This week I am talking to Pranay Kapedia (@pranayk), Founder and CEO of Notable (@notablehealth) a company that is taking the adjacent possible from the finance (Intuit and Turbotax) and mortgage world of customer service and bringing the technology to bear on the beleaguered healthcare system.
Scars and Skills
As he described it he has taken the scars and skills from these industries and complex interactions that have much in common with healthcare and applied the learning to improve healthcare. As he describes the shocking statistic that more than half of calls made into healthcare are about scheduling, and that does not take any account of the outbound calls that are not tracked.
You can read all about their announcement from HIMSS “Intelligent Scheduling from Notable Aims to Eliminate Call Centers From the Health System” that takes on the challenge not just of inbound calling but the much more complex follow up and coordination especially with specialty care.
As I shared my own personal experience was filled with frustration as I tried to schedule an investigation only to be sent a message that my long awaited appointment had been cancelled because my pre-authorization had not been received. This is the kid of problem Notable is solving for proactively and automatically reaching out to patients to ensure appropriate appointments are scheduled, matched to the right clinician for that patient and their needs.
War on Call Centers
Listen in to hear how their approach tackles the entirety of the continuum of care from the first time you actually look for care and need to actually see your provider all the way through proactively monitoring follow up appointments, investigations, test and insurance authorizations. As you will hear Notable sees the days of the call centers for healthcare as a piece of history to be replaced by intelligent technology that makes for a better friction free experience
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Pranay Kapadia. He’s the CEO and co founder of notable Panay thanks for joining me today.
Pranay Kapedia
Thanks so much for having me.
Nick van Terheyden
So if you would, you’ve got unusual background, certainly from a healthcare standpoint, I think there’s a lot of relevance to our discussion. Tell us a little bit about that journey, and some of the companies that you’ve had the fortune of participating in, and how you ended up here.
Pranay Kapedia
Sure. So I started out being an engineer, engineer by training from Madison, Wisconsin, lambda badgers. And I found myself finding the need to tackle incredibly hard problems and sat at the intersection of heavy compliance, lots of workflow. And a lot of red tape. It started with FinTech and finance. And working on products like TurboTax. QuickBooks, mid comm Quicken. I have a terrible mortgage experience, and so dedicated years of my life and transforming the mortgage industry. And if you’ve applied for a loan with banks, like Wells Fargo US Bank, you’d actually utilize products and platforms that we’ve actually built in changing what used to have a net promoter score of negative 70, which is close to cable companies to actually being something that is transformational and had a net promoter score of plus 70. After years of doing that, my family of physicians actually complained about being the highest paid data collectors in the world. And when you look at health care at large, I was struck with how manual the operations from the front desk to the back office were Dr. deck we actually call him as a patient from the time that you call in to the time that you get a bill, there’s likely between 20 and 35 sets of hands that have actually touched that data, despite the digitization of health records. It’s insanity. And the physician and the caregiver was at the core of it all. And so we started notable to help health systems and caregivers thrive by digitizing their operations, such that they can now tackle some of the hardest industry challenges. And those challenges exist across the continuum of care, creating friction for patients at every single point, whether it’s helping them acquire patients, whether it’s competing with the digital upstarts as patient expectations are changing in their markets, whether it’s ensuring that every patient gets personalized care, in a consumer framework or consumer like mindset, or in the era that we live in health systems that are trying to tackle those problems, dealing with it with the most critical staffing shortage that the industry has ever seen. And so what noteable does is provide the technology via our Intelligent Automation platform actually solved those needs for health systems.
Nick van Terheyden
So first of all, I didn’t know that net promoter scores went negative. So thank you for that indication. I guess I’m fortunate enough to work for companies that haven’t had that problem. So that’s a discovery. You know, you identified one of the things that we saw, not just in the paperwork in the backend, but that was also true in the hospital. One of the surveys that I did very early on in my career was the number of touch points with a patient in a 24 hour period, we did time emotion studies, and it total up to over 130 people that visited a patient in their room. And, you know, that was shocking, I think to many of us that you go really that’s the kind of interaction and I think you’re seeing the same with the whole process that goes through to sort of create this interaction that you know, at its core is relatively simple. You know, you examine the patient take a history, but to get to that point, there are so many contributory parts. So notable has sort of taken an automation approach, you’ve clearly got experience, you took something that I don’t know if it’s comparable, and you’ve obviously got the experience to talk to this. I I certainly feel like the mortgage experience is complex. I don’t know if it’s as complex what’s the similarities and what did you benefit from in that?
