In this episode of HealthBizTalk, host Tony Trenkle sits down with Tom Degemis, Chief Growth Officer at Onyx, to explore how FHIR-based interoperability is reshaping the healthcare landscape. With deep roots in finance, tech, and healthcare, Tom offers sharp insights into the evolution from X12 to FHIR, the future of clearinghouses, and how real-time data can ease administrative burdens. He also reflects on the promise of value-based care, blockchain in pharma, and empowering consumers with a unified longitudinal health record. Don’t miss this forward-looking conversation packed with strategy, policy, and innovation.
Transcript Of The Podcast
00:00:00 Intro
Welcome to HealthBizTalk. The industry’s leading podcast that brings you today is top innovators and leading voices in healthcare, technology, business and policy. And here’s your host, Tony Trenkle, former CMS CIO and health IT industry leader.
00:00:16 Tony
Hi, welcome to another edition of HealthBizTalk. I’m Tony Trenkle, and I’d like to welcome our guest today. Our guest is Tom Degemis. Tom is currently the Chief Growth Officer for Onyx, a position he’s held since February of 2025. Onyx is focused on providing fire based interoperability solutions for healthcare payers, providers and others in the ecosystem. Tom is accomplished executive leader with a wealth of experience and senior positions in the healthcare, finance, banking and technology sectors. His experiences included working with prominent healthcare and financial services companies such as Oracle, Cigna, Aetna, Cardinal Health and State Street. So Tom, welcome to the podcast and looking forward to some interesting conversations so.
00:01:09 Tom
For sure great to be here and thanks for inviting me to the discussion.
00:01:13 Tony
Thanks. So first, I tend to ask people, how did you get to where you’re at today? What was your background? What are some of your interests? How do you kind of, how did you kind of evolve to be the Chief Growth Officer at Onyx? I know you’ve had worn a lot of hats during your career, so I think it’d be interesting to the listeners to get a little bit more about your background other than my 22 second intro that I gave a few minutes ago.
00:01:38 Tom
Sure thing. So thanks again. So I I’m a finance guy by trade, believe it or not. And so I have worn operational HR and now growth hat in my career. So to me, you know, for my career, what’s, what’s been notable is every good business model or business entity starts with, you know, does it pencil? Does it create value? Like does it hit the target on what you’re trying to do? I started in public accounting and consulting. I did some advisory service consulting there and, and you know, now I’m a growth officer. Go figure how I got to this in my career. But so I, I’ve moved and this is where I think when I look at my career, I’ve moved fairly frequently both within companies and different jobs. And then I cross companies and even in some instances, as you mentioned, across industries. The way I go about kind of looking at, you know, my career is I do everything like a one year free agent. Am I having the impact I want? Am I having fun? And the rewards usually follow. So I’ve taken roles where, you know, it’s a sidestep or a step back to gain some experience doing some other things. So that’s kind of helped shape me. The other thing that I think it’s really helped shape me is both I started early days in public accounting, you know, so you’re going from engagement to engagement. And then I left that and I went to actually Cigna and I was in the financial development programme, which really by design rotated people around, ended up running it. That was my stint in HR. So I came out of the programme after five years and then end up running it. So I’m kind of used to change and so for me it’s more about the problem and, and kind of what are you attacking And, and if the challenge feels right, then I’m very willing to raise my hand and say I’ll take a crack at it if you want me to take a crack at it. So that makes sense.
