Join me for an insightful discussion on the intersection of healthcare and technology with Joan Butters, CEO and co-founder of XSOLIS. In this episode, Joan delves into the transformative role of artificial intelligence in healthcare. She provides a detailed analysis of how AI is reshaping the industry, focusing on the challenges and opportunities it presents for payers and providers.
The conversation covers the practical applications of AI in streamlining healthcare processes, emphasizing its potential to streamline complex systems. Joan discuss the significance of maintaining a human-centered approach amid the increasing integration of technology into healthcare.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
Join me for an insightful discussion on the intersection of healthcare and technology with Joan Butters, CEO and co-founder of XSOLIS. In this episode, Joan delves into the transformative role of artificial intelligence in healthcare. She provides a detailed analysis of how AI is reshaping the industry, focusing on the challenges and opportunities it presents for payers and providers.
The conversation covers the practical applications of AI in streamlining healthcare processes, emphasizing its potential to streamline complex systems. Joan discuss the significance of maintaining a human-centered approach amid the increasing integration of technology into healthcare.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
0:00:03 - David Williams
2023 is the year of AI, but some companies have been innovating with AI and healthcare for the last decade. Today's guest is Joan Butters, CEO and co-founder of XSOLIS. We'll be speaking about integrating AI solutions into healthcare operations and taking friction out of the payer-provider relationship. Hi everyone, I'm David Williams, President of Strategy Consulting for Health Business Group and host of the Health Biz podcast, a weekly show where I interview top healthcare leaders about their lives and careers. If you like the show, please subscribe and leave a review. Joan, welcome to the Health Biz podcast.
0:00:45 - Joan Butters
Oh, thank you so very much. I'm glad to be here.
0:00:48 - David Williams
We're going to talk a lot about what you're doing with your current company, but I want to wind the clock back, if you don't mind, and hear a little bit about your background, your upbringing. What was your childhood like? Any childhood influences that have stuck with you in your career?
0:01:00 - Joan Butters
Yeah, thanks for the question Interesting. I have a pretty boring childhood. I certainly didn't grow up thinking I was going to run a multi-million company, let alone one in healthcare I think. But early in my career I was focused on technology and always curious about how we could do things better through the use of technology. I think healthcare became a byproduct of my exploration in that space. I came to a quick realization that data and technology could really have a material impact on the industry. I think that's affirmed by being here in Nashville. Certainly there's over 900 healthcare companies that operate here. I think between just the fact that I found myself here in Nashville, worked for a startup in 1996 and worked my way through that organization really did help solidify that technology can do better. I do have to give a nod to my dad. He throughout my childhood he did prescribe to the give it 100% or don't do it at all rule. I think that rule is the driving force behind everything I do professionally and personally.
0:02:12 - David Williams
That makes good sense. Now you make it all sound like it comes together. You have this realization, and I think it's good to have that realization early in your career, because the alternative is just to bang your head against the wall for a while. I feel you studied international relations in school. That was not necessarily healthcare, I'm guessing.
0:02:31 - Joan Butters
No, not at all, far from it. Interestingly enough, I originally pursued a double major in accounting and computer science. That started off as a freshman with that course curriculum. Good thing those courses are coming in handy now. International relations was a passion for me, much like today, as I lead a company solving problems in healthcare. It was a bit ambitious. I wanted to have a part in solving the world's problems, in particular the empowerment of women in third world countries. I guess it's somewhat fitting now that I am a female CEO, somewhat inspired by the women that I've studied.
0:03:14 - David Williams
No, it makes good sense. Among the women in my life, my mother-in-law. When I first met her and I told her I studied economics, she says, oh, that's for people who can't get into accounting. Anyway, she would have been more impressed with you than she was with me. I'll just say that.
0:03:28 - Joan Butters
I love my numbers for sure.
0:03:31 - David Williams
What was the start-up in 96?
0:03:33 - Joan Butters
Yeah, thanks for that. The start-up in 96 was AEM Healthcare. Again, my path took me here to Nashville, again not intended for healthcare, but met up with who is now my co-founder and chairman, jim Soar, who is the founder of AEM Healthcare. That was my first foray into healthcare Little unknown fact I started. I can't figure out what I want. To be right, I started at AEM as an accounting clerk, answered a small little ad in the newspaper and started with AEM. At that point they had about 20 employees. We were. Aem was a company that was involved in cost containment services. How I got into technology and healthcare was at AEM. Jim Soar came back from a road trip one day and, for those of you that remember Floppy Disks, threw a floppy disk on my desk and said hey, the customer that I'm working with thinks that there is some payment anomalies in this file. Can you go find them?
