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The Redox Podcast 44: Extracting paternalism from the patient experience with b.well CEO Kristen Valdes

Posted December 15, 2021
By Miona Short

Kristen Valdes is the founder and CEO of b.well Connected Health. She is a transformative force in today’s healthcare marketplace, spearheading the conversation on how empowering consumers can transform healthcare delivery. With over 20 years in the industry, she lends her insight on paternalism in healthcare, b.well’s vision for the future of healthcare, and the reconciliation of value-based care with the current ecosystem of consumerism.

Redox Podcast_Kristen Valdez B.Well: Audio automatically transcribed by Sonix

Redox Podcast_Kristen Valdez B.Well: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristen Valdes:
Imagine a world where whether I’m a healthcare provider or an insurance carrier or an employer or even a pharmacy with over three hundred thousand digital health applications that sit on the cloud, how can we help bring them to market in a way where consumers, one, know that they exist because we don’t have healthcare consumers today that think, oh, I’ve got 20 free minutes Googling the internet, let me go see if there’s a caregiving app out there. Should I ever become a caregiver, right? And by the way, which one? How do I know which one to trust, right?

Niko Skievaski:
Welcome to the Redox podcast, where we explore the intersection of healthcare and technology with some of our industry’s most notable contributors. I’m your host, Niko Skievaski, in my day job, I’m the co-founder and president of Redox, where we’re on a mission to enable the frictionless adoption of technology and healthcare. We started the show to share what we’re learning and hopefully allow you to skip some steps as you embark on your journey through making healthcare a little bit better, so without further ado, I welcome you to the Redox Podcast.

Niko Skievaski:
Many entrepreneurs come into healthcare with a big vision, wanting to be the central hub for the digitization of the patient experience. They want to bring together all of the big stakeholders like payers, providers, patients, employers, only to be hit with the hard reality of trying to make it all work once their product sees market. Then, they end up slipping into a refined point solution, focusing on a single stakeholder, shrinking their market and their aspirations alongside of it, and our industry merely inches along on this marathon towards digital transformation. But Kristen Valdes is not one of these entrepreneurs and b.well, the company she founded in 2015 is not a company easily-fit into a category like patient engagement, pop health, care coordination, et cetera. It’s all of these, but in some ways it’s really none of them. I was able to press Kristen on what they actually do, along with how that fits into her vision of how this industry needs to evolve in the coming years. I’ve always admired Kristen for her ability to make me want to collaborate with regulators and advance our cause. She describes how she’s ridden the momentum of regulatory changes and numerous opportunities for others to do the same. I always learn a ton talking to Kristen, as her background in the payer space, coupled with her ability to make complexity so simple, make me pause and really think about what I’m doing with my life. Well, at least my Redox life. So without further ado, I’d like to welcome Kristen Valdes, founder and CEO of b.well to the Reddox podcast,

Niko Skievaski:
To start off. Give me the four-minute version of your story and how you came to found b.well.

Kristen Valdes:
Yeah, absolutely. I’ve had the good fortune of being a healthcare executive almost my entire career. I had the opportunity to go to work on a contract for the Centers for Medicare and Medicaid Services, shortly after college, and had the opportunity to, and I think this is right in your wheelhouse, but aggregate the Medicare Part A and Part B data for the first time ever to create the largest repository of national data that existed and then expanded that scope into doing federal and state data matching, all for the purposes of doing fraud waste and abuse detection work to protect the trust fund and then also to create a scope of work around analytics that have become the underpinnings of value-based care. So think to …. HCHAPS really aligning to that evidence-based medicine, and then I left and had the chance to start a health plan from the ground up with a company that I joined called XL Health. We were one of the first private Medicare Advantage plans in the country. We were known as a C-snip, which meant that we only enrolled seniors suffering from chronic diseases, diabetes, heart failure, COPD, and end-stage renal. So high acuity, lots of claims, lots of medications, and we were one of the only profitable C-snips in the country. And so six years later, we had expanded to twelve states and then we were acquired by UnitedHealthcare. So the opportunity to stay on there for many years. But during the time that I was helping to build XL Health with an amazing team, we, my second child was born, my daughter Bailey, and she was born with a very significant autoimmune condition. It took me seven and a half years to navigate her around the system to get a proper diagnosis, and she had a near-fatal incident when two EMR systems couldn’t connect with one another.

Niko Skievaski:
Wow.

Kristen Valdes:
So she was given a medication for a routine sinus infection from a pediatrician that was contraindicated to a disease that sat in a specialist EMR system across the state. So we ended up in the hospital for quite some time, and at that point, I just recognized that all of this work that I had been doing in the space for 15 years was culminating into the fact that we had failed to give consumers and their families the tools they needed to be active participants in their own healthcare. And so I set out and said, OK, well, I have enough confidence that I can get another job in healthcare if I need to, but I really think I know how to solve this problem. And so I left and I launched the b.well Connected Health, named for my daughter, Bailey. I’ve called her B since the day she was born.

