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John Santelli
CIO UnitedHealth Group
EVP Optum Technology

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CIOs lead the move to value

The way we deliver and pay for health care is unsustainable. As payers and providers, we contributed to the problem. But we're all part of the solution.

I recently wrote an article for Becker’s Hospital Review, sharing my perspective on how we need to collaborate for success. Now that quality- and value-based outcomes are more important than ever, this is especially true. And I also share why CIOs and IT leaders are uniquely positioned to enable this collaboration.

Enjoy the read.
John

READ PERSPECTIVE

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Collaborate for collective success

Value-based care is changing everything for CIOs. In this Tech Talk, John Santelli discusses how IT leaders are trusted to help their organizations and partners succeed through data sharing.

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Narrator:                            Value based care requires that payers and providers work together, specifically to share and collaborate on member and patient data. In this segment of TechTalks, John Santelli, CIO of UnitedHealth Group and executive vice president of Optum Technology explains how CIOs are perfectly suited to lead this type of collaboration, which will ultimately drive value in the new health care economy.

Narrator:                            John, how have the roles of both payer and provider CIOs changed within the last five years?

John Santelli:                     Traditionally, technology, whether it's payer, provider, have been more of a necessary evil. I need you to get this done. I need you to put in my ERM system. I need you to pay these claims. And what's happening, I believe, in the progressive systems with progressive leadership, the CIO is playing more of an advocate role in saying there is greater value in technology integration, greater value in data, greater value in investing differently than we have in the past, as instead of just operational investments, are there strategic investments that have greater return when you look at the clinic improvements that you can potentially get out of data investments.

John Santelli:                     And so I think we see progressive systems, you're seeing progressive CIO leadership that are leading the business thinking around how to enable the data they have differently, how to get value out of the data they have differently to be more strategic in the investments that they're making. That goes for the provider or the payer communities.

Narrator:                            How can payer and provider CIOs work together to help each other succeed with value based care?

John Santelli:                     When you see the progressive systems working well together, both systems understand that in order for risk to be shared or risk to be taken there's a desire for the payer and the provider to ensure the providers are successful in whatever that spectrum of risk that they've agreed to contract on. And so I see the progressive systems being led by their CIOs and their IT leaders to figure out how to solve that problem of not understanding their risk, their patient panel and how to take action on it. And that requires pretty strong collaboration, pretty strong leadership, and the ability to realize the value of the data outside of your own four walls, as well as the data within your four walls.

Narrator:                            In your role within UnitedHealth Group and Optum, how have you helped payers and providers collaborate?

John Santelli:                     It starts with building relationships. At United, we've created our own forum where we host 50 of the largest hospital systems that we have relationships with and their CIOs. You know it's an amazing kind of thing that happens with the amount of opportunity that you start to realize when you have a direct conversation between a CIO and a payer side and a CIO on the provider side.

John Santelli:                     You know, this will sound simple, but we've had material improvements with some of our biggest relationship taking paper and fax out of the equation. Although it may seem kind of archaic, there is an amazing amount of fax that still run the healthcare system, an amazing amount of paper. Quite frankly, the CIOs are the ones that kind of see that opportunity. It's not always seen from the business lens. And that leads to higher value opportunities around data sharing and around how do we actually integrate to serve more electronic transactions versus paper based and batch oriented.

John Santelli:                     So we've done quite a lot to build relationships, create forums for these kind of ideas to free flow. The community continues to expand, and we made it action oriented. And so some great software, some great actions, some of our investments, quite frankly, were steered by those relationships and by those forums.

Narrator:                            What are some near term opportunities for payer provider collaboration?

John Santelli:                     What I've seen are things like paper based referrals, they can be a real pain point, things like pharmacy authorizations as another really big pain point. And those being manual. The best way to kind of approach how do you find something you both can win at, may not be the most intriguing thing or attractive thing to do, so that's why I think it's really important that, pick, something low level. Pick a fax process or a paper process that is really painful in the workflow. Fix it. Show that it can be done. Set the framework and how you work across a different organizations. And by the way, you have to commit resources externally. Relationships require investment, investment in people whose job it is to focus on external relationship, which includes the activities, the frameworks, the project plans, the commitments. And so put all of that framework into place, the people, the funding, the committed resources, the regular meetings, the travel that's required. Get one thing done, and then use it to pivot to the next and the next and the next.

Narrator:                            What do you see as the CIOs role in those kind of collaborations?

John Santelli:                     I think as you look at the ACOs starting to mature, more and more commercial arrangements becoming the norm as you look towards the day when kind of the utilization incentives shift. You know the CIOs role is going to become critical around how we share data and share patient insights effectively. And I think the businesses are going to turn more and more to their CIOs to solve some of these really hard problems of data liberation, data integration, connecting data between EMRs, connecting data between providers and payers at the patient level, helping to drive further interoperability standards as regulators want to move more and more to interoperability standards.

John Santelli:                     I think as you look at the CIO role moving forward, I think the role will shift from very inward focused kind of traditional IT, I call enterprise technology to a more leading kind of IT role where the leadership requires you to have relationships, to have a business acumen, probably above and beyond what you knew in the four walls of your business, and to take the time to invest and understand the patient journey more holistically and how your services fit into that, and how you can shape the patient journey beyond just the systems you control.

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