And I'm like okay, I don't know anything about healthcare, I don't know. All I know is numbers and certainly and I can pivot a mean Excel file, and so that became the birth of data mining for the company AIM that I worked with, and then that grew to about a $60 million vertical within AIM and then ultimately we sold to Optum I worked with. I stayed with Optum for I think three years before I decided to leave in the end of 2012, early 2013, and found XSOLIS again with my former CEO and Jim Soar co-founder.
0:05:10 - David Williams
Nice, when we can tell sometimes the error by talking about the technology, as you were saying, like a floppy disk. So I came in just as they were going from the eight inch floppies to the five and a quarter inch and they had the three and a half inch disk and people used to call it a floppy and the people that got in there, it's like this thing is rigid, like why is it? Why would you call it a floppy disk? No, it doesn't make any sense. But it sounds like you're about the five and a quarter era that was there and, as I remember, aim was focusing on, like American image management, something like that.
0:05:38 - Joan Butters
It was American imaging. No wrong one. No. Asset investment managers, Asset investment management. Okay, so you did often get confused with that.
0:05:46 - David Williams
Yeah, I'm glad I made brought that up so as not to not to confuse it.
0:05:50 - Joan Butters
Yeah, no, it was. It was fun, it was a. It was a great organization, fantastic culture. I took a lot of what I learned at AIM and now apply it to what I do today at XSOLIS. All you know a lot of what made AIM successful is what's making XSOLIS successful in terms of how we treat our customers. We are probably we we over index on making sure that our customers are delighted and happy, and I think that's something I learned from my time at AIM and continue at here at XSOLIS as well. Got it.
0:06:20 - David Williams
So, when you were at AIM and then it, you know, became part of the bigger organization, and then what? What need did you see in terms of you know why, you know, why do you need to excel us when you have, you know, other organizations? What was, what was the additional reason to start that up?
0:06:33 - Joan Butters
Yeah, so we'll get into this in a little bit. But the genesis of XSOLIS was not necessarily data and technology. It was around providing a service to our hospital customers. Back in 2012, 13, there were a lot of owner, the, the, the. There were audits that were being performed on behalf of CMS, and hospitals just couldn't keep up with the volumes of audits that were happening, and so we started off XSOLIS as a service to help provide people resources to, to solve for that problem.
We like for those of you that are listening that have a business premise, don't be afraid to pivot, because we had to pivot mid year of 2013. The government decided to put a pause on those audits and so, whatever you know, our original business premise was somewhat non, non, non relatable anymore, and so, but what we did learn through that, the work that we did early on in XSOLIS? We no-transcript Decisions were made, not data-driven decisions, lack of technology, a very revenue-sensitive function within the hospital was being underserved and not being identified as needing tools and technology to help solve for some of their problems. So that's where we said, hey, what if we can solve for that subjectivity and decision-making, solve for the manual work that the hospital is doing, solve for the reduction in touchpoints by having the technology be at the front end of the process as opposed to the back end of the process. And so all those learnings that we gathered from our time, during the short bit of time we did during services, we took and became the foundation of what we provide today for our healthcare customers.
0:08:32 - David Williams
So it makes sense to me to say, hey, you're doing something in service or you're adding people. Even at the time, it's not so easy to hire people and train them up and so on. So sure technology, but that doesn't always work out so well. Was it clear? I mean, it's clear that what you wanted to do, but was it clear that there was technology that would enable you to do it? Or how much of inventing did you have to do?
0:08:51 - Joan Butters
I had to do a lot of inventing. So that's a great question, david. Yeah, we did a lot of inventing and a lot of internal prototyping and a lot of, you know, reaching out to our customers to ask them what their problems were and how could we solve for that. It was a lot of fun in the early days to sit across from a customer and say here's what we're thinking, and for them to come back to us and say, well, gosh, we've been, that's something that I've had on my wish list, but nobody's ever been able to do it, and so it was very satisfying in those very early days to be able to say, hey, we've thought about this. Can you affirm, can you? Can you? Can you? You know what? Do you also believe that technology can solve the problems? And we went out to the market and talked about that. It was, it was. It was exciting to hear that they had the same sort of technology thoughts in mind as well.
0:09:47 - David Williams
I want to go back to the idea about the startup. You know you were joined AIM when it was a startup, not in a senior role, but were there things that you learned from the? You know the early growth of AIM that you've applied. You know, and starting your own company Were there. You know lessons learned from that.