Niko Skievaski:
Oh, that’s nice.

Kristen Valdes:
As a way to remind us, one, why we’re doing what we’re doing every day because the hard part is, you know, as the foundational work of changing the infrastructure of how healthcare operates. But the reimagined consumer front-end is equally as important in order to give consumers and their families the tools they need.

Niko Skievaski:
Yeah, yeah. And so that is a huge undertaking, right? If you think about the problem you just described, how does b.well actually do that? And you know, the way that you describe the problem here, you will sit at the center of the patient, the providers, all the specialists, the payers, like that sounds wildly complex. And if you were an early startup that had no traction, I would be like, I think it’s too broad. Like, like, tell me about, tell me how it actually works and how you actually get this thing off the ground because it is. And you can also talk about kind of where the company is today to, because you’re certainly not that early-stage company that doesn’t have any traction.

Kristen Valdes:
Yeah, you know, it’s funny. You’re not the only one to say this is a big vision. This is a lot. right? And it sometimes can also be overwhelming. But I think what we saw very early was that there would need to be a shift and a pivot in our healthcare ecosystem towards consumerism. We were already so far behind the curve and so, we also recognize that healthcare has been operated in silos from a buyer perspective for a really long time, you have health systems, you have insurance companies, you have self-funded and large employers and retail pharmacies, and they all kind of operate within their own silos. But when you think about the consumer experience is that we have to interact with all of them. And so the data sharing was quite frankly the biggest hurdle we had to get over, I mean, I know you know this because you were an early entrant in the space as well, but six years ago, when we first started, we were educating people on what interoperability and information blocking really were and why they were so important. And we placed a bet very early that they would become regulated, which they did. And we knew enough of the folks involved in the federal government’s space to know that CMS, HHS, and ALC, we’re going to really double down on creating a shoppable healthcare consumer, and that meant that data liberation had to occur. So the standardization of data, I always tell people, and I know you know this, but collection of data is not the hard part, right? The standardization and how you use that data is really difficult. And we didn’t set out, by the way, to be, you know, a data standardization engine, but it was a bit of a means to an end because what we really wanted to do was consume data so that it could be leveraged and utilized to truly personalize experiences for consumers because what consumers want is quite simple, be there for me when I need you, tell me when there’s something I need to do, and in order to deliver on that commitment, we have to give them access and transparency to all their healthcare data in one place, in a way that’s shareable at various security levels and consent levels, but that data needs to be used to personalize and experience to them that’s relevant and timely because for far too long in our industry, we’re chasing healthcare, right? We’re identifying gaps in care at 30, 60, and 90-day intervals depending on when batch claim files come in. And we’re using nurses and doctors to pick up the phone and try to tell people when they have a gap in their care. But the reality is, is that we live in a digital-first world so we can use digital to create those personalized experiences to help consumers become educated and close their own gaps in care. But then we had to make it simpler by not just telling them what they needed to do, but navigate them to care in person, virtually, digitally, and now more frequently asynchronously. But that meant that a lot of reimbursement models had to change as well. So I’m a bit of a regulatory nerd, and I think it’s important that we always help to shape and create the regulatory environment that we operate in, which is why I sit on the board of the care and alliance and help put in sweat labor to help to draft how we need to operate in this new digital-first world. Because anyone in the government will tell you that regulations were often created for a different type of healthcare landscape than the one we’re sitting in today, and they really do and want to modernize those rules and regulations. So for us, we took on the big vision by saying we do think that data collection and standardization will become much easier over time and therefore less expensive. But in the meantime, let’s go prove that by collecting this data, we can engage and activate consumers better and give our healthcare stakeholders a lot better tools to reach out to those members in a more personalized way to help get them a simple or an easy button for healthcare. And that is a big lift, and there’s still a lot more we have to do.

Niko Skievaski:
So it sounds like you have kind of under the hood, you have a product that can take in a bunch of data from numerous sources, standardize that data, and then you actually build an experience for patients such that it can drive behavior in a positive way. How did you actually get that into market? If you can give like a concrete example of where that’s being used? Because I feel like there’s a lot of companies that will have a vision that broad but kind of stumble on the like, it’s almost a chicken or egg approach. Like, if you could, if you had all the data, then then you can make it work and you could potentially sell that vision to providers and patients and payers and people taking on risk and other groups. But like, how did you actually get from zero to one in that world?

