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Thought Leaders in Healthcare IT: Carol Clayton, Relias (Part 3)

Posted on Wednesday, Jan 30th 2019

Sramana Mitra: How do you charge your clients?

Carol Clayton: If you are a provider agency and you’re going to buy a performance solution like Relias, we’re going to look at your enrolled population. It’s generally because in those arrangements, the provider is being paid per member per month (PMPM) to manage that. 

We generally charge a PMPM fee for the use of the solution. It is basically some percentage of the PMPM fee that they are receiving to manage that population. We understand what they’re receiving at the PMPM model. A percentage of that comes to Relias. When we show them the savings, we’re also showing them a return on investment, which is generally from a 2:1 ROI up to about 10:1.

Sramana Mitra: Got it. What are the open problems? In what you’re doing, what kind of open problems do you see?

Carol Clayton: There are a couple of things. I’m going to start with data. One challenge that occurs in the field is that obtaining data sources to fuel a performing solution can be challenging. You need paid clients’ data in order to do a retrospective look, predictive modelling, and trend analysis. You also need clinical and more real-time data that is close to point of care in order to address the individual consumer. A provider organization in these models needs those. Paid claims data sits over at the payer. It’s at the insured company.

Any of these models require payer and provider collaboration. In the field, there’s not a lot of history of trust to do this kind of data exchange and data transparency. On the real-time, what you often get is incomplete data. It tends to be less robust, less reliable because there’s a lot of human error. That would be one big challenge any entrepreneur who gets really good at data ingestion of multiple types of data and being able to do it really fast and then turn it into actionable information.

It’s a great place to be in terms of investments of opportunity. Another place I would go is the level of competency. It’s a skill and competency issue even if you have the data coming in and you have it stood up in a tool. People don’t know what to do with it when they get it. In this phase in healthcare, selling a tool as a technology vendor, people don’t have the competencies in the field. They need structure.

Sramana Mitra: I see what you’re saying. One of the trends that we are seeing is this model of do-it-yourself versus do-it-for-me. You’re talking about the latter where you need expertise to be able to run the tools. Just giving tools is not adequate. You’re saying that you need people who understand how to do this. SaaS is not enough. It needs to be software-enabled business process outsourcing.

Carol Clayton: It does. I totally support that. It’s another kind of vulnerability in the field. There are large organizations who think it’s a do-it-myself thing. Then they find themselves pretty limited because they don’t have the technology chops or resources. They are more service-oriented to do it themselves. If you are purchasing a tool through a vendor, you also don’t have the chops to know how to turn it on and use it. It’s a business model change. It’s not just a technology. It’s driven by a change in how you do work related to value-based care. You captured it really well in your words.

Sramana Mitra: Great. Thank you for your time.


This segment is part 3 in the series : Thought Leaders in Healthcare IT: Carol Clayton, Relias
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