00:03:34 Tony
That makes a lot of sense. And you know, asking you questions is, is so enticing because you have worn so many hats, you’ve been involved in so many areas. But one of the things that that I’m been into a long time is the whole area of the healthcare interoperability. I got involved in a lot when I was at CMS and when I was joined IBM after I left CMS. So you of course been involved in healthcare interoperability from for many years and a lot of it was been on the finance side. And I know for many years we’ve had EDI X12 transactions worked very well. I, I would kind of call them kind of like, like the COBOL of, of, of healthcare because they’ve really been the, the glue that’s, that’s held it together in a lot of ways. So now you’re in a new role with FIRE and looking at that from not only a clinical side, but also to bring fire into a lot of other types of transactions as well. So I guess a question I have is, you know, where does fire fit into this overall area? When I say overall area, I’m really looking at the admin business side as well as the clinical side. And then how do you think it changes the traditional methods, which for the most part I’ve been, you know, fairly to me, I’ve been pretty successful. We’ve handled it’s CMS, we handed billions of transactions a year using X12. So it’s not like it didn’t work in the past. So what do you see as you look at the interoperability space today from your new perch at Onyx?
00:05:14 Tom
So interesting times and part of the reason I took the role. So like you said, NCX 12 pardoned works kind of a workhorse, the EDI gateways. I do think 1 interesting observation I’d make to my most recent job at Oracle is I think that was when Change Healthcare went through some of their issues. I think it was a big wake up call for some of the clearing houses and just how that whole ecosystem operates. I think like you said, the code set and you know X12 transactions is very good. So now enter the role of where fire is going, where I think CMS is really trying to move the needle in a big way and in a progressive way, right? We’ll see how this all starts to burn in when prior auths go there. But I think what it does, it actually complements. And then I think use cases will start to emerge because what you’re going to see is just to use the old X12 transaction code, set the 278 while it’ll still be used, you’ll see a less reliance on it as we move to fire. And so that’s where I think you’re going to start to see new use cases emerge. I think the clearing houses will be around, around for a while. So the gateways, but I think over time it’ll change. And then the question is less reliance in certain areas, some reliance on on others will continue into the future for quite some time. So big picture here from a fire perspective, just to kind of talk about it from an ecosystem, what I see happening, not not payer provider, but more like who it benefits. So you know the doctors, right, We have very fragmented data, the whole CMS 0057 initiative that is really going to start to break down some of that fragmentation and really provide kind of that longitudinal record. So you’ll see docs be able to work more seamlessly without gaps in data or having time to grab data to do certain things. I think consumers, you’ll start to see continued proliferation of consumer tools where they can see their longitudinal health record. And candidly for me going through the process with my parents when they were ageing, it’ll help actually those caregivers as well. I think the technology will really drive toward new standards. And when you think of very API centric, you know, the prior auth, the patient access API, the provider access API and the pair to pay or there’s some there’s some really good stuff that’s underneath the hood now. So I think like I said, it’ll be the next evolution of where does antsy go to Antsy will stay around because some people are not going to be able to change out to the new technology until it’s further adopted. And then the other thing that I think is really good about what Fire’s doing, what CMS is doing is the metrics. I think it’ll be the first time you’ll get to see kind of performance metrics around why were you denied the prior auth or power, Like what are people’s stats around those metrics which gives transparency to how it’s working. Like I said, I think there are some roadblocks. I think there will be some smaller payers or providers where they just don’t have the funding. So you know they’ll still be able to use next 12 until the day comes. I think the government and state of Medicaid will start to or is funding some of the shortfall. And then the other thing I think that’s really good about fire here is when you think of the I GS, I think it’s really been well done when you look at how, yeah, how the data format, the security protocols and the process hangs together. So I think it’s a really positive step forward that will start to give us more transparency and more, I’ll say lineage of everybody’s kind of particular situation. That makes sense.
00:09:07 Tony
Yeah, it makes a lot of sense. And, and actually you’re, you’re discussion led me to a couple other thoughts around that. I I think to me one of the key advantages that fire can give you also is well, you know, the traditional X12 was really heavily focused around administrative.
00:09:26 Tom
Transaction. Financial settlement.