Kristen Valdes:
Yeah, mean, so we were really fortunate that when we were first getting started, we had signed a big payer deal for a patient-centered medical home model that was created under the Affordable Care Act. It was a co-op and, unfortunately, more for them than for us, but the federal government shut down that part of the ACA, and so we really had some good opportunities to learn in a payer environment to get installed and really refine the product as our first opportunity and go to market. Now, none of the co-ops exist any longer, but we were able to take our tool and then go immediately into the self-insured employer market with the stats that we had gained and the outcomes from those learnings on the payer side. And so we started bringing on self-funded employers. We are, now, we have employers, health plans, health systems, and retail pharmacies all on the platform today. And that’s because our vision, as you know, is to be net neutral and designed for consumers. And that means that we need to bring all kinds of companies together to deliver on that commitment to meet the needs of today’s digital-first consumer.

Niko Skievaski:
One of the, I have a lot of questions about everything you’ve said so far, so we’re going to kind of bounce around and poke within that. But one of the seemingly paradoxes of, I think, our trend of consumerism in healthcare that I’ve been trying to grapple with and I think you probably have some good thoughts on is when I think about consumerism, the shoppable consumer and healthcare, they are informed, they are engaged like a consumer is and they can basically choose, you know, do I want to do telehealth? Or do I want to go see my provider? Or do I want to do a virtual first sort of model with these new companies that are popping up like they have the ability to shop and they will march with their dollars to where they want. And so I think that’s, you know, it’s helping to essentially fix our healthcare market by empowering consumers with the sovereignty to choose, which is why markets work in general. Like when you think about going to the grocery store, that’s how those markets work, right? But then I contrast that with the business model of value-based care in that, and you know, there’s obviously different ways that plays out a regulatory standpoint and taking on risk and stuff, but the gist of it, in my understanding, is we’re taking on risk on a patient’s life and therefore we want to to have great outcomes and minimize costs. And the we involved in that, like if it’s a health system who is moving towards value-based care and sharing risk with providers, essentially they want to own the whole patient experience and have the like, if you think of the traditional sort of Kaiser model of doing this, where the really the patient stays within the Kaiser ecosystem, so the patient doesn’t really shop, the provider will tell them, oh, you need, you need the screening, you should go here for it. We need a, you know, some other procedure, you should go here. But like the healthcare organization is the one sort of playing the quarterback role for the patient and monitoring what’s going on and making sure they’re doing all the things necessary. And so in my mind, there’s almost this contrast between the consumer who, if in the consumer’s a model, the patient’s at the center, they’re the one choosing and they’re going wherever the heck they want. And it’s not controlled by a central sort of power, whereas in the value-based care model, it seems like it’s almost Big Brother, like I’m going to watch all the data, population health management, right? Like, look at my whole cohort and figure out who I need to intervene with. How do you? Much of what you’ve talked about is a confluence of those two, in my head seemingly, opposite ends of paradox, like, how does that, is what I said, striking anything with you? Does that make sense at all? How does that work?

Kristen Valdes:
Yeah, there’s a little nugget in there. That’s the epiphany that I think the healthcare system is starting to finally realize, which is you need to earn a consumer’s loyalty by being the most convenient for them, and meeting their needs. Because consumers don’t want to generally go shop the healthcare system, they actually want to know that they’re getting good quality care at a fair and reasonable price, and it’s easy for them to do, right? And we are highly fragmented, right, today. And we also have had some perverse incentives that make it very difficult to create a culture shift inside of health systems in general. Because, you know, doctors historically have been in control of their own schedules and just getting them on mobile appointments scheduling has been like a life-altering event for these health systems. But convenience being the new currency. And so I think the epiphany is that once you embrace that, consumers really do want convenience, that it actually paves the way for new and different kinds of partnerships that are incredibly important in the risk-based model moving forward. So we have a health system and a retail pharmacy that are working right now on a scenario whereby you can use a platform like a b.well, because of the data transparency, the bi-directional writing into the EMR to say things like one of the most common value-based and risk-based measures is something as simple as colorectal cancer screenings. Now it’s not simple, right, because nobody wants to have a colonoscopy, so, you know, they vary across the country. But if you’re sitting at a thirty-five percent rate in the population that you’re at risk for for colorectal cancer screenings, and you’re seeing this crazy trend line where more and more people are actually getting colorectal cancer and they’re getting it earlier in life, it becomes important for us to screen people. So let’s think about the workflow a little differently, which is instead of waiting for me to be sick and show up at the doctor for them to pull up an EMR record to go, oh well, yeah, I can treat your sinus infection. But by the way, I see you’re overdue for a colorectal cancer screening, can I get you scheduled for that colonoscopy? Which oftentimes doesn’t happen when someone’s in for an acute issue.

Niko Skievaski:
Hmm.

