.AI and our team is made up of technologists primarily from outside the healthcare arena. Our co-founding team has experiences like, building the platform for a current unicorn, starting and running AI Centers of Excellences and founding and selling ecommerce businesses and really the three co-founders got together a little over a year ago now and the more we talked about starting this company, we decided to tackle healthcare because there’s an intersection of where our technology background interests in the largest societal impacts and the opportunities match and so I’m looking forward to talking to you a little bit more about what we’ve been working on and some of the things that we’re going to continue to pursue but the first thing we tackled, we partnered with a large academic medical system around to solving the prior authorization problem because that was the CFO’s biggest pain point. That’s really been a successful endeavor and now we’re in the process of expanding with numerous other organizations.

Dave: That’s really interesting. There’s a couple of things in there and before we get deeper into the work, I’m always fascinated by people who have come from outside of healthcare into healthcare. I personally feel like, we need more ideas from outside healthcare but healthcare is also an interesting space if you will. Take a minute and tell me about, you know, what your experience has been as a relatively new entrant to this crazy bizarre kind of area?

Justin: Yeah, so you know, it is obviously an interesting space and you know, I think like a lot of things in life you know, it’s a space that I think frankly you know, people will use terms and concepts primarily as a barrier to entry and what I mean by that is given my Economics and Finance background, what you see in across numerous industries, a lot of similar patterns of behavior but every industry believes that they are unique in some way and well, that’s true to some extent and healthcare is no different. There’s a lot of unique aspects to it. Fundamentally, when you’re looking at things like supply and demand and following who bears the risk and where the money goes, a lot of the common economic 101 problems still exist at the basis and so there’s more of the backstory of how we got into healthcare, a number of personal experiences both with children. One of my Co-founders is the son of the Chief Medical Officer and his mother was a nurse and so a lot of kind of personal things that came together at the same time to bring us into healthcare but it’s been a great, great, great experience. You know, a lot of the pain and the slow moving things that people warned us about certainly, we’ve seen that, they’re out but I think there’s a lot of unique insights and ideas that we’ve been able to bear and bring coming from the outside in.

Dave: That’s terrific. I mean, I personally think the best outcomes are gonna be a mash-up of old and new. There’s reasons why somethings are done in healthcare the way they’re done but it’s also terrific to have. As you said, there’s an amazing experience to be drawn from other fields. We just have to all come to it with an open mind and a shared purpose. I’ve sometimes say, I’ve built a whole career by looking outside of healthcare for what people are doing and then figuring out how to bring those ideas in. So, good on you. You must be involved in a lot of different things. What’s the most important or interesting thing you’re working on right now Justin?

Justin: Yeah, one of the things given again my economics background that I’m really fascinated by is, if you look at the growth of healthcare costs over the 45 years, clinical costs, if you look at the numbers have barely grown outside of inflation and yet at the same time per capita cost in healthcare increased by 2800% since 1970. So, you know, it leads you to question, you know, where are the cost coming from and when you look at the data, the costs are coming from administrators in healthcare. So, over that same time period, the number of administrators have grown 3500%. So, it grown much quicker than even per capita healthcare costs, much quicker than in clinical, obviously and so you know, my opinion is this is a trend that cannot continue but one of the most interesting things we are working on right now is you know, how do we use the technology platform that we’ve built. We basically built a robust platform with AI embedded from the ground up, assistance intersection of payers’ providers, self-funded employers and consumers and so, how do we use our platform to help decrease the friction and address this problem holistically because I think people are starting to recognize that you can’t just keep putting band-aids on the problem and expect different results. So, what we found is, when we get the right players at the table and look at the problems and ask questions about why things were done historically a certain way, it opens above our opportunities to come up with some new solutions and so I think the most forward-thinking organizations regardless of where in the healthcare ecosystem they sit, recognize of their business model is under threat and will be obsolete a lot quicker than most probably want to admit. So, those are organizations that don’t think their business model is under threat, are probably the ones that aren’t gonna survive too long. So, we think we’re gonna have some really exciting opportunities working with some leading organizations to help them kind of radically change the way that their business model currently operates and so that’s some of the interesting things we’re thinking about and solving with technology right now.

Dave: Now you’re specifically interested in artificial intelligence. Can you talk in a little more detail about a specific area that you’re applying that where you’re seeing some return from that effort?