00:09:28 Tony
Financial settlement, administrative transactions, and it was also really focused around certain types of data. But now we’re in a world where we not only have clinical data, we have social determinant data, we have, you know, wearable data. We have so many new sources of data that that that really X12 was in these and the standards weren’t set up to handle that. And I, I remember, you know, when we got in some of the areas and we’re looking around claims attachments and how difficult that was to, to kind of tie that to The xx 12 world. And so I, I think, you know, the flexibility that it gives you with all these new types of data that are coming out is, is another thing. It seems to me that fire has an advantage. I don’t know what your thoughts are.
00:10:16 Tom
Totally agree. And I think when you the the G10 piece of the regulation with the 29 resources determinants of health and counter data, it makes the the holistic record, not just the kind of the eight 37835 settlement piece, the 272 it, it rounds everything out so that both the consumer and the doc have the better picture. Plus it will it will close gaps where you’ll speed up in near real time. What do I need to get this approved? I submitted this. All I need is this and this. And if I have that information in near real time, you won’t be waiting, you know, and The Reg mandates that there’s a certain period of time they have to do with them. But I think it’ll start to accelerate kind of the, the speed at which somebody gets and gaps in care will start to get eliminated. There won’t be the the timing. So I think it does a great job adding value to the the existing framework, which is like you said, more administrative in nature.
00:11:10 Tony
And I think once we we get the CMS Reg once it becomes operational or really start to see a lot of change in the way prior authorizations are done.
00:11:20 Tom
Probably.
00:11:21 Tony
Probably even eliminating them. And when you add in, you know, AI and RPA and some other areas, it’s, it just seems to me like we could really cut the amount of of prior also and certainly the time by quite a bit.
00:11:38 Tom
Materially and, and actually one of the things that Onyx that we’ve seen is when we just did some simple modelling and what if there’s a lot of times auths are created just in case. So they’ll submit them. And now instantaneously we can cut those off. And we’ve kind of said there’s probably 40 to 60% of offs that may be submitted just in case today that actually will be just separated from that workflow, which is a huge, a huge lift, right? So, so wait, administrative waste of time. And this is that’s an area where there’s a point of pain in the doctor’s office.
00:12:13 Tony
Oh yeah, believe me. And. And for the and for the for the patient as.
00:12:18 Tom
Well, everybody involved.
00:12:20 Tony
Everybody involved well, that’s, this is great time. I, I’m going to kind of switch a little bit here. And because a few years back we were all talking about another new way of improving transactions and and back end and it was called blockchain. And I know you got heavily involved in it. When I was at IBM, it was, you know, we had staked a lot on the future blockchain and you know, it seemed to offer a lot because of the security, Providence tracking, technical non repudiation, obviously financial settlement. And you know, we all said, well, it’s going to take a while to get it up to speed. But in a few years, this is how it’s, you know, pick on the finance area. This is the way transaction can be done. They’re going to be all blockchain enabled. Well, here we are today. Obviously that’s not the case. So what do you think? Where does it stand today in healthcare operations? And is it a part of the future or is it something that you think was a a time and moment type of technology that now we have easier ways to to do to achieve the same outcomes, I guess?
