RamaOnHealthcare March 31, 2022
Today, we are fortunate to have another transformational healthcare leader share insights with us. As our industry struggles with a pandemic, we wonder if it will ever subside. Even before the Internet, humans were and continue to be, very interconnected and interdependent upon each other. Today, illness connects via hidden opportunity and impacts so much and many more beyond each ill person.
Today, I’m speaking with Josh Schoeller, CEO of the Health Care business at LexisNexis Risk Solutions and Global President of Elsevier Clinical Solutions. I have watched Josh is custodian for all things data and consumer powered knowledge. This interview is about the consumer, health, and data.
Mohan: Welcome Josh. Data has been the subject of discussions in healthcare in so many perspectives. From privacy, silo-busting data walls, ubiquity, HIPPA rules management, to the most important issues of governance and fluidity of consumer data gathering. You are in the middle of it all. Give us a perspective on how you parse all that is going on with health data management?
Josh: The biggest thing to wrap your head around is the rapid growth of healthcare data, and how all this new data can be harnessed and transformed into meaningful insights that can improve patient outcomes and create healthier communities.
In 2008, there were something like 153 exabytes of healthcare data generated around the world. In 2021, they’ll be over 2,000 exabytes of healthcare data generated, so there’s no shortage of data. But to maximize the potential of that data, you must contextualize it and turn it into information.
The Health Care business of LexisNexis Risk Solutions has one of the largest repositories of de-identified medical claims data as well as consumer data from over 10,000 sources, so not only can we help with the data management, standardization, and regulation, but we can also enhance or augment that data by linking it to other data sources to make it more complete, accurate and current. That makes it more powerful and useful and turns just “data” into valuable insights.
Mohan: Interesting perspectives and we will follow through on some of these issues. But consider a consumer in healthcare sitting in their living room talking to their family and their high school child asks the question “I’m really trying to figure out how my personal health data is so restricted. Why should that be? Does a parent know enough to answer that question? What would you say?
Josh: Today, I would say most parents likely don’t know enough to answer that question, but there is a huge movement towards consumer driven healthcare. We’re seeing that increase year over year. Consumers want to be more educated and better understand their health, so as time goes on, I think parents will be able to provide their children with more context and clarity around personal health data.
For me, I would tell that high schooler that your data is your data, and your health data is very personal – more personal likely than your banking information, so it should be treated as such.
A big part of what we do is try to create greater access for people to their health information. But we do that in a way where we’re doing identity verification and identity authentication to ensure that the person is who they say they are before they get access to that information.
Mohan: The recent Cures Act seeks to break the stronghold of medical data beyond hospitals and EMR systems to allow for data and information sharing to allow the consumer to engage in multiple ways to engage their health using the system. How has that transported your view of data management support?
Josh: The 21st Century Cures Act is enabling the exchange of health data at a much more rapid pace than ever before. As more data becomes accessible and transferable, we need to have the right controls around access to that information as well as the right data management capabilities. If you think about a lot of the work that we’re doing with medical data and CPT codes, that was pretty easy to translate what a 3-digit code goes to. Now we’re talking about doctors’ notes and non-structured data and being able to bring those into clinical decision support solutions and give doctors better tools to help them with care pathways and driving better outcomes. The stakes are much higher now. You can’t have mistakes. Mistakes can correlate to patient safety risks, so there’s just a high, high bar to managing health data, and there should be.
Mistakes can correlate to patient safety risks, so there’s just a high, high bar to managing health data, and there should be.
Mohan: You and your business serve a large population of our world through your partners, and you have a privileged and earned view of how data is being used and what is to be achieved in data for the consumer. Tell us what you think is the next big thing for the consumer.
Josh: Consumers are going to become more intimately connected to their health information, and the next evolution will be having all their health information right at their fingertips on their phone. Having immediate and convenient access to that data when they walk into different care settings or when they’re accessing telemedicine via their phone really changes the way that healthcare is delivered. It can cut down on costs because you can avoid procedures that might have already been done. It cuts down on patient safety concerns with counter interaction of drugs or the wrong records being tied to the wrong person. With this evolution comes a renewed focus on consumer consent. The consumer will be empowered to consent to how they want that data used and how they don’t want it used.
Mohan: Many view data and AI in the same lens. But they are different. Talk to us about what is your view of the enabling value of AI and about what is just hype and continues to cloud the views of the audience?
Josh: Data is not AI, but you can’t do AI without lots of data…and we have it. We’ve been using predictive analytics to understand risks in healthcare for a very long time. Those were generally generated off looking at historical or retrospective data. AI and machine learning enable us to build analytics that are constantly learning as new data is presented. That’s critical when you think about the growing amount of data that’s available and the pace of medicine today.
Doctors and clinicians have more to do today and less time to do it than ever. What artificial intelligence can do is help give additional tools to clinicians to be more efficient and avoid potential risks. There are lots of opportunities here but think of Clinical Decision Support where we can use evidence based and peer reviewed care pathways the help streamline and standardize treatment plans that correlate to optimal health outcomes. To be clear these are not automating clinical decisions…people and conditions are too complex, but it can be a valuable tool for the clinicians to reference and learn. If a Clinician goes off pathway they can document why and we can record the outcome and then modify best practices over time back to the pathways. The data and technology are here to do this today.
What artificial intelligence can do is help give additional tools to clinicians to be more efficient and avoid potential risks.