Justin: Yeah, absolutely. So, in the specific first use case that I’ve mentioned that we work for the Florida Academic Institute was around prior authorization and for those that are familiar with the process, it’s really, it’s a way for hairs to historically help manage the care and the cost around care with these authorizations and what’s happened over time is that as more and more procedures and drugs are required for authorization is created this tremendous administrative burden both for the provider but frankly for the payer as well and so I think one of the statistics that I’ve looked at you know, says that this process cost the providers alone over 30 Billion Dollars a year and on the payers’ side, it’s even double of that amount. So, what we’ve built is a platform that can sit on either the provider or the payers’ side and really use artificial intelligence to predict the outcomes and behaviors and so, if we can predict kind of the clinical outcome of a certain individual, it’s going to allow that authorization which is currently a very meaning of review process to basically be done at real time and so on the broader side it gives them certainty around how long authorizations are gonna take the schedule and things like that. So, it’s seen some phenomenal results and ROI numbers that are in the 600% range for these organizations, so some great outcomes.

Dave: That’s terrific! You know, I’ve worked both as a health plan medical director and I’ve been a practicing physician. So, I’ve been on both sides of these discussion and to me this is such a great example of where technology can really play a great role. We’re taking some of the friction out of this. It simplifies and it reduces the cost. It reduces the cycle time too and so in addition to pleasing the providers and the payers, it’s also better for care because patients get the care they need in a more timely fashion and one could argue it’s a better use of economic resources. So, maybe not the most sexy problem in healthcare but when you start to drill into it, it is I think a great example of where ideas like you bought from outside of healthcare can really be applied. So, that’s terrific.

Justin: Yeah, absolutely and we always start with the consumer. I mean, that consumer experience I think is a key part that often gets lost. So, I mean, I can’t tell you the number of cases that I actually, personally had a case about a month ago where I tweaked my knee playing basketball. I needed to get an MRI and the day in my appointment after I had already gone through the intake process was told, sorry, we got to reschedule your insurance company didn’t authorize the procedure.

Dave: That’s right, that’s right.

Justin: I said, whats the irony of this happening to me?

Dave: [Laughing], to you of all people

Justin: Yeah, for me and all people but you hear a lot more heartbreaking stories of people you know, getting you know, more critical care whether it’s, you know, a cardiology procedure or something and not being able you get that, you know, due to some of this. So, I think it’s, I think it’s the old way of looking at it. It is very much a provider versus a payer mentality but I think through the use of technology we’re able to show that it’s really not a zero sum game anymore that can be more effective care overall for all of the parties involved, so…

Dave: Right and at lower cost hopefully as well.

Justin: Absolutely.

Dave: Do you foresee a time when this could evolve from what as I understand now is kind of there’s a set of rules and an algorithm and that’s applied and to the particular case or request in front and approved or not approved which is terrific again as we said but do you foresee a time where we may use even more advanced AI techniques to look at profile in providers to see you know, of their groups that really could be just exempted from prior authorization or groups that need additional training or what have you and I use the word profile advisedly because I understand that can have both positive and negative connotations. Maybe a more elegant way to ask this question is what do you see around the next couple of corners once you automated the, sort of existing algorithmic approach?

Justin: Yeah so, it’s actually not around the corner, we’ve already built into our platform, a whole AI model around, I think kind of what you’re referring to is around quality and so we can go to a plan and basically create kind of a new generation of gold cards for them, right. That allows them to scrutinize, well I mean, the first part is identifying, right. Identifying what are the cases that need to be scrutinized versus kind of an automatically approved and so, that’s certainly something that we’re real excited about that we’re already engaged with multiple parties on doing it. So, I really think that the implications are tremendous when you think about the second order of effects that come out of something like that.

Dave: Yeah, if you indulge me for just one more minute on the topic of AI. It sure seems like there’s a lot of low-hanging fruit around the kinds of activities that we’ve been discussing. When people ask me amateur that I am what’s next, I usually say, well my advice is if you are in a pattern recognition business, if your specialty involves a lot of pattern recognition, you probably should rethink your future career. My theory being that the next set of skills to be automated are going to be things of which we know which we do today. So, reading a pap smears radiology, you know, other imaging, pathology. Am I full of it or do you think there’s some truth in what I have to say here?

Justin: No, I think you are absolutely correct. I mean, even looking outside of healthcare when you look at any of the jobs this era most likely to be automated and then your terms that you know, accountants are top of the list, again because it’s that pattern matching that they do. So, I certainly would agree with that versus the clinic. You know, I don’t buy the, you know, I don’t think we’re gonna get doctors anytime soon. I think from the clinical side of things, the bottom of those lists least likely are things like Therapists, right where you need that physical touch and so I think absolutely that your thesis is accurate.

Dave: Yeah. Well so, when I’ve had this conversation with my wife, she says, I’m not worried because I’m a Sergeon. I said, yeah honey but the robots are coming too. So, let’s see. Alright, I wanna move on to the question three and at this point I usually remind my guests, this is a family show, it’s a PG-13 rating. So, with that in mind, tell us Justin, what’s your pet peeve or favorite rant these days?