Kristen Valdes:
Instead, why don’t we simply push them a notification that says something like, hey, happy birthday, Dr. Smith wants you to be screened for colorectal cancer! Now, we probably wouldn’t push that message on someone’s birthday because nobody really wants it. But the reality is is that it’s proactive, it can drive education, you can do it in a digital environment, but then we can offer the convenience. Would you like to mobile schedule an appointment with Dr. Smith? Or can I get you an FDA-approved toilet water test to be sent to you in the mail that you can drop back in and Dr. Smith can set up a visit? Or I see you’re picking up your medications on Friday the pharmacist can give you a cologuard. When we recognize the need for convenience, it creates the opportunity for new business models to emerge. We have health systems and pharmacies that are now working on creating more common, convenient workflows for things like colorectal cancer So this gives the consumer choice that fits into their lives. They get a say in what it is, and they’re more likely to follow through because you’re honoring the fact that they have choice and you’re helping them to understand the expectation both on timing and cost upfront. And so these new kinds of partnerships that are emerging will help lean into value-based in a much broader way than it has been before. But it’s going to require new kinds of partnerships and data sharing than we’ve ever seen in healthcare.

Niko Skievaski:
Yeah, nice. I have actually asked that question to a lot of people because it’s been on my mind like, how do you reconcile consumerism with value-based care? And that concrete example, I think, is an amazing way of reconciling those two in my mind, seemingly opposite ends of behavior and that with consumerism, consumers need to be informed of what’s going on and the risks and the benefits in order to make those decisions. And that’s really where those two areas collide because the healthcare organization is the one who, looking at all the data and epidemiology and the quality metrics and stuff they’ll know, oh, this patient needs a colorectal screening, and educating the consumer on why that’s important allows the consumer to actually go be an informed consumer and making the decision about how they want to go about doing that, but offering the different types of solutions. That’s where the shopping, I think, comes into your typical population health management, command control society that I was thinking of in the extreme example. So I love that example. Thanks for pulling that through. You know, you.

Kristen Valdes:
There’s another theme there, Niko, that I’d love to pull on the thread of for a moment, which is.

Niko Skievaski:
Yeah.

Kristen Valdes:
You talked about this a little bit, which is very kind of Big Brother. I always like to say paternalistic, and it’s not an intended paternalism, to be honest. It’s de facto built into our system. We like to be very top-down in healthcare and tell consumers what’s best for them. We do it on the employer side, through their benefits. We say we’re going to purchase three different benefit designs, maybe if you’re lucky, and you get to pick one of those three, but you have to pick one of those three. We’re also going to provide you benefits for things like weight management service, a maternity service, musculoskeletal, behavioral health, but we’re going to pick one and that’s the one that you get, right? And so our buying cycles in healthcare really are alternative to how healthcare should work if we’re moving more into a consumer as a model, which is choice-based. And so one of the, my favorite themes that I like to talk about is in order to get away from this paternalism, we need to get to a different framework that looks a little bit more like an Amazon, right? Where if a consumer has a need, from a healthcare perspective, that they have choice and they have a say in what they want, but it requires a different kind of technology infrastructure. And it’s why I think digital transformation is so important to healthcare today, because we’re effectively saying to healthcare stakeholders that you can decentralize your data model and you can bring the outside data in, through the patient right of access, and you can use that data to put all kinds of personalization engines and to drive your value-based care initiatives. But you can also API out everything, and we always encourage people to do that because it makes you a little bit easier to work with. But imagine a world where whether I’m a healthcare provider or an insurance carrier or an employer or even a pharmacy with over three hundred thousand digital health applications that sit on the cloud, how can we help bring them to market in a way where consumers, one, know that they exist because we don’t have healthcare consumers today that think, oh, I’ve got 2 free minutes Googling the internet, let me go see if there’s a caregiving app out there. Should I ever become a caregiver, right? And by the way, which one? How do I know which one to trust? And so being able to access and tap into this more robust set of data where you truly know the human being that you’re targeting, you can also invite digital health applications onto a platform where you can start to use data science and machine learning for what it was originally intended to do, which is how do I get the right information in front of the right human, that they’re more inclined to react to, and that also gives them choice instead of saying, hey, you want to lose weight? Here’s Weight Watchers. This is your only choice! And people are continuously surprised by the fact that there’s less than five percent engagement in these point solutions when you only offer one choice. But you can actually increase engagement by saying, oh, here’s four different maternity solutions that we think matched to you, given what we know about you. You can choose one of them and participate using identity. Management, and other things to make it seamless for the user. And if that one’s not working, there’s three more right behind it that they can switch to, and we see a world where new benefit design starts to come into the play as well because we think that consumers should have the ability to purchase the types of healthcare services that they’re more inclined to engage with or activate with because they are each uniquely human, they are an N of one. And I think that what we talk about with digital transformation empowers the ability for healthcare stakeholders to stop being paternalistic, stop their annual buying cycle and budgeting time frames, and all their crazy implementations directly to the EMR or everywhere else. Let’s bring the ecosystem to play. Let’s give consumers choice, get their engagement and activation up, and uniquely actually service their individualized needs. And that’s another benefit of the type of digital transformation that we’re talking about here, that the unlocking of the data can now provide us the ability to deliver.