Mohan: When you download your health data onto your own device, your phone, or your computer, it is no longer protected by HIPAA and becomes your responsibility to manage and control. Many consumers do not know that and still believe they are protected. Is that a concern? Ubiquity can be the opposite of protection. Where is the balance in your mind?
Josh: For my businesses, we’re not in the consumer app space, but we still have very strict guidelines on using data ethically and using data for good. Honestly, that’s the foundation of our business. That said, the thing that we as an industry must be concerned about is when people download their data to their phone or computer and then inadvertently give consent to whatever app their using without reading or understanding the fine print. I think that’s the real point of emphasis. We need to educate consumers to be very conscious of what they’re consenting their data to be used for. I believe there will be more legislation coming around this to protect consumer privacy.
Mohan: What are you excited about lately? Why?
Josh: I believe we’re in the middle of a healthcare renaissance. Healthcare is changing so rapidly; partially because the global health pandemic has forced us to expedite the advancement of digital health and consumer-driven health. The move from fee for service to value-based care has changed payment models. The 21st Century Cures Act is the most significant legislation that we’ve had in health in over 20 years since HIPAA.
I believe we’re in the middle of a healthcare renaissance.
These dynamics and many others are going on around the world, and so I’m excited because our solutions help improve patient outcomes and help create healthier communities. As we emerge from this healthcare renaissance, better data and better analytic solutions will play a pivotal role. One of the things I’m excited and optimistic about is our ability to link de-identified data sources – like clinical, SDOH, identity, claims and mortality data – to create a more holistic view of health. This will help us better understand the factors and challenges around health equity and give clinical researchers a much richer dataset for use in medication and disease research.
There is so much misinformation out there, and we can help with that. At Elsevier, we talk about taking on the “infodemic”. Our content is evidence based and research driven, and now more than ever, healthcare professionals need a trusted knowledge partner to help battle this misinformation so prevalent in our lives today.
Mohan: We know that healthcare data is 10x more valuable that consumer data today in the dark markets. Institutions are relentlessly focused on protecting this information and I applaud those who stand against such criminality. What are your views and what should healthcare consumers be mindful of to keep their data protected?
Josh: Our business is to B2B, so we don’t interact directly with consumers, but we have a whole army of employees whose fulltime job is data security. We live in a digital age, and data breaches are just part of the reality across every industry not just healthcare. That’s why we put so much focus on data management and security. For consumers, they don’t have a former brain surgeon as their CSIO like I do (yes, literally). They don’t have a team of experienced professionals with industry-leading technology to keep their data protected. That’s why it’s extremely important for consumers to be vigilant with their health data. The most common way data is stolen is through phishing attacks. When consumers get an email asking for access to their health information, they need to verify that this is a real email and not from some type of nefarious source.
Mohan: Imagine we are now 10 years older. What is the data world now? How does a healthcare consumer conduct themselves with data? What happens to the walls in healthcare between provider, insurer, and consumer?
Josh: If we’re successful in 10 years, we will have achieved true interoperability in healthcare, which means consumers will have full control over all their health information and can conveniently guide their data to their different medical touchpoints at their own discretion. The walls between the traditional institutions like payers and providers will start to be more like fences that allow for us to exchange data more easily and effectively. All of this gets us closer to lowering costs and improving outcomes.
Mohan: Josh, I’m a fan of all things transformational. You lead a major part of the transformational journey to be taken by healthcare. Guide us to where you believe we should be in a few words. I know the world is complex but sometimes principles allow us to win clarity.
Josh: The cost of healthcare today is unsustainable. Access to care is not equitable. Health outcomes are not optimized. These are the areas that we need to focus on. We need to lower the cost of healthcare. We need to make sure that everybody has equal access to care, and we need to ensure that we’re optimizing the outcomes, so that everyone’s healthier. All things transformational need to be viewed through the human level because that’s what healthcare is about.
The cost of healthcare today is unsustainable. Access to care is not equitable. Health outcomes are not optimized.
Mohan: Which leaders do you admire, read, or view as they give you a perspective to lead?
Josh: I could list the great CEOs of our time, but I will answer a little closer to home. I have been very blessed to have worked for some incredible leaders in my career – as well as some really bad ones. I learned a lot from both. Someday, I will write a book to thank them and share what they taught me, but a few names that immediately come to mind are Ken Rapp, Mike Ruehle, Gordon Cameron, JC Wood, Sean Downs, Joel Portice, and Lee Rivas.
Mohan: I know you are a musician and a guitar player. If you could personify your leadership with one song what would that be?
Josh: I wish I was musical because I love it, but I never picked it up. I have been to hundreds of concerts, and before my data, analytics, and healthcare career, I was a band manager for some award-winning artists and was booking gigs at some of the Midwest’s top venues. I thought that would be my career but am happy with where I landed.
Mohan: I’m grateful that you have a leader in our industry, and I know you are always trying to lead with integrity and support. I appreciate your willingness to stand on your own voice and charge the industry to mature beyond its usual siloed impressions. Thank you.
About Josh Schoeller
Josh is the CEO of the Health Care business of LexisNexis Risk Solutions and the President of Clinical Solutions for Elsevier. He has over 20 years of experience across payer, provider, life sciences and pharmacy industries, leading product and growth strategies. Contact him at https://www.linkedin.com/in/josh-schoeller-8566a8/.
About Mohan Nair
Mohan is CEO of Emerge Inc, about all things business transformation. He is a 3-time corporate executive, 3-time emerging business executive, 10-year Innovation Officer and 3-time author. Contact him at https://linkedin.com/in/mohanemerge or book his keynote/moderator skills at