00:13:36 Tom
Interesting question and I’m going to answer it with it depends. And, and it’s interesting to ask that question because I actually have seen it from 2 dimensions, a piece through the healthcare side and a piece when I was at State Street from the banking side. So let, let me give you a little bit of couching here and then. So, so I think it’s still nascent in healthcare and I think it’s because the use cases, you’ve got to find the right actors involved and the use cases involved. But I’ll give you a couple examples. So I, I, I, I in the healthcare sense, I would say it’s nascent currently where I’ve seen it done. I, I was working at a payer client at one point and there was a lot of work around real time claim payment. And so where, where I’ve seen most of the use cases in healthcare, it’s really around financial settlement, the 835, right? Because it, you can really weed it out. Now you could argue as you further that if you were to get the provider networks, the claim contracts, all on smart contracts, it could be a quantum leap forward. I just think there’s so much technical potential challenge to that depending on the use case. There’s also data security challenges and there’s also performance challenges to pay upon, you know how how scalable it is. So I think in healthcare, it’s nascent. I do think though with the real adoption now of Gen AII, do think you’re going to start to see more of those used kisses get teased out where it can be used. However, I will tell you in healthcare where I did see 11 instance of it work and I’m sure there’s multiple instances on a smaller scale where it actually works. But medi Ledger which is in the pharma space. So when you when you look at the space where you have basically settlement transactions. So when you think of the trading partners, pharma manufacturing company wholesale or PBM and what they did very effectively, and it was actually driven by a rag, I can remember the exact rag, they actually use it to create very accurate because once it’s in like the chain has to, to work and that so the smart contracts, they would settle and there would be no broken chargebacks. So it was clean. And the other thing that the the pharmacos liked about it was different. Pharmacos couldn’t see, even though they’re part of the blockchain, couldn’t see the other competitors terms because it’s, it’s, it’s, it’s private, it’s ultimate security. So it worked quite well in that instance and it was an interesting thing to watch take hold. But that, that use case was very specific and it, and it did it create a lot of value. I mean, I, I saw numbers like, well, chargebacks stop broken chargebacks and, and like they saved around 80% of the cost ’cause everybody had their own canister and it was actually extremely effective at tracking where the compounds were or where the, the, the drugs were. So seen it work. I think scalability and I think there’s regulatory compliance issues depend on how you look at it. So I, I see more, it’ll evolve in healthcare more in hybrid models or hybrid architectures. I I just, it’s going to be tough in healthcare because the system is so.
00:16:46 Tony
Complicated. One of the things I I saw where it did seem to work as well was in the supply chain. So like the medical supply chain, there seem to be a lot.
00:16:55 Tom
Of pharma. Pharma, that’s what that is.
00:16:57 Tony
One, yeah, is is the is the biggest one, but even even with food safety and some of the other areas being able to track.
00:17:03 Tom
Absolutely better use cases there than in payer provider land.
00:17:08 Tony
Yeah, exactly. I agree. Yeah, I, I, that makes sense to me. I, I, I think the same thing. And, and I also noticed that the government really has never at least certainly HHS and CMSFDA did a little bit of work and blockchain a number of years ago. And and I think they were looking at primarily like you said from the pharma standpoint, but CMS has never really gone really big into blockchain and I haven’t really seen payers really getting too engaged with it.
00:17:38 Tom
Yeah, I just, I just think of the old provider networking contracts piece and especially when you start to get into, you know, alternative payment models or value based care, the complexity in some of those contracts, they use a smart contract and set it up and get everybody to agree. I think it’s a pretty high degree of difficulty. I’m not saying it can’t be done, but the thing that may actually be the key that picks the lock is it could be Gen AI that helps standardise some of those use cases to figure it out. But again, scalability on the blockchain side, it’s it’s, you know, Ethereum, you know, isn’t, isn’t, it’s not like, I mean, think about the old IBM mainframes and X12. Those things chug very efficiently.
00:18:19 Tony
Exactly. Yeah. And and they and they did and and and and continued to.
00:18:25 Tom
Right, exactly.
00:18:27 Tony
Wanted to actually step back a minute as, as we kind of finish up this discussion on interoperability and I, I forgot to ask you, what do you think the future is of clearing houses? Because obviously they were, they’ve been a big player over the years and, and X12 was kind of one of the areas they really stepped in. They were even looking at blockchain for a while, and now with fire it seems to me that there’s an ability to really bypass the clearing houses.
00:18:55 Tom
Yeah, I think they’ll be disintermediated. I just don’t think it’ll, I mean, if you think of the amount of investment and the, you know, in between the payer and the provider and what the service they provide. I do agree that I think FIRE 278 is a good transaction to talk about. It’ll eventually not be running through any sort of EDI gateway and clearinghouse. So it’ll be all those API working across the ecosystem. I think the same thing’s gonna happen when you look at 27271, the claim data. Eventually they’ll start to dissipate, but you have to get everybody that’s in that ecosystem up to the same common standard. Right now it’s Medicare, Medicaid. So eventually when the commercial payers, but I think the, I think the clearing houses, their business model will be reinvented or disintermediated depending on how they do things.
