The Future of Healthcare: “We need to have ubiquitous preventative care” with Kelli Bravo, VP at Pegasystems
Ubiquitous preventative care: We need to invest more money in upfront care to prevent ballooning costs down the line. For example, when a mother and child receive excellent prenatal care, the outcome for both will be much better in the long run which not only increases patient satisfaction and loyalty with that health system but also drives down costs. The same can be said for chronic illness management like diabetes and COPD. Improved care navigation and care management programs help those who need additional support through their care journeys and help drive better outcomes. Systems that offer a complete view of the patient and member also facilitate gaps in care closure and support care programs that engage patients and members in their health.
As a part of my interview series with leaders in health care, I had the pleasure to interview Kelli Bravo, VP Healthcare and Life Sciences Industries, Pegasystems. Ms. Bravo has over 15 years of customer-focused solution and go-to-market experience at healthcare and life sciences companies. She brings to Pega her successful experience with payer, provider, and life sciences technology and operations to lead the Healthcare and Life Sciences CRM industry team. Prior to Pega, Ms. Bravo was the VP of Product Marketing at Casenet, an enterprise population health and care management solutions company. Ms. Bravo has previously held executive management positions at McKesson, Microsoft, Epocrates, and Athenahealth, where she was responsible for transforming the go-to-market strategy, leading the voice of the customer initiatives, and evolving marketing operations. Ms. Bravo has an MBA and an MS in Manufacturing Systems Engineering from Stanford University.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
My interest in the healthcare industry started when I was 13. I was diagnosed with scoliosis (serious curvature of the spine) and was sent to Boston Children’s Hospital for a back brace. I had a 42-degree curvature, which is pretty serious and almost too late at that age to be fixed by anything but surgery. In the waiting room, I noticed small children weighing no more than 50 pounds with ill-fitting artificial limbs that weighed more than they did, and that didn’t seem right to me. I thought to myself, “We can do better,” and decided to become a biomedical engineer to design the best artificial limbs possible for children. Fast forward to when I was a graduate student at Stanford University and was doing my independent study work across several hospitals in Palo Alto. I noticed another issue was present in the hospitals I studied at — processes were broken and weren’t letting providers treat patients effectively. Patients couldn’t get their results quickly. Specifically, in the radiology departments I studied, I observed that it could take upwards of 80 days to process an X-ray from when it was taken to when the requesting physician received it. As part of my independent study project, I took on the responsibility of understanding and documenting the steps that would help these health systems streamline their radiology and transcription processes. I recognized that there were many processes within a hospital, outside of direct clinical care, that could be improved through workflow and process automation. Now I work to help the healthcare system improve processes and enable more personal patient and member interactions which results in better outcomes.
Can you share the most interesting story that happened to you since you began leading your company?
A large payer partnered with us to completely transform their customer service model. After the transformation was complete, we later connected with our executive sponsor to see what the greatest benefit of the project was. We were expecting to hear a response, such as increased Net Promoter Scores (NPS), decreased average wait times, reduced call handle time, or quicker training for agents. But her response was, “We’ve taken 100 seconds off every call. And that’s just respectful to our customers’ time.” It was refreshing to hear her focus on the member experience, rather than discussing her organization’s increased efficiency or cost reduction. It designates a true shift in the way payers and other organizations are really looking at patient and member engagement. Healthcare organizations don’t always operate on a patient-centric or member-centric model, but when they do — they not only experience better health outcomes, but also better business outcomes.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Early in my career, I tried to build a customer referral program for the organization I was working for at the time. My team and I assumed that if we offered free product subscriptions and no other incentives, clients would flock to the program. Needless to say, this didn’t happen. After our slow start, we discovered our clients wanted the opportunity to communicate with each other. They wanted to be part of our community and the solution, rather than receive compensation in the form of free technology. They were already bought into the technology (we offered a free and paid subscription model). What they wanted was the opportunity to easily network with their peers in a controlled environment. Once we understood this, we completely revamped the program. We also had a good laugh about how our laser-focus on our customers didn’t quite hit the mark. We needed to listen even more closely to them to understand their needs.
What do you think makes your company stand out? Can you share a story?
I would further expand on the payer customer story that I just shared which focused on saving customers time — we feel Pega’s clients find value in our offerings because they allow providers, payers, pharmacy benefit managers (PBMs), and pharma companies to focus on their customers first via a patient- or member-centric model. Pega’s unified platform enables our clients to more effectively deliver personalized and proactive experiences every step along a customer’s end-to-end health journey. We do this using the latest AI technology, robotics, and world-class workflow and digital process automation capabilities to enable our clients to deepen customer relationships; increase retention; streamline customer service, care management, and claims; and deliver frictionless experiences while proactively engaging patients and members. Our capabilities ensure our clients can transform their businesses to meet their needs today and tomorrow.