Pranay Kapedia
There are times where we pinch ourselves on the similarities now there’s a lot that is different But there are three stakeholders if I could simplify the the world of lending at large, it’s a consumer. It’s a banking system, and it’s an investor who’s actually backing that loan. The consumer goes through a variety of steps to prove they are who they say they are to prove that they can actually pay back what they’re asking for. And to prove what they’re actually buying is worth what they’re paying for. The bank, are the lenders collecting that data, packaging it, sending it back to the investor to say, here’s the loan, will you approve it? Let me pause for a second. That’s almost exactly how healthcare works. There’s a patient who’s actually they’re not trying to buy anything. Yeah, they’re trying to take care of themselves, that they still have to go through. Are you who you say you are? Can you be paid for via insurance in some which way? And what is wrong, which is is the collateral we are the collateral in healthcare. There’s a health system that’s trying to collect all of that data on you to try and figure out and identify, do I have all the right information to provide you with the best care, and then will it be paid for on the back end. And then there’s the payer, who’s actually providing all the rules that the whole system is trying to abide by, to provide the best care, just like in lending, those incentives do not align.
Nick van Terheyden
You know, I, without you sort of running through that it would never have occurred to me, even though I’ve been through the mortgage experience, and you know, struggled with all of that. But those similarities are striking. And obviously, you managed to smooth out that flow with automation with technology, you’ve now taken that experience. And based on the recent announcement, you’re applying this in, you know, some pretty important waits ways that, you know, are going to impact that experience. And we’re not just talking about the primary interaction with patient and provider. But going beyond that, and starting at the first interaction that we have with the system, which let’s be clear, has got to be one of the most frustrating experiences for anybody that lives in the 21st century, we sort of check our, you know, usual experiences and say, Oh, no, it’s healthcare, everything’s different, right?
Pranay Kapedia
It is, this is why we’re so excited about this release, and why we’re so excited about the new addition to the notable platform, you know, intelligent scheduling that can help systems allow patients to book appointments with the right caregiver be matched with the right caregiver. But what’s key about it, is witness. We’re not just saying you can now book electronically. Our goal here is to eliminate call centers from the entire American healthcare industry. Think about it for a second. When was the last time you as an individual called a travel agent? Setting up a flight is hard. It’s actually digitized operations. It’s consumer friendly, where my parents, my grandparents, actually do it without a phone call. And we still have to say no to a ton of upsells and added points and whatnot. But it’s hard if you actually step back and think about it. And yet, we live in an era where 55% of all calls in a call center for health care are tied to schedule that needs to stop.
Nick van Terheyden
That has to be the lowest hanging fruit on the planet, in my mind that the idea that we’re over half of that activity is about scheduling. And there’s nobody that I know, I mean, maybe the the sort of the silent generation might prefer that interaction by telephone, but most don’t. Why is that the case? Why are we still there?
Pranay Kapedia
There’s two problems that we’ve actually seen. And you could actually break it down into there’s an inbound problem of complexity. And then there’s an outbound problem of just knowledge. The inbound problem, it turns out, is actually tied to patients are unaware of how to even get to Self Scheduling. Try going to your health system today and figure out how you can do that. It’s faster to get there with Google by putting in schedule Add your health system than it is to actually navigate the websites. Right? There’s another issue on the inbound side, where turns out about half of all of those calls that are actually coming in are tied to specialty scheduling. And now this is a really hard problem to tackle. Because those specialists that actually tried to open up their schedules would actually have patients booking the wrong appointment types. So we’ve had, you know, partners of ours before actually working with notable where they actually were a foot and ankle specialist, but they actually had a patient self schedule, as soon as they opened up their schedules for shoulder injury. And they’re like, Well, this is a waste of time for everyone, I can’t actually help this patient. And so there’s been this anxiety to turn things on, in certain ways for the inbound. And on the outbound side. What’s actually really interesting is, I actually there’s one more thing on the inbound side, that’s really crucial, all the existing point solutions that actually help this today, collect information from you as the patient and then drop it into a work queue, you still get a call, Hey, can I just validate your insurance information? Can I validate your address, can I and so you still have this manual touch point, even though people think they’ve solved online scheduling. So that’s the inbound problem. On the outbound problem. This is the one that actually surprised us the most. No one even tracks it, no one knows how. And everyone’s focused on the upside on the upfront issue. But it turns out 80% of scheduling actually happens after that first appointment, for follow ups, for orders. For follow ups that you didn’t follow up on, there was an x ray that was scheduled that we know you haven’t come back in for, for care gaps, where we actually know you need to come in for a Medicare annual wellness exam, but it hasn’t been scheduled. And the way that those