Bringing it All Together to Lower Healthcare Costs

How does someone go from a self-described kid building forts in the woods of upstate New York to a robotics engineer at NASA to a CEO focused on customer experience in the health insurance space? On this episode of Mastering Innovation on SiriusXM Channel 132, Business Radio Powered by The Wharton School, Zipari founder Mark Nathan describes the creative thread that connects the many and various points of his career. He explains why providing consumers more information is key to bringing down healthcare costs in the U.S., and lays out the team-oriented approach he takes to innovation in his company.

An excerpt of the interview is transcribed below. Listen to more episodes here.

Transcript

Saikat Chaudhuri: When you talk about cost, are you talking about the cost for the consumer going down, or are you also talking about the cost of all the other players in the system, especially the health insurance companies, also being driven down in the process?

Mark Nathan, Zipari
Mark Nathan, CEO of Zipari

Mark Nathan: The others will also be driven down, but the goal is that if we want consumers to make the best decisions, we have to provide them with the most information so that they don’t just Google “MRI” and go to the closest place. It’s very complicated: cost transparency, what’s in network, what’s out of network — it’s way too complicated. If we can help the consumer understand from a cost perspective what’s going to be best for them, it’s going to have a ripple effect back through the system. When a consumer is unknowingly purchasing procedures that are very expensive, it’s expensive to them, but it’s generally expensive to the entire system as well. So it’ll start moving everything in the direction that’s best for the consumer. And as a result there will start to become optimization. This is the big, broad picture that we see. This isn’t something that just happens overnight.

Chaudhuri: Absolutely. That’s the point that I wanted to ask you about. There are so many different players and stakeholders and I dare say a lot of incentives that are at play in the healthcare system. Do you envision yourself working with other partners, perhaps in an ecosystem format, in order to really make a dent?

“We believe that the answer is getting the right information into the hands of the consumer.” – Mark Nathan

Nathan: Absolutely, Saikat. It’s interesting that you say that, because my background has been in technology, and there’s different systems and algorithms and patterns that I’ve built over the years while working at different companies. When I started Zipari, I had this idea that if you could really aggregate the data or the information from all these different systems, both internal and partners, and if you could bring all the consumer-related information together, then that’s when you can start making the appropriate recommendations. There’s a lot of interdependent pieces of information necessary to make the right recommendation to the member.

When we set out to build that technology, we quickly learned that we can’t just go to these enterprises, these very large health insurance companies (and the small ones as well), and say, ”Hey, why don’t you buy this technology?”

That’s what ended up leading us to create the member portal, and the mobile app, and a broker portal for brokers to generate quotes to sell health insurance to different companies. That’s when we built the call center technology and all of our different products. Our products support this core algorithm, which we call our CX engine. So for instance, we have a health plan in southern California. (We have about 20 health plans that use our products.) And in the one in California, their nurses were getting lists of members that had a prescription adherence issue, so they didn’t refill their prescriptions. And they were Medicare patients, so older members who typically might have chronic or comorbidity issues, or just complex cases taking many medications.

Of course, all of these nurses were calling patients. And nurses are expensive, and that’s not their core competency to make phone calls. They were spending all this time, and getting voicemail and all that. So what we did with our call center software is when the representative of the health plan answers the phone and they answer the [member’s] questions, then at the end, they say through our recommendation notification, “Oh, by the way, I noticed you didn’t refill your prescription. Can we find a pharmacy that’s closer to you, or send a mail order, or maybe speak to a pharmacist about that?” So this got those expensive nurses out of making phone calls when they could be doing things that could really improve health. And we ended up closing 4,000 gaps a month just through inbound on a very small health plan there.

That gives you an idea of why the products are so important, and not just the algorithm. We also partner with dozens and dozens of other products that interface with the consumer, whether it’s a nurse chat or care management or disease management. Our goal is to help health plans understand the consumer at every touch point. Whenever that consumer is interacting with the health insurance company, we want to understand that so we can improve that experience.

About Our Guest

Mark Nathan is the founder and CEO of Zipari, Inc. and has been featured in Forbes, The New York Times, The Wall Street Journal, TechRepublic, Crains, and other well-known health, business, and technology publications. Mark began his 25+ year career as a robotics engineer at NASA and spent half of his career leading the modernization of customer experience at Guardian, one of the largest insurance companies in the nation. The other half of Mark’s career has been dedicated to developing enterprise-level, consumer-oriented technology for large consumer brands, like Apple, Disney, and ABCNews.com. 

Michelle Eckert is Marketing and Communications Coordinator for the Mack Institute, where she works to engage students, researchers, and corporate partners in opportunities for collaboration. Michelle received her B.A. in Art from Valparaiso University in 2007. Her background includes two AmeriCorps terms of service working to teach mathematics, computer literacy, and job readiness skills to out-of-school youth in Philadelphia, focusing particularly on promoting access to post-secondary education.

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