Payment Accuracy Podcast Series

How health care CIOs can transform their operations

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Welcome to the Optum Let's Talk Payment Accuracy Series. In this podcast, Julie Durham, Vice President of Software Engineering and Payment Integrity at Optum discusses enriching the data to learn new things.

Are you enriching your data in real time to make decisions earlier in the value chain?

Payment integrity really is about those high end insight, finding the next best action, and digging through data and looking at it in a very unique way. And then as quickly as possible, getting that to our operational partners. And I'm always constantly looking for that next thing, that next thing, that next thing. So there really is no status quo.

And I think that drives us to not only be relentless, but consistently be creative on how we go after it every single day. So we're always evolving our models. We're always evolving our operational processes. Our technology is constantly evolving because as we enrich it with different data, we learn something else.

And I think that's what makes the role of the CIO a little more unique within payment integrity because I have a huge accountability to my data scientist team to make sure they have real time access to the most modern tools, and also support my operational business that's consistently looking for ways to lower operational costs and better implementations.

If you think about-- everybody's got these big process diagrams that you've seen, right? Like, claim comes in, it goes here. Or I make a phone call. It gets routed. And then at the end of it, you've eventually got enough data or whatever that is to take action on it. And shift left basically says, can't you do all that workload that you were going to do way over here sooner in the value chain?

Because the sooner you do it, the more valuable it is. Right? So don't wait two or three days for that particular data to move from this system, to that system, to that system. And that's right, because we're going to move it from system A to system B. And then it only runs at midnight to 2:00. And then it's going to move to the next system. And then we're going to see it.

And you've basically lost three days in the overall value chain. Why can't you just take the analytic or whatever you were going to do at step three, and run it at step one? And a lot of times, the reason you can't do that is the way that step one was architectured was just that little [INAUDIBLE]. It just moved things from left to right.

And there isn't enough horsepower right there to run that analytic. And that's really where streaming and Cloud infrastructure comes in. So now you have the ability to take potentially workload you would have done later and run it. And if you've only got 10% of the data, that's OK. That's 10% more than you wouldn't have known later.

And you can watch that data, build in real time because you have the ability to hold all of it and watch it kind of mature on these new architectures that you've got available within Cloud, right? Because you can scale those up and down like you couldn't do before, which was a huge reason why you were moving that workload to system C because only system C was big enough to handle it.

Now if you truly understand Cloud engineering-- which, by the way, most people don't. Cloud is a competency, not a destination. It's not just put it on the Cloud, you're done. You truly have to re-engineer quite a bit to get that to work.

Those are kind of those insights that we're talking about that you can do with shift left, is how do you pull some of those decisions earlier in the value chain? Because now I've built an architecture that's flexible enough for you data scientists to come in and ask it whatever question you want right here.

And if you had done that before, you would have broken my whole stream, right? Because you've heard that, right? Someone ran something. It broke the batch. Now what I'm saying is, OK, I'll give you a space that you can then scale up and scale down right here. But we're going to co-exist and live in this space together. And we're going to start sharing tools and best practices, et cetera, in how to do that, which is new, right?

And that breaks apart the [INAUDIBLE]. We're all going to collectively take some accountability, and add in new tools, and allow us to scale up and down where if you think you've got an idea that you want to run here in the value chain versus there, I'm going to create an architecture that will let you do that.

That didn't exist before, right? So you just couldn't do that five years ago with some of the way the systems were set up.



Enriching the data to learn new things

Our technology is constantly evolving,” says Julie Durham. “Because as we enrich it with different data, we learn something new.” Enriching data in real time allows you to make decisions earlier in the value chain.

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Welcome to the Optum Let's Talk Payment Accuracy Series. In this podcast, Julie Durham, Vice President of Software Engineering and Payment Integrity at Optum discusses how the Cloud makes you competitive.

Cloud is a competency that makes you competitive. Are you truly embracing it?

Nothing is more competitive than the public Cloud. Period. I think this is a huge, like-- it shocks me how few CIOs are working on this. Every line of code you're writing that isn't on the public Cloud and ready for the public Cloud is irrelevant because eventually you know you've got to put it there to stay competitive.

Yet I think a lot of us are kind of ignoring that fact, or hoping someone else will come by and show us how to do it. I think that that's a pretty long journey and a different set of skill sets and competencies you should be working on as a CIO.

I think the first reason why there was hesitation was overall viability of the public Cloud market. Like, you go back five six years ago, we talked about Cloud, but we didn't really know, like, oh, my god. Like, it's massive. It's going to be around.

It's not just kind of a one and done. It happened, right? So I think some hesitation was just viability of Cloud. I think the next hesitation was security, right? That is an easy thing to say. It's not secure. Whoa, OK! We're not going there then.