00:19:41 Tony
Yeah, I think one of the pushes is certainly going to be the the government related claims work. I know Congress has been looking at trying to expand the prior author and fire to mandate hasn’t happened yet, probably won’t happen anytime soon. But I, I think from a business standpoint, it would seem to me it’ll probably evolve naturally once it becomes successful in the government son.
00:20:08 Tom
So we’re we’re seeing actually some of that where you know, we’re we’re selling Onyx OS into the arcade, the Medicare section of of commercial payers. We’re seeing some commercial payers that are saying we’re actually going to do it for, for the risk line of business for our commercial line of business right from the get go. So some of them are already actually thinking forward that way. They’re not waiting for the mandate because I think they know if it works, it’s supposed to work for everything.
00:20:35 Tony
Right, right. And, and, and that’s what we tried to do with CMS was we figured we had the demand pull and then the supply side would, would follow as we, we pulled the industry along. And it looks like that’s the way it’s going to work in this case. And I think companies like Onyx are certainly well positioned to to to help companies health, health plans and others to, to deal with that.
00:21:00 Tom
Yeah, exciting times. That’s why I’m here.
00:21:03 Tony
Yeah. Well and that and that kind of leads into the next area. You’ve been in a lot of different industries. You were in finance, you were in technology companies. Now you’re in a healthcare company. So what about the health space has made you most energised and why did you decide to move more firmly into healthcare and the business side of of healthcare as opposed to the finance side?
00:21:27 Tom
So, so for me, like I said in the beginning, like seeing a problem statement or a challenge and, and this is such a new burgeoning mandate in space, I saw it as a huge opportunity. And, and, and then if I think about it, I’m going to think about it from a consumer perspective. So I, when I was an Oracle Cerner, I saw it from the provider EMR perspective and it, it’s a point of pain period, end of story, prior auth, OK, or prior auth. And then from a consumer perspective, just the ability to have all your information required, know where the off stands, what’s the status and thing, things like that. There’s a real consumer angle to this that creates value. It takes cost out. If you’re, if you’re going to the right provider and the quality’s there, the value goes up, right quality the same or better at a lower cost. So there, there’s a huge opportunity to pull waste out of the system and friction out of the system. And to me that’s, that’s huge because you know, if a provider needs some historical data from another payer when they’re evaluating submission of authorization, whether they even do it, all that information is starting to coalesce together as part of this. So that that to me is a huge opportunity set. And and not going to lie to small business aspect is, is quite appealing to me. And then, you know, just taking a step back, when you look at just the healthcare spend in total in the USI think it was like 5 billion, and you know, you got a billion spent a lot.
00:23:00 Tony
Bigger than. It’s a lot bigger than 5 billion.
00:23:02 Tom
Yeah, well, I think like 3-4 years ago, I think that was the number I pulled. But I I sit there and I look at medical costs, 40 trillion, Sorry.
00:23:10 Tony
That’s I was going to say, I think you need to add a few more euros to.
00:23:13 Tom
That 555 trillion. So yeah, you’re right. I wasn’t thinking clearly. So 5 trillion in in the spend, you know, 4 trillion on medical and 1 trillion on admin. Well, if you look at some of the government based, you know, programmes, Medicare, Medicaid, their admin load is not 20%, you know, 1 / 5 trillion is 20%. So it’s, it’s really a way to drive more dollars going to the care side. And if you have the better information that longitudinal record for the provider, for the consumers making the educated decision and then you have and we’ll, we’ll probably end up talking about this at some point value based incentive programmes, you’ll actually see both numbers go down, which is that’s the well go down, they’ll at least slow materially and rate of increase. And so that’s a huge lever for all of us as U.S. citizens and consumers. It just means my health policy is probably going to be better for me and it’s going to be cheaper. So provide more value. Cheaper per unit cost. Or at least I won’t get large rate increases every year.