Niko Skievaski:
That’s amazing, vision for the future. I feel like, you know, the, there’s these waves of digital transformation in healthcare. The first one, probably being the meaningful use wave, like let’s just get people using EHRs. The second one that we’re probably living in right now is let’s build a bunch of apps on top of it. And now we have hundreds of thousands of apps that people don’t know about or if we have this very fragmented ecosystem of all of these different applications. And then this third wave you speak of, it’s almost an intermediary that provides, that creates the market, that allows providers and patients to understand the benefits that they might receive from any specific application. And what applications are available is an amazing vision. Is that what b.well is doing? Because I know you have a very partnership approach to how you bring different products to market. Are you positioning yourself as that market maker that can serve up these different applications for patients and for providers?

Kristen Valdes:
So we’re a big believer in helping the healthcare stakeholders of today to be successful with engaging their populations in a more disciplined manner. Getting down to that N of one, we believe that there has been a missing layer of technology, that healthcare is just not had because we’ve, to your point, we went through meaningful use, our providers, we were trying to get onto EMRs. And unfortunately, we’re now trying to make EMRs more than what they were originally designed to be. And I think that in order for us to have one good market competition to have a unique value proposition to the populations that we serve and the fact that every stakeholder is unique in even the services that they provide, that we can provide an architecture layer that allows them to not have to go figure out how to bring the outside data in by managing consumers informed consent and their patient right of access and who they want to share that data back with. Because consumers uniquely do want their doctors to have access to all their health information when they’re treating them. But we can also use that same platform in a kind of we’re a fire native approach. We bring lots of data in, we standardize it, we wrap useful logic on top of it, and then we API out for partnerships so that in that platform, all those digital solutions can come together. Because remember, we always tie everything we do back to the consumer. Access and transparency to their data and care when, where, and how they want it, and that means that you have to have a combination of in-person, which is where most health systems are working in their digital transformation or what they’re lovingly calling their digital front doors, right? When somebody shows up and needs something, are you making it easy for them to find a doctor, find care, make an appointment? The digital transformation touches the entire continuum of care, which means that you have to be able to involve and communicate with consumers when they’re outside the four walls of the doctor’s office. And so when you get into digital solutions, which can support consumers in that open time frame, how do you present them with things that they’re likely to engage in that actually solves problems for them based on their unique makeup as an individual? So b.well’s platform provides that framework. But then we also attach a user experience. So a UX/UI on top of it that’s configurable for our clients so that they can maintain their own unique identities. You won’t often see b.well in the market because we’re completely white branded to our clients, and that’s because we want them to have their own personalities in their own experience and deliver their own services to the populations they serve, because we know that loyalty really does need to sit with the provider and with the pharmacist or the payer people that consumers trust.

Niko Skievaski:
Nice. Yeah, and where would you find b.well used right now? Do you have public partnerships that you could talk about? Just as some examples?

Kristen Valdes:
Yeah. So we have partnerships with various health systems across the country. Medstar, Thedacare, Unity Point are good examples, that have both local and regional employers. So we work with a lot of trucking and distribution organizations like LNF, Trinity, Burris. We have national employers like the Pentagon Federal Credit Union, where we have employees in every state, including Puerto Rico. We have partnerships with organizations like Walgreens from a pharmacy perspective, and we’ve had various payers, including even alternative payers like CMS-approved health ministries, like Altrua. So those are some good examples.

Niko Skievaski:
Awesome. That’s really cool. I want to go back to the regulatory front. I think that a lot of startups in our space are kind of scared of the government or of trying to figure out how to fit their products within that landscape. And as you mentioned earlier, you’re kind of a policy nerd and you also mentioned using the patient-centered medical home as a kind of starting block for b.well, how is b.well taking advantage of any kind of regulatory momentum right now? And how should companies in general just be thinking about the government as it relates to their strategy?