0:10:05 - Joan Butters
Well, sure, and I think it goes back to execution. In fact, if you ever have a chance to talk to a founder, it's always how do you get it done right, and that not let bureaucracy be the enemy of progress, and so it was. You know, it's always about the art of the possible and being able to say let's not think about why it can't be done, but let's think about how it can be done and change the narrative. And so what we do that today, at XSOLIS as well, is to tell don't tell me why we can't do it, Tell me why we can do it and let's solve for it that way. So I think it was just that that we, even at AIM, we started a company that was doing something that had never been done before, and there was never a question in our mind that we could do it. And similarly, at XSOLIS, it's we there's problems to solve. How do you solve that in a way that has a material impact on how things operate?
0:10:58 - David Williams
And I've seen in your positioning you talk about tackling some of the challenges or frictions between payers and providers, and I'm wondering what, first of all, what you would identify as those challenges or frictions? How do you tackle them?
0:11:11 - Joan Butters
How much time do you have? I've got time.
0:11:14 - David Williams
If people could listen, if they could listen on fast speed if they want. It's just sort of the nature of it that these are just adversaries. It's like how do you fix frictions between you know, defense attorneys and plaintiffs? You?
0:11:26 - Joan Butters
know it's absolutely. I think the challenge is there's a lot of challenges. I think there's, and it's getting better. I've attended a lot of conferences of late that where there is there is more identification and more alignment between payers and providers, that something's got to change, and so that's very encouraging to know that people that payers and providers are realizing that things need to be done differently. However, there's a lot.
There still is friction, there's mistrust, there's a concept of a zero sum game, and I think that that payers and providers you know if we're going to solve for these challenges, and I think that the administrative challenges between payers and providers are probably the most most difficult.
They've got people doing the same things, that they've always done it the same way. There is differences in how people make decisions. They don't have a common framework to make those decisions, and this is kind of where we come in, because, at the end of the day, we're enabling more clean decisions, seamless decisions, all through artificial intelligence, and it's really exciting. I like to think about how AI becomes this and I use this before this dispassionate and mediator right, it's not meant to be an end all to be all, but it helps call out the information that's going to help make decisions more aligned between payers and providers, and it's somewhat, somewhat simple, right? Sometimes, when payers and providers are trying to make a decision, they're using two different sets of information and so just by the framework that we've provided allows for those payers and providers to see what's going on with that patient real time and have an alignment on the decisions that need to be made based on that information.
0:13:08 - David Williams
So I think that goes back to maybe another concept of like a single source of truth, and it's like, if we're, we may still have a different view about the right, what we want to do with it, but if you think that I, you know, went to the hospital five times and I think I went twice, they've never going to solve anything.
0:13:25 - Joan Butters
Yeah, or a better example would be if I think the person is needs to be treated in a less, a lower level of care versus a higher level of care, and I think that's because AI help make that decision for them, or at least have a dialogue, at least you start the dialogue between the two in a different way, as opposed to I'm looking at this information, you're looking at that information. Here's what we can look at together to help make those decisions, and I think that's really helping to address some of the challenges that payers and providers are having on that single source of truth, that trust that that I can use data in a different way to help drive some decisions.
0:14:06 - David Williams
Some providers have also become payers, like some health systems that started, you know, medicare Advantage plans, and some payers, like Optum United, have become providers as well. Is it the same dynamic even within those organizations, or what's what's what's it like?
0:14:22 - Joan Butters
Yeah, you would think, yeah, you would think that they there would have, they would have better alignment. I think it's that still, at the end of the day, and both entities, even though there's a really a umbrella organization, both entities are still having to make the same decisions about how do I but financial decisions right? And so as long as that becomes the, the, the, what's driving people, you're still going to have that friction. And I think the other thing, david, that that is probably prevalent even in the, in the provider owned health plans, is you would think that they're, they are sharing the same data, but they're not right, and I think that's where we come in is to help provide that shared look at a patients condition differently than people have been able to do before.
0:15:09 - David Williams
Now, who would be the people that are your customers or users, Like whose problem do you go and solve and whose budget does that come from?
0:15:17 - Joan Butters
Yeah, so it varies, right, but for the most part in both our.