00:24:20 Tony
Yeah, I, I think, well, a couple things off of that. The value based care has certainly been the Holy Grail that we’ve been talking about for a long time. And it, it hasn’t, at least in my opinion, really hasn’t achieved the savings and success that had been talked about 10-15 years ago. There’s probably a number of reasons for that, some which I know, some which I probably don’t know, but I didn’t want to get on to that right now. I wouldn’t really wanted to. You’ve mentioned consumers several times when we’ve been talking and I wouldn’t have kind of get some of your perspectives and part of the problem I, I, I am a consumer. So you and I, I have so many portals now that it amazes me. And so I’ve got, you know, I’ve got a portal for my, my provider, my main provider, my specialists in everything. Problem I have is I’ve got portals for them. I got portals for the for, for Quest and LabCorp. I’ve got portals for advanced radiology, I’ve got porters for CMS for my Medicare and I I haven’t totaled them up, but I’m sure I’ve got at least a dozen of them and as long.
00:25:40 Tom
As your passwords aren’t all the same on every portal.
00:25:42 Tony
Well, fortunately a lot of them use facial recognition. So I guess I do the two factor that way. But, but, but the problem is, you know, we’ve talked a lot about use of APIs and fire and, and, and other types of techniques and technologies over the years. But it still seems to me when I get, at least for me personally, and then from what I see in my universe, it’s it hasn’t gotten materially better for the consumer. And maybe this prior auth Reg and the work around that will be the the the will break the logjam. But I tell you it’s it’s. It’s not fun to me.
00:26:22 Tom
Yeah. So I, I actually think, and if you look at the patient access API, right, and kind of the exhaust that comes off of 0057, I actually think it’s going to be the progression forward. Because I think I do think one of the things you’ll continue to see is a trend toward digitization, but one stop shop because if you’re on one EMR, on another EMR, depending upon your specialist versus your PCP, that information’s all in different fragmented systems. So this will start to push everybody together. Now where how does that get consumed? Does it get presented through my charts or are you going to buy a consumer tool oriented tool where all your information is in one place? But I do think that this rag will be the thing that starts to make a progression forward. You talked about it. You’re going to have different information, social determinants of health, other things. So it’s going to be a more, it is going to be that longitudinal record that if you can access it one place for me or if I’m my parents caregiver, that’s huge. Because then like you said, I’m not, I’m not going in for my lab results into Quest. I’m not going into my, my, my charts for my, you know, my PCP in my hospital. And then if I got a specialist that’s out of that, I’m not going into like 7 different portals. I think this could be the technology like the the mandate that actually starts to break those barriers down.
00:27:48 Tony
Yeah, I think that’s going to help. I also think if we build a wave of using shared credentials along with AI, you can, you can at some point use AI to kind of go out to all the different portals and bring it together for you. Assuming from a from a access standpoint, you can have it. Like I said, it either share some type of shared credential biometric or something allows you to do that and then that tied with the.
00:28:19 Tom
Ties them all together.
00:28:20 Tony
Exactly. And then and then with fire based standards, then the transactions can flow that that to me would be a vision that would be helpful. And I think not only for the private sector, but I push this in the government for years, is you have a lot of different government health systems you’ve got.
00:28:41 Tom
VADODEL, yeah.
00:28:43 Tony
Exactly, VAVADOD, you got the federal workers health system, you’ve got Medicare, you’ve got Medicaid, you’ve got a number of other smaller ones like Indian Health. And even if you could build or see a government health record to start with and then bring in the commercial, kind of like what we’re talking about here with with the fire transactions and APIs, it just seems to me that there’s now I don’t know who’s going to pay for all that. That’s the problem. Where’s the who’s going to, who’s going to step up to the plate? But from the consumer standpoint, it would make everybody’s life a lot easier.