Kristen Valdes:
Yeah. Well, the government is friend, not foe, especially in healthcare. Healthcare is right now uniquely bipartisan supported, and especially in our political climate, I think that’s particularly important. And what you’ll see is an acceleration on top of the former administration’s agenda and the one before that, but has been pretty consistent for the last several administrations that have gone through the government. The government welcomes feedback and I would encourage every startup, one, especially if you’re in healthcare to really know and understand the regulatory environment that you operate under, because not only is it changing faster than it’s ever changed before, but you do have a voice and an opportunity to influence policy and rulemaking and regulations because the government actually does read every comment that comes in on every proposed change to legislation. And you have a voice, and I would encourage people to get to know and participate in those things. The government really does want to do a great job. Now, they’ve been very clear that they’re trying to create this shoppable healthcare consumer because we are in a pricing crisis in healthcare in our economy. And quite frankly, the only way out of that is to put the consumer in charge, get them educated relatively quickly and give them choice. And so by making transparent their data, but also putting in place lesser known regulations that actually change the game a little bit in how we’ve been a bit handcuffed in healthcare before, like things like the anti-kickback and stark safe harbor rule that was put in place, where if you are in a risk-based model, you can now for the first time ever, start to refer, you know, inside your own walls, but also to incentivize consumers. I’ve given a lot of talks to government organizations around the fact that in a digital first world, we’re inspired by loyalty programs. I fly Southwest, my husband flies free on my companion pass, I get to board first, I get to feel pretty special. I also live in Baltimore, there’s really no other option to fly out of, but I really do applaud my loyalty and I will absolutely fly Southwest first. But we’ve never had that concept in healthcare because it’s always been considered steerage. But the reality is is that these safe harbor rules now allow for a monetary equivalent if consumers align to close gaps in care. So if a provider is now suggesting that Kristen needs a colonoscopy, Kristen gets a colorectal cancer screening and closes a gap in care, there’s an opportunity now for payers and providers to create a loyalty program, something new in healthcare, that Kristen can adhere to. And there are a lot of quote unquote gamers in digital environments because we’ve trained them for that. People expect free things, and now we have some opportunities to offer that that the government is allowing us. But by not knowing the regulation came out or what the rules and limitations are of that regulation, you really can’t start to take advantage of those things.

Niko Skievaski:
Yeah, it sounds like there’s a huge opportunity for companies to exist to create processes and experiences, user experiences, around those types of loyalty programs, as well as educate healthcare providers on it. Because, as you said, for so long, that sort of behavior has been, we’ve been scared of doing anything like that because of the stark laws and where this came from. So yeah, that’s, that sounds like a total sea change in where the government stands on that regulatory approach. What else on the regulatory front do you think is really exciting right now that there might be opportunities in for companies to learn about and potentially build business models around?

Kristen Valdes:
Yeah, there’s two actually that are really exciting to me now that are upcoming. I know we’re still talking a lot about information blocking and interop, but they’re here, right? That ship sailed, we’re now heading down a new path. But the combination of price transparency and no surprise billing, I think, are really powerful because effectively every commercial plan in the country by next January is going to have to have all pricing out to market on healthcare benefits, and consumers are now obligated to have access to pricing before they receive a service outside of ED. And when that happens, if the payer does not provide that information transparently to a consumer, then they are going to receive stiff penalties, much like we saw in information blocking and interop. So there is a huge opportunity right now for something aligned to consumerism that’s never been possible before, which is true shop ability based on price. We encourage our customers to not release price without quality. So it’s naturally forcing the conversation because we know in healthcare cost and quality are not correlated. But the reality is that consumers do want to know they’re getting high quality services, which means that providers can start to change how they think about things like provider directories and how people find and match to doctors, so being able to publish provider directories and have new and enhanced provider data where not only are addresses and phone numbers finally accurate, as well as whether or not someone’s accepting new patients or not. But now we can add unique data differentiators to the provider directory around things like is this provider published? How many people have they treated with the specific condition that I have? How long have they been in practice? What languages do they speak? Will they text message with me? Do they offer telemedicine? And those are the things that are really going to drive consumers to match to a doctor, including tracking things that you would think we track already. But we don’t like race and sex. It’s becoming more and more important for people to find doctors that fit within their lifestyle and that look like them and have experiences like them. And we have a real opportunity to change that with these new regulations.

Niko Skievaski:
So that this is, I want to pause here before you go on to the next one, because this is a really big deal. It’s basically at the center of what I think most consumers are frustrated about with healthcare and that you have no idea how much it’s going to cost, you have no idea what the outcome might be, it’s all a black box. I know that there was some regulations in the, in the last administration around price transparency and really on the health system side, forcing them to post their their charge masters, which is kind of a lot of debate on if that’s going well or not. But you’re saying this is bringing the payer into into the space and saying that the payer has to actually provide like what the out-of-pocket price is going to be for patients for all procedures and anything that they’re getting into, based on the providers that they might choose.

Kristen Valdes:
It’s huge. I always like, I used to refer to information blocking and interoperability is kind of the sentinel event that changed healthcare forever, that no one saw coming. And this is like doubling down on that, right? And so if you just keep in mind that the shoppable healthcare consumer is coming and the government is putting their full weight behind it, change is going to happen. And so the transformation and the culture shift is that payers and providers can no longer treat data as intellectual property, and they can’t treat benefit costs. And they’ll say, oh, well, you can reverse engineer my IP and my actuarial underwriting, and I would challenge them change your underwriting, it’s not working for consumers anyway, right?