Justin: So, I think my favorite rant is that I’m constantly talking to our team about creating what I call a forcing mechanism. Human nature not to like feel under rejection but I really believe a lot of the reasons startups don’t succeed is that they don’t get feedback quick enough and are not constantly iterating quickly enough and so I think it’s much more natural. In fact, it’s safer to let something run its course rather than putting in a forcing mechanism but the problem with that approach is what you need forcing mechanisms in order to grow and so I think my team is so sick of me. You’re hearing me talk about forcing mechanisms. They probably wake up in the middle of the night in a cold sweat hearing forcing mechanisms in my voice but I’m a huge fan and making sure the appropriate forcing mechanisms are in place for our business and frankly for helping us make decisions. So, I’d say, that’s probably my favorite rant that I’m on right now.

Dave: Give us a concrete example of one of your forcing mechanisms.

Justin: Oh, it’s a good question. So, you know, I’d say, a lot of it has to do with decision points. So, whether it is in the sales process with our business or with the clients, I think making a decision, again going back to I think humans don’t want usually confrontation, they don’t want to feel rejected. So, let’s say we’re working with a client and we need to make a decision. I think natural maybe to let that decision linger but I think you know, concrete example would be putting in something in a project plan for example that creates that decision to be made sooner rather than later. So, there’s no way to avoid it, it has to be made and so it may be made even sooner than the people are comfortable with it but I’m a huge believer that you know, even if I would rather you know, I want data and I want information to make decisions, I’d rather make the wrong decision quickly than wait too long to make the right decision and I think a lot of, we study the history of companies and businesses, a lot more fail from waiting too long to make the right decisions than they do from making the wrong decisions quickly.

Dave: Yeah, that whole idea fail fast and learn from it.

Justin: Yeah.

Dave: I think is a great one. As a Master Procrastinator I probably could learn some things from you about forcing functions. I do know from my own experience if I’m working on something or working with the team, if we haven’t clearly defined who’s gonna do what by when, it’s highly unlikely than anything is gonna actually happen, so I like that.

Justin: Absolutely.

Dave: Last question today, what’s your most sage advice for us?

Justin: So, my most sage advice is pretty simple but to be kind. So, I think there’s way too much animosity in our society right now and I think businesses and startup leaders have a responsibility to create an organizational culture of kindness. I’ve been fortunate enough in my career to work with and for some a wide variety of leaders including Four-Star Generals to Fortune 50 CEOs but also in that mix of this include some world class jerks and never once were those jerks more effective leaders than the ones who were kind. So, you know in addition to being kind you know, having that be the right thing to do, I think it also makes the most business sense. So, if you believe like I do that human capital and high functioning teams are the biggest competitive advantage your organization can have, it just makes the most sense. So, I’ve seen plenty of unsuccessful teams that were as sound technically or hire better ideas as any other but the didn’t trust each other and ultimately didn’t succeed. So, if you look at the root cause of that I think  it really comes down to a lack of trust and cynicism and too often I think organizations make success of zero sum game for their team and so I’m a huge believer in the rising tide lifting and all those are digitizes, three core values or trust transparency and courage and those are the things that we really try to live out. So, certainly being kind to one another and being kind to all the people that we interact with I think is again, simple but sage advice.

Dave: Well, that’s just really terrific and definitely makes my heart sing. I could not agree more that not only is it the right thing to do but it’s god business and I would highly encourage our listeners to check out the work done under the title firms of endearment, for our hard data that shows that companies and individuals that behave this way towards their colleagues, towards their customers, towards their competitors, outperform the SNP-500, outperform the good great companies. It’s fascinating work and you know, the other thing for me is we spend a lot of time at work and so to have that be an environment, that’s encouraging and nurturing and just a nice place to be. I think it’s just important to life in general. Now, it’s called work for a reason, right. Justin, it’s not play, it’s work but the way we approach, it can make a huge difference. So boy, I really appreciate and admire your sage advice. Any last words for us before we wrap up today?

Justin: No, I just really enjoyed the conversation and would love to come back on and maybe six months from now and tell you some of the neat things that we’re up to then, so…

Dave: I’d love to do that and at that point I’ll wanna hear more about your journey into the world of healthcare and it’ll be interesting to see what your pet peeves and rants are at that point as well, [Laughing], well, thank you. We’ve been talking today with Justin Adams, Co-founder and CEO of Digitize.AI. Justin, thanks so much for joining us today, we really appreciate your time.

Justin: Thank you, Dave.

Dave: You’ve been listing to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host Dr. Dave Levin, thanks for listening.