00:29:23 Tom
Yeah, the flip side of the who’s going to pay for it? Is it the first? And this is one of the problems I think in the healthcare spend in general there. Then we talked about the clearing houses. There are some models that to to create value you’re going to blow up some revenue stream. So there could be some first movers that figure it out and actually they can fund it, but at the expense of it’s not a positive sum, it’s a negative sum game. And I do think if information gets more standard as far as security presentation of it and I think the fire standards will help, I think some of those models will start to emerge potentially.
00:30:02 Tony
Yeah, I, I, I think you’re right. And, and, and part of it is, you know, the, the way to do disintermediation sometimes involves people destroying weather on business lines. I saw that with IBM when they were, they had their their strong mainframe business and then cloud was coming along and it was like you, you know, you would be jeopardising your.
00:30:25 Tom
Cannibalise or you don’t.
00:30:27 Tony
Particularly if it was, it was two different groups of salespeople selling it, which was at IBM. And I, I was like, you know, you got to give somebody a place to, to rest on this. Because if you think if you keep pushing them to stay with mainframe, then they’re going to go to somebody else for the cloud if they’re not ready loud, and then they’re not going to be upset if you try to push them off the mainframe. So you have to build a glide path. So I think for any of this stuff to succeed, and this is where I think Onyx and others can be helpful with how do you build the glide path so people can move from their current business models to 1.
00:31:02 Tom
Switching costs and.
00:31:04 Tony
Yeah, exactly, exactly. All right. Well, we’ve talked a lot about a lot of different things so far. And I guess so I’ll switch off a little bit, Tom, since we only got a few minutes left. And so when you’re not thinking about interoperability in healthcare or what, what do you do? What keeps you busy when you’re not doing that?
00:31:26 Tom
Well, of course, family. Family’s paramount time with my wife. I have a grandson. My youngest is getting married soon. Thanks. Thanks. So that’s all exciting. Believe it or not, I’m heavy into learning Italian. I’m 420 days straight and Duolingo, and I’m actually applying for my Italian citizenship based on my my grandfather. Yeah, So that’s exciting. And then last fun fact is from a Derby perspective, given it was Saturday, I own a couple thoroughbreds with a bunch of healthcare former colleagues and executives. So we’re partners in two thorough beds that that’ll be running this summer in Saratoga. So I like the horses too.
00:32:07 Tony
Oh that’s exciting. Well on the Italian side, my wife is of Italian lineage and my daughter is getting married to someone who’s half Sicilian. This.
00:32:18 Tom
Nice. Congratulations.
00:32:21 Tony
So we’re, yeah. So we’ve got a lot of Italian roots in our family as well. So it’s, it’s fun and.
00:32:26 Tom
We my case is in the court, so keep your fingers crossed.
00:32:32 Tony
But OK, well, I appreciate that, Tom. And unfortunately, you’re not having a horse in the Preakness because it’s, of course the big event that comes up in Baltimore every year.
00:32:43 Tom
Sure.
00:32:44 Tony
Thing Anyhow, also the other thing I wanted to ask you is if people want to learn more about what we’ve talked about today or there’s certain podcasts beyond this one, blogs and other types of references. What are your? What are your kind of go to?
00:33:02 Tom
Yeah, so I’m gonna rattle off a bunch of things. This is interesting. Interesting because, you know, since AI chat TPT it my way of approaching things. I still get I’ll give you the regular list my go to, but it actually makes me dive into deeper pieces of research. Believe it or not, when you ask the frame, the questions are So it’s it’s actually changed the way in which I consume, but I still get the big consulting shops put out. Great thought provoking kind of industry leadership. McKenzie, BCG, Accenture, Deloitte, PwC, Those guys go to industry specific. Little more, you know, NCQA, McCall, Beckers, KKFF, right, Kaiser Commonwealth Fund, that’s where I go there. And then of course for me, believe it or not, one of the better resources is cms.gov and go and go and go into the innovation centre. It actually it sprouts out and then you start diving for other things. But CMS is, it’s actually a very productive asset for me.
