What if you could crack the code to healthcare’s most complex data challenges? In this podcast hosted by Chenny Solaiyappan, Virtix Health Vice President of Payer Strategy and Success Tom Shankle will be speaking on transforming payer operations through clinical data innovation. Tom shares his unique journey from weather forecasting to healthcare leadership, offering insights into how standardized data exchange can revolutionize patient care and healthcare operations.
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Show Notes
- Tom Shankle’s career journey began with atmospheric science and transitioned into healthcare leadership
- Clinical data acquisition is crucial for accurate risk adjustment and quality measurement in healthcare
- The current healthcare data exchange process is complex and inefficient, requiring manual record retrieval
- Medicare Advantage pays out approximately $540 billion annually through risk adjustment calculations
- Health plans can lose entire margins if star ratings drop
- The Trusted Exchange Framework (TEFCA) aims to standardize clinical data exchange across healthcare networks
- Providers spend significant time and resources responding to medical record retrieval requests
- Digital quality measurement is expected to replace manual record collection by 2025
- CMS is planning to audit and potentially claw back billions in payments from previous years
- Entrepreneurs should focus on solving specific niche problems in healthcare rather than attempting comprehensive solutions
- Patient experience should be the primary focus when developing healthcare innovations
- The current healthcare data exchange involves complex interactions between payers, providers, and vendors
- API integration and standardized data formats are key to future healthcare information exchange
- Health information networks (HIEs) currently struggle with non-standardized data collection
- Veteran Affairs is committed to implementing standardized data exchange through TEFCA
- Aspiring healthcare entrepreneurs need mentors and industry guides to navigate complexity
- The average Medicare member requires 1.5-2 medical record retrievals
- Providers are increasingly hiring third-party vendors to manage medical record requests
- Venture capital in healthcare is becoming more challenging with reduced “easy money”
- Future healthcare innovations must prioritize reducing administrative burden and improving patient outcomes
About the speaker
As Vice President of Payer Strategy and Success at Virtix Health, Tom Shankle leads his team to modernize health plan operations and improve overall health outcomes for Americans. He leverages his 15+ years of experience in HEDIS, Risk Adjustment, and payer-focused consulting to guide health plans through the ever-evolving complexities of managed care. He is a a trusted partner to over 100 health plans nationwide, playing a key role in helping payer clients enhance operational efficiency and financial performance. He has worked in many areas of healthcare and his diverse experience brings a unique perspective to Virtix Health clients. He has seen healthcare from many angles- from selling commercial health insurance, to delivering QI, RA, and MRR solutions, to consulting, to providing frontline virtual clinical support during COVID, and most recently he led a member engagement startup. Outside work, he is on the American Diabetes Association Leadership board, supporting the ADA’s mission in the DC, Maryland, and Virginia regions. He holds a Bachelor of Science in Atmospheric & Geographical Information Science (GIS) from Salisbury University.
About the host
Chenny Solaiyappan is the Director of Product Management for Cognizant Trizetto's Government and Quality Solutions, and a founding member of the ClaimSphere suite of products, encompassing quality, HEDIS ®, CMS Stars, and clinical solutions. An accomplished Intrapreneur and Lean Startup Practitioner, he plays a pivotal role in shaping the overall product strategy and serves as the HL7 DaVinci Business Co-chair. With a notable track record, Chenny has provided consultancy to over 30 health plans across the nation, consistently raising Quality and Star ratings in Medicaid, Medicare, Federal Employees Health Plan, and Commercial health plan sectors, collectively supporting 30 million lives. His outstanding leadership and innovative contributions have earned him prestigious awards, including the 2023 Top 20 Global Product Manager Award by Products That Count, as well as the 2021 and 2019 Product of the Year awards by Cognizant Trizetto.