Our care management capabilities make a real difference. One of our clients is focused on improving outcomes for moms and babies — specifically focusing on women who are experiencing high risk pregnancies. The care navigation program will use Pega Care Management to ensure the care of these mothers is highly coordinated across care teams, community resources, and family members. This will result in healthier moms and babies.
In summary, we aim to create technology that allows healthcare organizations to deliver the right personalized, contextual experience to their patients and members at the right time for improved outcomes.
What advice would you give to other healthcare leaders to help their team to thrive?
We need to listen more. It’s so easy to get swept up in outreach, product, and business development strategies, but the true focus should be placed on listening and understanding the customer. We’re here to solve a business problem, but we cannot understand what the problem is unless we really listen. From my own experience, visiting a client and watching people perform their jobs is truly eye opening. I am able to see exactly what they are struggling with and what their successes are. When we listen and collaborate with our clients, we can bring about effective change. Working together — providers, payers, PBMs, and pharma — we have the power to transform healthcare, make it more patient-centric, and drive better engagement and outcomes.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
We actually have the best health system in the world when it comes to advanced treatments and specialty needs. However, because we work so hard to be all things to all people, we take on more risk than most other health systems. In order to change that and improve our overall outcomes, we need to fundamentally change the way healthcare is delivered in the U.S. We spend significantly more money on healthcare in the U.S. compared with other high-income countries, but we rank lower than most in patient outcomes. The system has flaws, and it’s up to us collectively to fix it. Here are five things I think we should start with:
- We need to look at the whole person which means including behavioral and mental health needs with medical needs. The U.S. is slow in adopting a whole-human view of care and lags a bit behind the rest of the world. Just treating the medical issue does not help the patient if mental or behavioral issues are preventing the medical care from being carried out. Care processes and systems today need to be designed with the whole person in mind and must assist in streamlining the care process, so care providers can spend more quality time with patients.
- More is not always better…more tests, longer stays, more procedures. More does not solve everything. What works better is appropriate care given at the right time with both physician and patient involvement and tradeoffs considered. This is especially true for end-of-life care, when patients most often want to be comfortable and yet more unwanted tests are often the norm. More drives up healthcare costs for everyone but does not necessarily change the outcome. Much of the rest of the world is much more pragmatic about the types of treatment and care that is provided — focusing less on more, and instead on those treatments that really make a difference in the quality of a patient’s life.
- Our reimbursement models focus on quantity versus quality. With the move to value-based care, instead of our current fee-for-service model, the focus would be on quality outcomes. When health system revenues are tied to the number of visits or procedures completed — and not the outcomes they provide — their clinicians can’t focus on what they entered the field of medicine for — to help their patients. Much of the rest of the world focuses on care quality and outcomes and not payment by procedure. Their patients are assigned to a provider for life (or for as long as they live in that area) so that provider is bound to ensure that patient stays healthy. Our systems and processes need to be designed to support value-based care and payment models.
- Patient access is different in the U.S. than in most other countries. When people don’t have access to basic care, preventative care is put off which can create a long-term problem for that individual’s health — and eventually, it can cost more to care for that person than the upfront investment in their care would have cost. Healthcare needs to be more accessible and technologies such as telehealth in rural areas or for homebound individuals are starting to fill that gap. We are slowly making strides here but the rest of the world is ahead of us.
- As a nation, we are not the best at being accountable for our own health. Looking at how the U.S. stacks up against other countries: we have higher obesity rates, smoke more, drink more, and are more sedentary. We have to encourage people to take a more active role in their health to create a healthier U.S. population. This is probably our biggest challenge, and one we must solve together. Our technology and processes need to better engage individuals in their health and must be able to include social determinants of health, community resources and patient input as well as improve care team collaboration.
You are a “healthcare insider.” If you had the power to make a change, can you share five changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Improved transparency: We can improve patient outcomes through increased transparency resulting from better technology adoption. If medical information was more easily shared, fewer unnecessary treatments would occur and appropriate interventions could happen more easily. We should be working toward increasing transparency, efficiency, and engagement. With improved technologies and greater technology adoption, we could more rapidly move toward a value-based care model which would enable our clinical teams to focus on patient outcomes. For example, adopting telehealth or patient portal platforms helps streamline patient experiences and provides access to care for even those in remote areas. Data transparency will also eliminate the unnecessary, frustrating, and also ripe-for-error process of repeating medical history information for each new clinician. When you have a loved one in the hospital like when my Dad was there, it is difficult to focus — never mind remember every medication prescribed. Often the list is different each time you have to recant it. There must be an easier way.