00:34:08 Tony
Right. I’m glad to hear that, of course. OK, well, we’re going to finish this off here, Tom. We caught our kind of our our quick answer to several questions. So we’ll try to keep you to under 2 minutes or less for these next three questions before we end up the podcast.
00:34:27 Tom
I’ll go as fast as possible.
00:34:29 Tony
OK. And I know you’re from the Northeast, so I know you can move pretty fast if you have.
00:34:36 Tom
The Boston thing.
00:34:37 Tony
That’s right. Exactly. So what do you see as the biggest change in healthcare in the last five years?
00:34:43 Tom
So I, I think COVID had a major shift. I think people were forced to digitise. So when you think of remote, you know, remote monitoring and just I think it had a profound impact on payers and the delivery system. So I think you’ll continue to see because of COVID and we talked about some of this accelerated digital transformation for sure. I think the value based care piece is still alive and well. I know I would give it mixed marks like you have, but I think both the government and others are trying to figure that out. And I think you’ll continue to see value based care, alternative payment models continue to be a trend. And then I would just say you’re going to see a lot of continued kind of read and react to regulatory initiatives for sure, because it’s just, it helps shape the contours. And like I said, you know, the private sector pays a lot more in admin costs, you know, claim billing and everything then the public sector, so that there has to be a way. And I, I did even life and annuity insurance and, and then and the admin loads there were much lower than healthcare. So I think you’re going to continue to see that kind of regulatory and financial pressure on, on the system. It’s unsustainable that the rate we keep growing at and demographics factors into that, right? We’re an ageing population. So. So I think you’ll see those three major trends continue.
00:36:09 Tony
Great. And I guess security is something that we haven’t really touched on today, but what do you see as the biggest security challenges? Because I can bring the whole system down basically, and it has hospitals and and and.
00:36:25 Tom
So I was just going to go there. So I think when you think of ransomware attacks, it’s a really big issue. I mean, change change got burned by it and it brought down payments to hospitals for the better part of 2 1/2 weeks. So that’s, that’s one that, you know, got to be impenetrable from a security perspective. I think third party vendor risk because just because your technology’s buttoned up, it doesn’t mean because the ecosystem has a lot of partners. You talked about some of the different portals you have. I mean, there are so many entry points. So I think that’s another one. And then I think the other one, when I look at payer provider or even, you know, TPA, whatever part of the ecosystem I talk about, I think legacy systems once it’s in like legacy system vulnerability is also another potential area of, of issue. So you know, data security, network security. I just think, I think legacy systems, depending on what what you’re talking about, still are a target and can be breached potentially because there’s a lot of tech debt out there and you may not know how buttoned up everything is.
00:37:33 Tony
Yeah. And, and one of the issues we ran into when I was at CMS was when you switch from one contractor to another, you know, understanding what the vulnerabilities are and keeping the patches and and other types of security.
00:37:49 Tom
Data application or network security and then and then now that we’re going to cloud, right. So it’s a cloud misconfigurations, things like that. There are real things. You have to kick the tyres and pressure test very well.
00:38:01 Tony
Right, right. All right, Tom. Well, I appreciate the time you spent today. We’ve covered a lot of ground in this past 40 minutes and I want to wish you well and your new road Onyx. And and thanks again for being part of our podcast.
00:38:18 Tom
My pleasure. Great for great discussion. I appreciate it.
00:38:21 Tony
Thanks.
Disclosure: The host of this podcast is a paid Onyx Board member.
FTC Disclosure: Some guests pay to advertise on the podcast. Opinions expressed by guests on the podcast are solely their own and do not necessarily reflect the opinions of the host or HealthBiz Talk Show.
