A CEO Thriving In Healthcare’s Data Driven World

How does one go from Harvard Medical School and an internal medicine residency at the world-renowned Johns Hopkins Hospital to the corner office?

For Keith Dunleavy, MD, CEO of Inovalon, a company in Bowie, Md that produces a cloud-based data analytics platform for healthcare companies, the exam room was simply no match for his pursuits in business. Dunleavy always thought he’d combine his background in engineering (and an undergrad electrical engineering degree from Dartmouth College) and his background in medicine. He also recognized the healthcare industry had a lot of catching up to do when it came to technology.

“When I got to residency, I was rather amazed at how little computer science and technology was being used in the healthcare world. Not MRI machines and ultrasound machines, but leveraging data on [treatments] to benefit of the patient,” he says.

That’s where Inovalon came into the picture. Dunleavy arrived at the company in 1998, helping organize predecessor organizations into one company. Since then, they have ridden the wave of healthcare digitization thanks in large part to federal healthcare reform.

In the early days, the Medicare Modernization Act of 2003 geared up the ability for companies like his to access data from health plans and physicians in hospitals. Later in the decade, additional Medicaid and Medicare legislation incentivized data-driven payment models, which made even more information available for Inovalon to parse. By the time the Affordable Care Act came into the picture, the private sector was driving the industry’s demand for data and regulatory world has taken a backseat, Dunleavy says.

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The data demand has driven the company’s growth (doubled revenue over the course of a 5-year period) and helped it go public in 2015, says Dunleavy, without ever relying on private equity financing. More than that is just the sheer data its compiled into its system. The company claims it has run analytics on 941,000 physicians, 483,000 clinical facilities, 243 million Americans, and 38 billion medical events.

Dunleavy talked with Chief Executive about the increasing ubiquity of data in healthcare, how the company’s technology works, challenges he faces in healthcare and more. Below are excerpts from this conversation.

You work with all of the major players in the insurance world and a lot of the major players in the pharma world. But most people wouldn’t know that your technology runs their data and you have the analytics on their data. How does your technology in the background of all these companies, whether they’re an insurance company, a pharma company, or something else?

Well, a lot of it has to do with connectivity, right? We mostly started with health plans. They, initially, would provide the data to us, so that we could run various different analytics on their data over a longer period of time. With the progression of technology and with connectivity, the timeline of running those analytics has shrunk and the nature of the connectivity is done increasingly in real time. Real-time into the health plan administrative systems, real-time connectivity into electronic healthcare records systems, into health information exchanges, into laboratory systems, and so forth.

So as that connectivity spread, the number and the variants of the different types of parties that would benefit from this ecosystem of connectivity grew. And now, it’s really, every party is benefiting from this connectible nature with others. So it’s typically, as you pointed out, in the background. And our connection into an EHR system or to the laboratory system is typically in the background, and even seeding the analytical results back into the point of care, very often, happens without great obviousness.

What areas of the healthcare system will your data get plugged into next?

Well, specialty pharmacy is the fastest growing sector of healthcare today. Specialty pharmacy is the provision of pharmacy services to [patients with] high-complexity, high-cost conditions. And as the pharmaceutical industry continues to make new discoveries and increase things like precision and personalized healthcare, and amore personally designed care regimen, the demand for specialty pharmacy is just increasing. The numbers have gone from roughly $100 billion in 2015 to close to $300 billion by 2020. And that’s a three-fold increase in just five years, that’s massive.

So, in there is an enormous need for coordination between the various different parties. If you think of a high complexity situation in a pharmacy, you have the need to coordinate with the health plan, the need to coordinate with the patient, the need to coordinate with the physicians, the need to coordinate with the actual inventory of the drug, the authorization of the drug, the distribution of the drug, the management and payment of the drug. All of this coordination, if not done right, lead to delays in care for the patient as well as higher costs of operation.

What would you say are the biggest challenges you’re facing in healthcare today?

The greatest challenges in healthcare today are just the complexities of how care is operated. The enormous number of diagnoses, there are, in the neighborhood of 180,000 different diagnoses in the ICD-10 diagnosis system. There are over 60,000 medications in the MDC medication system. There’s over 100,000 different treatment modalities in the CPT system.

And so, for a physician to know how to navigate the assessment of a patient quickly when they have so little time with the patient, and the healthcare system has become very complex in its payment models, in its quality incentive requirements, and it’s very stiff in regulatory requirements, it’s harder and harder for the physician to deliver great care, consider all of these things, and still be mindful of the economics while trying to be a healer.

And a lot of tools are needed to allow that to still happen really well. And I think that’s a challenge that physicians face, it’s a challenge that administrators face, it’s a challenge that regulators face, and these are the challenges that our tools look to solve to provide great care while also being mindful of the economics.

Read more: Navigating The Growth Of A Major Healthcare Platform