Niko Skievaski:
Yeah.

Kristen Valdes:
They don’t really, if you go up to the average consumer on the street and go, man, how many podiatry visits do you get this year under your benefit? How many people do you think will know the answer to that question, right? Well, it’s totally misaligned, right? But we also underwrite benefits assuming that an entire population is going to utilize those benefits at certain percentages and based on inflationary costs based on where you live. Underwriting has to be reimagined and change, and one of the, I would love, love, to see a new kind of payer emerge that says I’m going to underwrite a benefit that the people want, right? And I’m going to take away some of those podiatry visits and PTSD and OT and I’m going to let you buy up if you need them throughout the year. But I’m not just going to assume that everyone in the population is going to use them. And instead, what I’m going to do is I’m going to say I’m going to cover your hospital and your medical, your preventative services at cost, and I’m going to give you a pool of money, consumer, and you’re going to go to a marketplace and you’re going to pick the solutions that you need. And then I’m going to create a loyalty program that actually incentivizes you to use them for prevention and to use them for control. And you get to pick who decides because I will say that I have seen and we’ve experienced as a company as we’re integrating with employers and payers and health systems point solutions that sometimes solutions are selected by their hype, how much money they’ve raised, you know, who their investors are, and the fear of missing out is very real in healthcare. And so sometimes you might say, oh, well, here’s a small kind of mom-and-pop-type shop that’s hasn’t raised a lot of capital, but has phenomenal outcomes and engagement that if people just knew it existed, they might select that. So we’re big believers that we need to let the people choose, and we ultimately need to create the almost product review for these digital solutions that consumers will utilize and that they find value in that actually add meaningful impact to their lives, but get away from the paternalism. So I’d love to see a payer create that new model. And so if anyone’s listening and wants to create that with me, I am here, please contact.

Niko Skievaski:
I was going to say it sounds you kind of sound like the right person to start that, but you’ve got your hands full with b.well right now.

Kristen Valdes:
Yes, I do, no, it’s fun work though, right? I mean, we get to see, if you think about it, we’re positioned to see what each part of the healthcare ecosystem is going to do in reaction to these new business models. And most importantly, what we love is connecting them so they can start to partner and not necessarily compete. So the consumer has a more well-rounded experience where they’re in charge.

Niko Skievaski:
Nice. Was there another regulatory trend that you wanted to talk about? You said there were two, but I don’t know if that kind of encompassed it.

Kristen Valdes:
Yeah, so provider directory was the other one.

Niko Skievaski:
Oh yeah.

Kristen Valdes:
And we kind of naturally tied into that, you know, and provider directory, I’ll just get on my soapbox really quickly on this one, which is really that, we don’t track the right information for consumers to match to doctors and quite frankly, provider directories weren’t created for people to search digitally to find a doctor. They were created to show that there was enough adequacy within a certain location and mileage for our credentialed physicians to meet adequacy needs for a health plan. So by saying if health systems are working on their digital transformation and they’re thinking, oh, we’ll just provide our provider directory on our website and help people find a doctor to schedule. I can guarantee you you’re not taking the friction out of the experience, right? And so having provider directories be published for Medicare and Medicaid actually helps us to start to allow new companies to enter the space to cleanse and provide better solutions for provider directories across the board where we can find out, are they practicing on Monday, Wednesday and Friday in certain locations, Tuesday, Thursday on others, where people are making an appointment that’s actually convenient for them? So I’d love to see some companies emerge to take advantage of those new data sets and provide, quite frankly, selfishly, simple APIs for someone like myself to consume that. I don’t want to go cleanse the data, build it and make it smarter, someone else should do that, but we want to make it easier for people to find doctors that they can match to and build in those additional data sets and elements that are missing from the provider directories today.

Speaker4:
Hmm. Nice. Yeah. And you know, as b.well, kind of sitting at the center of a lot of these types of services that technology companies are providing, are there holes in the market that you see right now or are there types of partnerships that you’re looking to create with companies that you’d really love to bring into your ecosystems that you’re just not seeing?

Kristen Valdes:
Yeah, I mean, I think that there is a few of them, right? I mean, provider directory is probably the biggest example right now, but we just talked about price transparency. I mean, when you openly discuss that, there’s some debate around charge masters and how valuable that data is, and on the hospital side, one of the biggest challenges is that the data was required to be made accessible on a website, right?

Niko Skievaski:
Yeah.