are tackled today is another work queue. For somebody to actually in a health system, pick up the phone and call you. The crazy part about it all, is with all the new operating systems. on phones, nobody’s answering phone calls anymore, go straight to voicemail. And so that’s the part that you know, we’ve actually seen with our both with our research, how we think about it. Our approach to it is the only solution that actually tackles the entirety of the continuum of care from the first time you actually look for care and need to actually see your provider all the way through proactively monitoring. When you need care, automatically reaching out to have you scheduled with a specialist checking to see if your prior auth is actually been status correctly. And then having you scheduled your one of the examples that we actually saw in our research was there was an inordinate amount of patients that were queued in work queues waiting for the prior odds to be saddest. Even worse, 20% of them had actually scheduled and now needed an outbound phone call to reschedule because the prior author was not had not been approved yet. Now that’s a terrible experience for the patient because they’re just going to go somewhere else, or at least try to. It’s a waste of resources for the health system. And it’s a job that is perfect when automated well. And so we are the only solution that can actually support the inbound and the proactive outbound while eliminating the need for staff work.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Pranay Kapadia, he is the CEO and co founder of notable we were just talking about the outbound half of this or I say half, it’s probably actually more we don’t know what the content of that and, you know, I’ll just tell a personal story. I had this whole experience with prior auth. I had something scheduled. You know, I had navigated around actually getting that appointment, which was a difficult process in its own right. And, you know, had booked all of my work activities so that I could accommodate that. And then I want to say a day, two days beforehand, I got a call. I didn’t get a call. I think I got a text, you know, it was all calls previously, but then I got a text and say, You’re canceled. I’m going, why. And of course I follow up and it’s prior auth it hadn’t been ordered. I mean, you you could not have found me more frustrated, more angry about the healthcare system. And it sounds like this is exactly the kind of problem Blum that you’re solving. So if you would tell us how notable goes about this and what’s going on behind the scenes to essentially fix for that.
Pranay Kapedia
Now, absolutely, there’s one one part of your story that I just want to call out and illustrate connect back to the the difference between finance and healthcare and a big, big, big in a big way. When it comes to lending, you’re actually purchasing something that you’re excited about. When it comes to healthcare. It is emotional, emotionally charged, from a consumer perspective, from a personal perspective. And the outcomes can only be drastically bad if you wait. And so we’ve had to actually think about what that looks like. And so how we solve that it actually starts with thinking about the consumer experience, thinking about how they engage, how they learn about things, and then designing the interface for patients. That is something that we can be proud of. That is second to no other industry. You know, we’ve actually seen patients, over eight years old, we’ve seen patients that are visually impaired, being able to access our scheduling solution using VoiceOver assistive technology and schedule appointments. So it starts with the patient in mind. The second part of it is thinking through the deep workflows for every specialty. For every type of patients, if you’re actually scheduling yourself on the front end, you actually need to be able to find how to schedule on a Health Systems website easily we help with that. You need to be able to use search, and not know whether you actually need to see an oncologist or an EMT, you should be able to start with your problems and get routed and matched to the right type of caregiver. Once you are matched, there’s actually a variety of things that we actually need to check. Are you eligible to see this caregiver? Have you fulfilled the need so as an example, you don’t, you might not want to see an orthopedic surgeon, if you haven’t actually gotten an x ray yet, might need to schedule the X ray, so that you’re matched with the right provider, all of the prerequisites have been provided for such that the time that you do spend with that physician, that caregiver allows for the highest bandwidth conversation for both parties. That’s the front end, on the back end, it’s proactively monitoring populations, and proactively mining to see to check for orders that may have been placed that actually need a follow up visit scheduled to check for referrals that may be coming in through a fax queue. We actually have digital assistants built that can actually mine through faxes to identify which patient this is matched with the EHR, and figure out if we should actually outreach to schedule to check prior odd statuses to make sure that patients are actually scheduling at the right time. And to support different types of care gaps in case you actually need care. Based on what we know about our best practices across the industry. The way that it actually works with existing technology is another key part of it, we’ve actually had to deploy not just using open standards and API’s, but working with the epics and the Cerner is and the other EHR is out there. They’ve been great partners to us. But also we’re API’s don’t exist, utilizing our own proprietary RPA robotic process automation, to actually be able to mine information from faxes from analog data in a way that can actually digitize this for patients, but also for staff. So deep, deep, deep understanding of the workflow, and then thinking through every single friction point, and applying technology in unique ways to actually solve it.