So this is an interesting phrase, but it's clinically driven financial operations, right? And so, again, not to get too far in the weeds, but both organizations payers and providers have a function within their organizations called utilization management, and their objective is to make a determination as to whether a patient needs to be admitted to the hospital or not, and it's not necessarily always a clinical decision. It's a decision that drives revenue, and so both of those are trying to figure out how do they make a decision in the way that is helps benefit both the payer and the provider uniquely. And so what? We are helping to connect those dots between those two functions. Both connect the dots between those two functions and then streamline that process between those two functions. As an example and certainly later there's other places and operations that are very similar in their decision-making, where they're making decisions in a vacuum, maybe length of stay where that patient should be discharged. Our goal is to apply artificial intelligence to those other friction points between people making decisions about the patient's journey.
0:16:42 - David Williams
So there was a time when people were talking about AI and getting excited about it I'm talking maybe 10 years ago or so and then there was some progress, but also you start to hear people rolling their eyes they use AI and then now this just in 2023, you start to hear about generative AI is becoming kind of over on the scene. What has it been like to be an early adopter of AI, and particularly in healthcare?
0:17:07 - Joan Butters
Yeah, yeah, it's a great question. So, like you said, ai was a part of Axelis's solution before. Ai was cool that was 10 years ago and it was fun being ahead of the market, but, like you said, in healthcare it was not easy. We had to overcome some perceptions, misperceptions about what AI was, is and what it isn't that still exists today. I think two of the predominant headwinds that we had to overcome was AI.
On one side of the extreme, ai was going to be the easy button. Oh gosh, all I got to do is make a decision based on what AI is telling me, as opposed to no, you're still going to need to use some clinical judgment in making those decisions. And then, on the other side of it, was the fear that AI is and we hear this now with generative AI that AI was going to replace clinicians. And so those are that you're trying to, as you're trying to sell and trying to make inroads into healthcare. You've got those two somewhat opposing and sometimes common objections within the people to which you're offering your solution. So we had to educate our clients about the end, the market, about the role of AI. And again, it's not either. It's not the easy button, nor will it replace the work that needs to get done, but, as I said before, it's that dispassion and mediator that helps provide alignment and clarity on a pathway for decisions to be made.
0:18:42 - David Williams
In starting late 2022, but in 2023. In particular, there's been a big emphasis on generative AI, especially since people have been able to experience it easily for themselves in a way they couldn't do before. I think that made a big difference. How do you think generative AI will impact health care?
0:19:00 - Joan Butters
Yep. So you're right, Genie's out of the bottle on generative AI. You can't not read a health care publication without reading it today, any sort of publication, without reading, hearing about generative AI. You know, I think that there's a lot of promise on generative AI, but I think importantly, and a lot of the things that we're trying to solve for, are the administrative aspects of generative AI Right. If I can draft a letter or if I can have generative AI document for me, obviously with some oversight, or if I can reduce the number of clicks or number of documents narrative that I have to provide, that's huge for clinicians. Right. And again, I think that the administrative aspects of generative AI have a lot of promise.
I think where there's and I think we're hearing it now is there's on the clinical side we should be thinking about. There's cautionary tale, you know it's. The generative AI is doing great at the ability to find a single diagnosis or clinical pathway, but we know that patients conditions are complex and when you start to add that complexity, it kind of it's falling a little bit short. It's getting there. But I think that that we I think lots of opportunity on the clinical, on the administrative side. The jury's still out on the clinical application of generative AI. You know we'll we're going to be closely watching the executive order just recently released by the Biden administration see how they will be able to, you know, balance the defined the framework for the responsible deployment of AI while not stifling the innovation and the promise that it can bring to the healthcare industry.
0:20:47 - David Williams
So you've had great track record over the last decade with excellence and I'm wondering you know where do you go from here and how would you expect some of these use cases to evolve?
0:20:57 - Joan Butters
Yeah. So, like I said before, I think you know there we talked about the friction points, the lack of alignment of the data, you know data sharing challenges that the healthcare industry has, and there are other friction points, like all across the patient's journey, and so if we think about where there's that inefficiencies, lack of alignment those are areas that will tackle very similarly to how we've done our core business right. So any time, you know, if there's an interaction that happens between the payer and the provider that makes a determination as to the administrative aspects or the financial aspects of that patient, we want to be in the middle of that and help facilitate coordination and collaboration between those entities.
0:21:47 - David Williams
Great Well, Joan Butters, CEO and co founder of XSOLIS. Thank you so much for joining me today on the health biz podcast.
0:21:54 - Joan Butters
Awesome. Thank you so much.
0:21:56 - David Williams
You've been listening to the health biz podcast with me, david Williams, president of health business group. I conduct in depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services and healthcare, check out our website, healthbusinessgroupcom.