Kristen Valdes:
No one loves a portal scraper or a website scraper where you’re trying to find different formatted information hidden behind different lengths, trying to standardize the data. If we really want to create an app ecosystem, that’s going to be useful to consumers, the data does need to be standardized and made accessible through APIs, which is what I loved about information blocking and interoperability it was the first time in history, I believe, that the federal government prescribed the actual technology standard to be utilized in the regulation, and that was game-changing, right? Because it had to be on the cloud, it had to be API-based and it actually helped to transform the industry faster than we even saw in meaningful use with the adoption of EMRs, which largely were installed on Prem in the beginning period so that all those same people had to transition to the cloud. So I think when we create these regulations, if we continue to keep current tech in mind, there’s a huge opportunity for all kinds of new businesses to emerge and fix the status quo. Provider data, I always like to say, is the root of all evil, just because it underpins everything and it’s so dirty and it’s so hard to match, right?

Niko Skievaski:
Yeah.

Kristen Valdes:
And so, you know, especially across federal and state, in different identifiers and things of that nature. Plus providers move, they move buildings all the time. It’s a lot harder to identify a provider, believe it or not, that it isn’t even human from an identity perspective. But I do think that there’s great opportunity for companies to emerge to take advantage of cleansing, standardizing and making accessible the data, but not just making the data that’s there today better, but actually improving and enhancing that data towards the consumerism that everybody wants to see in healthcare.

Niko Skievaski:
Nice. Well, this has been an awesome conversation. Do you have any parting words of wisdom to share with the audience, any other topics that you wanted to touch on that we didn’t get to?

Kristen Valdes:
No. I mean, my only kind of parting words of wisdom is keep an eye on the regulatory space, watch for these shoppable moments and regulations can be scary because they use a lot of big words and terms and they have to adjust kind of how they were written before. But at the end of the day, the meaning behind them is always what you need to pay attention to. Because if you start to watch where the regulatory environment and the rule making and where opinions are being asked for from the industry, you can often see where the industry is going to go before it gets there. So if somebody is looking to create a new company, watch the regulatory space. If somebody is looking to enhance a solution, watch the data that’s going to start to become accessible and figure out how you can make that better, smarter and faster. There’s plenty of willing participants like at b.well and many others that are willing to consume it.

Speaker4:
Where would you suggest going if you’re getting into this? Like, do you just go to CMS website or is there is there a place that summarizes effectively that might link to the source document? Because the actual regulation, like you were saying, is can be scary and intimidating to read. There’s a lot of capital, capital words in there that turned me off, certainly. Yeah. Where’s a good place to look?

Kristen Valdes:
You know, I wish I was only one place, but there are a number of list serves that you can get on. But there’s also a lot of public and open forums. So I always tend to look at the CMS agenda, the Office of the National Coordinator and ohm and CCMS and HHS, the Department of Health and Human Services, and so if you I watch those three agencies and sign up for listservs so that when new things come out, I’m just getting them into my email. And then there’s some really great and you can search for them, but you there are some email newsletters and distributions on all things health policy that you can sign up for, and there’s quite a few of them. So find the one that speaks to you. sign up for it, and then you’ll get some nice little summaries right in your inbox of what’s coming out and happening that typically will link you back into where you can openly comment.

Niko Skievaski:
Nice. Awesome. Great. Well, thank you so much for joining us. This is an amazing conversation, and it’s always so great to catch up with you and hear about what we wells up to. Yeah, thanks a lot.

Kristen Valdes:
Awesome. Thanks for having me, Niko.

Niko Skievaski:
And there you have it. That was Kristin Valdes, founder and CEO of b.well, if you’re interested in learning more about b.well, check out their website. It’s icanbwell.com. And that’s just the letter B, not the word be. So it’s I C A N B W E L L.com. One last thing if you’re in the payer world, Redox just released a suite of products for payers, including the compliance for new regulations around peer-to-peer exchange and electronic prior authorization. If you’re interested in that, check out redoxengine.com/Product/Payers for the details there. I’ve been your host, Niko Skievaski, and as always, thank you for listening to the Redox Podcast.

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When we recognize the need for convenience, it creates the opportunity for new business models to emerge.

Kristen Valdes, b.well Founder and CEO

Key Moments

2:15 Kristen’s experience and background in healthcare

3:45 the inspiration for b.well

5:20 b.well’s vision for healthcare

9:15 how b.well works, and how it got to market

11:01 the rise of consumerism in healthcare; reconciling consumerism with value-based care

18:05 paternalism in healthcare

22:32 b.well strategy for bringing an idea to market

25:15 where b.well can be found today

26.21 how b.well engaging regulatory momentum; how companies should think of the government in relation to their strategy

29:41 what Kristen finds exciting on the regulatory front, and where new business models might thrive.

33:00 reimagining payer underwriting 

37:15 are there type of partnerships that b.well wants to bring into their ecosystem that doesn’t exist yet?