So I think every public Cloud vendor heard that and responded, right? They built security in from their DNA ground up because they were ultimately losing deals around it. So I think that they kind of closed the gap on that. I think that was the second part, is hey, it's not secure. You know, if you really go peel back the covers.

Now it doesn't automatically secure itself out of the box. You still have to ask for it, add it, et cetera in understanding what you're doing. But now I think that most public Cloud offerings will go on par with any enterprise security patterns and guidelines.

Now there's vulnerability in every system that you create. But it's still on you as an engineer to implement that. But I think they've put that on level. But I think that was a huge reason why a lot of CIOs just kind of stepped back and said, we'll see how that one goes.

The third reason is don't underestimate the investment that you have in your current data center. Just walking away from that is difficult. That's not just for the CIO. Fundamentally, the dollars you have invested in those assets, that's hard, right? We may all want to live in air BnBs every night, but we probably own our house. So you got to figure out, like, what do you want to do with that?

And then I think the fourth part is, you know, I keep saying this. Cloud is a competency, not a destination. Like, knowing how to actually use the Cloud requires an engineering culture that may not exist within your company. You're going to have to understand Agile. You're going to have to understand DevOps. You're going to have to understand CI/CD. And if you don't know what that acronym is, you are not ready for the Cloud.

So these are, like, there's a fundamental cultural shift that you have to learn and embrace to get you there. There isn't a single college graduate that I'm hiring right now that doesn't want to work on the public Cloud. I can't even get them to come here unless it's public Cloud. Like, that's huge.

You go look at the hiring patterns for most of my competitors? They all want Cloud. Remember, Cloud's a competency. You have to understand modern software engineering in order to actually do anything meaningful on the Cloud.

So if all you do is pick up your current state infrastructure and move it to the Cloud, you'll get a one year benefit of the cost gain. You will. But if you bring all your Legacy processes, and all your Legacy COE, and you don't actually automate or do anything different, that's all it was. It was a one stop, one year benefit.

If you're moving to the Cloud, you're moving there because you're truly adapting and living, and breathing with all the things that I talked about, right? Otherwise, don't do it. It's just a one year interesting exercise.



Cloud makes you competitive

The cloud is a competency, not a destination. Discover how to embrace cloud technology and use it to your competitive advantage. Julie Durham on why health plans that hesitate may be lost.

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What I love about payment integrity is quite honestly, it is one of the most innovative spots to be sitting in. Right, like every day, you can come in and enable the data scientist and the operations team to stay one step ahead. Right?

So it is ripe for disruption. It is the perfect intersection between analytics, which is the feature of everything-- technology and operations. But the harder you work at it, the more you find. Right, that's pretty unique. So I think one has recognized the uniqueness of where you're sitting, and the ability to drive really unique thought leadership for your company.

And if you're going to do that, if you're in that position, why wouldn't you be doing everything you can do, everything you can do to be doing that on a public cloud that gives you access to this disruption and innovation at the lowest price point?

Take one of your most innovative business units and arm them with the most innovative technology you can. Now, you can't afford to do that as a CIO everywhere. You can't, right? But if you're going to pick a spot to do it, do this one.

And if you haven't recognized that payment integrity has the ability to do that between the data scientist finding stuff everyday, and the operational team to execute it, I think now is a really good time to work on that.

But if you're looking at your legacy stack, and you think it will be competitive in three years without knowing these tools, I'd really question what you're doing. The other thing too is if you're not spending every day with your business partners helping equally at that table, I don't know it's kind of saying a lot.

But I think it kind of distills down to probably recognizing uniqueness of payment integrity's intersection of the data scientist, along with the data and the ability to unlock new insights. Why not back that up with the most powerful technology you can.

And then probably the second part of that is if you're not involved or in the room with that leadership team, get up and go figure out right now why you're not because you should be, right? I think [INAUDIBLE] that that is a huge part of your job is being a change agent and a champion.

And rarely has IT but in the driver's seat of that cultural change. So it's not something we're all naturally equipped with that we got taught and trained. We were primarily execution. But make no mistake, that's a huge part of my job, right? I'm the cheerleader. I'm the collaborator. I'm going to get everybody together.

It's not about me picking the best technology. I've got engineers and architects that do that. It's about selling a culture and a vision that I wake up and do every day. So I think that you have to recognize that you are the change you've been waiting for, right?

So if you're not going to go pick it up and drive this culture, no one else is going to do it for you. So I think that's on you. There's no excuse. How hard are you trying to get in there? Because I think that's a unique part, right. You can't do this with every single line of business and have it be profitable or have it as innovation. I think payment integrity's setting the ability to do that.



You're the champion for payment accuracy

Payment accuracy is the perfect intersection between analytics, technology and operations. As the CIO, you can arm your most innovative business unit with the most innovative technology. This gives you the ability to drive unique thought leadership for your company.