- Ubiquitous preventative care: We need to invest more money in upfront care to prevent ballooning costs down the line. For example, when a mother and child receive excellent prenatal care, the outcome for both will be much better in the long run which not only increases patient satisfaction and loyalty with that health system but also drives down costs. The same can be said for chronic illness management like diabetes and COPD. Improved care navigation and care management programs help those who need additional support through their care journeys and help drive better outcomes. Systems that offer a complete view of the patient and member also facilitate gaps in care closure and support care programs that engage patients and members in their health.
- Focus on the whole patient: We need to look at the whole person, which means including behavioral and mental health needs with medical needs. The U.S. is slow in adopting a whole-human view of care and lags behind the rest of the world. Just treating the medical issue does not help the patient if mental or behavioral issues are preventing the medical care from being carried out. Additionally, we need to create a better balance that allows for improved collaboration between patients and providers which takes into account factors such as social determinants, diet, location, and more. The U.S. has some of the most amazing technology and leadership in healthcare. We do deliver outstanding care to the most difficult cases, and we can do ever better if we focus on the whole patient.
- Increased patient engagement: When we look at the role we play in our own health, we need to proactively take action to ensure we are properly educated on how to maintain a healthy lifestyle. Those healthcare providers engaged in motivating patients to improve their health can generate better outcomes with improved tools and processes that increase patient engagement. For example, incorporating health information into mobile or wearable devices gives patients better access to information that can help them become healthier. We have to find a way as an industry to better engage patients in their health.
- Enhanced payment models: With the move to value-based care, health systems can now focus on outcomes instead of number of procedures. Quality will be at the forefront along with cost transparency. Our current fee-for-service model does not focus on quality outcomes as the number one priority. Much of the rest of the world does focus on care quality and outcomes and not payment by procedure. Our systems and mindsets will need to change to support this shift in payment models.
- Simplified technology: Technology for technology’s sake has made things extremely complicated. If you think about the physicians — their passion is to interact with patients and not to work with complex technology systems that complicate their jobs. The onus is on the technology industry to do a better job of making it easier for clinicians to get their work done, and not only offering shiny new solutions that ultimately hinder patient care. Automation that removes redundant and error prone processes and workflows and next best actions that identify what more we can do to proactively help a patient are capabilities that help clinicians get back to caring for patients and away from administrative duties.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
I believe it’s all about these distinct groups (patients, payers, providers, pharma, PBMs, and technology vendors) collaborating with each other to achieve better patient outcomes. There is so much data and knowledge locked up inside these individual entities that if they worked better together, more could be done faster to advance individual and population health. Additionally, individual patients need to also take their health seriously and work with their providers, payers and pharmacists who are responsible for motivating patients to take control of their health and to engage in healthier behaviors.
Providers also need to collaborate with payers and other healthcare organizations to break down existing siloes. This includes implementing technology that is interoperable — meaning, it’s able to share information among different organizations. This shared information will make the entire health ecosystem more efficient and effective.
When we’re speaking to provider organizations, we typically are speaking to different departments (such as patient engagement, care navigation, sales, billing, and so on).These individual conversations, when pieced together, address the end-to-end experiences for patients. However, these conversations are often disjointed and disconnected. Everyone across the entire healthcare ecosystem needs to understand the importance of the end-to-end experience, and in turn seek ways to make every touchpoint a terrific one. This not only benefits those who need access to information, but also provides the patient with an accelerated, streamlined care experience.
And as I mentioned before, we as individual patients and members of the healthcare community need to engage differently in the way healthcare is delivered. As a patient, I need to be engaged in my care and make my healthcare about being the healthiest I can be. As a provider, payer, PBM, pharma company, community group, or healthcare IT vendor, I need to listen more to the patient and strive for patient-centric communications, processes and technology.
As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks: the mental and behavioral health one and general health one. What are your thoughts on this status quo? How would you suggest we improve this?
We currently do see two separate tracks between general health and mental health, but, in my opinion, they need to be combined and are starting to be. For example, providers do what they can to ensure a patient has access to the medications they need — but if the patient isn’t capable of remembering how frequently they need to take their medications or does not have the capacity to take their medications at all, the treatment will be unsuccessful.
A recent study points out that only 10 percent of health is actual healthcare. The rest is based on behavior, social determinants, environment, and genetics, etc. To do the best for the patient, you must look at a patient holistically. In addition to diagnosing a patient, providers today recognize that to drive positive health outcomes, the entire patient experience and how to navigate through a care journey must be managed. This is especially important in managing patients with mental illness. The most successful providers are bringing behavioral, mental, and social determinants into their care plans to create a single, integrated plan of care that focuses on the whole person — including all aspects of an individual’s health and condition — to achieve better outcomes.