Nick van Terheyden
You know, someone reminds reminds me a lot of the process that occurred historically with some of the financial systems, there wasn’t all of these API’s. I’m, I have a sense that you learn some of this and are applying that RPA principle here into the healthcare. The question I have is around how you process that because to me, it doesn’t sound easy. I as a clinician, if I was talking to an individual and shepherding them through to get them to the right place right to eight, you know, I’m not sure that I would be able to do that efficiently. But you clearly are, you’re pulling in much more than I potentially can. How are you going about how you training these systems?
Pranay Kapedia
Yeah, that’s a great, great question. Definitely a lot of insights coming from finance the way we actually connected TurboTax and mint and Quicken 260 100 different financial institutions was using RPA. Because there wasn’t an API that existed at the time that API’s were built over time. And we’re seeing the same happen with healthcare. So we’re super excited about that. When it comes to the actual mining of information, it’s actually what we find that’s interesting when you work with digital assistants and you work with bots, is there’s a lot better consistency. It doesn’t have to be blackbox. If it’s just like thinking for itself and going about doing things. But it’s actually consistent. If a physician is actually putting in a follow up, you follow up with me in four to six weeks. The way it’s actually done today is on the way out, or somebody on the front desk is actually looking at that, and then either asking you for it or calling you back, right, the way that we do it is the digital assistant just reads that text the patient on the way out to collect patients at on the visit, but also gives them the ability to schedule, all in one experience for that physician knowing that timeframe, because we can use natural language processing identify those things. So those are like looking
Nick van Terheyden
at the schedule for the in for the physician for the follow up and say, Hey, you’re four to six weeks out here are the ones I’ve got, can you pick one that’s exact, right. So you’re being pro, I mean, I gotta say, That sounds really exciting, because the other process is just woefully inadequate. I mean,
Pranay Kapedia
in doing these things, you’re just even with our early partners that we’ve actually, that we went live with that have been instrumental in helping us design these things, in a period of months, we’ve actually helped them eliminate up to 20,000 calls. Now, take that into consideration. 20,000 calls, the average time for a phone call is 8.1 minutes. That assumes you connect with the patient every single time or the patient doesn’t have a weight or you didn’t hit voicemail. That’s a ton of dead time. That actually frustrates all parties. And those are the types of results when we see that we see a patient satisfaction score of 97, we see the value. It’s amazing to see our health systems and partners and even their employees embrace digitization, because this isn’t a function that they wanted to do in the first place.
Nick van Terheyden
Yeah, I can’t imagine there are many folks that are sitting in a call center going I really want to do this outbound calling to follow up and leave messages that nobody ever listens to and struggles. I it’s just, it’s It’s extraordinary to me that we’ve gotten this far into it. And still not fixed that, but exciting that there’s potential and you know, clearly a solution that helps. So if you would tell us what you’re excited about for the future, and you know, what else is coming? Because it feels like this is just the tip of the iceberg.
Pranay Kapedia
You know, I won’t give away future product, details and roadmap, there’s a lot more coming. What we are excited about with scheduling intelligent scheduling really is working with partners, the wage war against the call center, let’s eliminate the call center together. This is the biggest portion of it all. What’s most exciting is to actually partner with health systems that aren’t in the well, there’s going to be someone that still wants the phone call? And the answer is yes, that is likely. But so was the case with electric vehicles way back when. But you want to skate to where the puck is going. And that’s the path that we’re on. And that’s the path that we’re enabling with intelligent scheduling. And we’re incredibly, incredibly delighted with the early results for it as well as what’s to come.
Nick van Terheyden
Well, I’ve just got to say exciting times I wish would have been available six months ago, if I could have had that experience, I certainly would have been delighted to I you know, agree with you wholeheartedly that the the process is so frustrating from both sides. This is not, you know, just patient saying this is not great. This is the people delivering the service who are frustrated with the experience. And, you know, you talk about the call center, you know, they have positive contributions, but they want to be doing it in a way that actually delivers value as opposed to just leaving messages and you know, interacting with essentially non existent in engagement. So, this is an exciting time. Congratulations on the announcement. Thank you for taking the time to speak with me. We’ll be looking forward to seeing Progress and getting an update in the future unfortunately we’ve run out of time so it just remains for me to thank you for joining me on the show Pranay thanks for joining me
Pranay Kapedia
thanks so much for having me