Care management technology is also at the forefront of that thinking and systems today support the ability (with the correct permissions) to combine physical and mental health information in a single plan of care to help care teams be more effective at managing care and driving positive health outcomes.
We can’t continue the status quo. If we don’t include mental health support, then we will not drive health success. A person’s physical and mental health are deeply intertwined.
How would you define an “excellent healthcare provider”?
Excellent care is about listening to patients, understanding their situation, and taking the time to know enough about them to understand their circumstances. This includes details such as issues they may be having at home, their inability to afford certain medications, and even how they travel to and from their doctor’s office. When we listen to our patients and anticipate their needs, we can develop a coordinated plan of care that gives our patients dignity and support throughout their entire health journey.
Partly, this means collaborating with the patient and other caregivers, such as behavioral health specialists or social workers who also have a stake in the patient’s health. Providers should also be open to embracing technology that supports their workflow and enables them to make healthcare safer.
An “excellent healthcare provider” is one that puts the patient at the center of all care planning and even includes patients in the decisions surrounding their care. She is transparent with the patient and enables the patient to be an active participant in managing her health.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My own personal mantra is “never give up.” Of course, it doesn’t only apply to healthcare — it’s true for just about anything, including raising my own kids. If it’s worth going after, it will take a bit of work, but you will get there. Even when we’re feeling down, we can’t give up as right around the corner could be the inspiration we need to get over the next hurdle. That was true for me when battling scoliosis. I was told that I was too old to have any treatment besides life-altering surgery. Instead, we opted to try the back brace route 23 hours a day and rigorous physical therapy to strengthen my back and teach me to walk straight again. It was that determination that helped propel me in my healthcare career. We can and will fix the healthcare system in the U.S. — the strides we have made so far have already made a positive difference. There is just more work to be done — if we don’t give up.
Are you working on any exciting new projects now? How do you think that will help people?
There are so many exciting new projects happening right now. It’s hard to choose just one. Though one of the most exciting projects I have seen lately is focused on the entire patient journey from diagnosis and treatment to service to billing and claims — because every touchpoint along a patient’s journey affects the perception about a health organization. In this case, multiple organizations and departments are working together to break down silos and look at all experiences from the patient point of view versus the process or business outcome. We are working with several clients who are looking to build bridges across payers, providers, and life sciences communities. We’re working on finding the best way to connect all the siloed departments and organizations so that providers and other healthcare teams can have access to the latest information available to drive the best patient outcomes. We’re seeing this model adopted across the wider industry as well — for example, large organizations such as CVS and Aetna are merging together to streamline and improve patient experiences.
We’re also working on how we can create a different future that proactively serves patients and solves issues before they arise. For a basic example, we can look at the “snowbird” population — the people who move from the northeast to Florida for the winter — and proactively reach out to them to send their medications to their winter locations with something as simple as a text message. The focus is on making the patient or member experience a better one by removing friction from the system and personalizing every interaction in context.
We’re also seeing collaboration with device manufacturers, so providers can use all of the IoT information they collect. This gives providers and payers alike the opportunity to monitor patients from a wearable device to not just check the status of a patient’s health by tracking weight gain, but by identifying and acting on exceptions like when a patient stops moving for a day. Knowing how many steps a person takes each day is not as valuable to a healthcare provider as being alerted to sudden changes in behavior. This enables meaningful interactions that not only deliver better health outcomes but also help individuals live more independently. The result is a happier patient, lower burden on the healthcare system, and bettter-managed care costs making care more accessible for everyone.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
If I could inspire a movement, it would be to make healthcare more transparent and more focused on outcomes, value, and quality care. It would combine collaboration with transparency. If we focused more on patient outcomes — rather than individual business goals — there would be fewer boundaries holding us back.
A recent study found 33 percent of US healthcare consumers have no experience with healthcare systems. In turn, it costs $26 more per interaction for this low healthcare literacy population than for those with high healthcare literacy. Transparency can help ease this burden. For example, in a previous role, I worked with a provider group that put all its costs and results online, so everyone had access to pricing — from a doctor’s visit to a hip replacement as well as outcomes and quality ratings. This behavior resulted in patients taking a more active role in how they decided what treatment they wanted, who provided it, and even if they wanted it. More transparency allows patients to plan in advance for costs and risks, evaluate the quality of different systems, and ultimately make the decision that’s right for them. Advanced technology systems today are enabling healthcare organizations to deliver proactive, personalized service, care and engagement that support every step along the patient’s health journey. Provider groups and insurers then focus on delivering the most appropriate and highest quality care which is a win-win for everyone.
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Follow Pega’s handle for how we’re changing the healthcare industry (and more!) — @Pega. Thanks!
Thank you so much for these insights! This was so inspiring!