Kristen Valdes, CEO of b.well Connected Health
Photo courtesy of b.well Connected Health
Kristen Valdes, CEO of patient-facing health management platform b.well Connected Health, sat down with MobiHealthNews to discuss how, she says, the Trump Administration is helping healthcare flourish and the inner workings of the CMS Interoperability Framework.
MobiHealthNews: Why do you think the administration is helping healthcare flourish?
Kristen Valdes: This administration knows the ropes. They've been here before. So, we've had four straight administrations of bipartisan support in health IT. It's not a very polarizing subject because we have this runaway freight train of a GDP problem in our country. We're tipping over, and we have to fix the problem. And there's been a belief through the last four administrations, you know, kind of regimes that if we create transparency and modernization in healthcare, that we can create better competition, which will, of course, bring cost down, quality up, etc. And also, we're really long overdue from a modernization standpoint.
So, what I really love about what this administration has done – and all the agencies are working so closely together, you know, from HHS [U.S. Department of Health and Human Services] all the way down – is that they understood that regulation and rulemaking are not going to get us where we need to be as fast as we need to get there.
They came to the table and said, "Look, we're open for business. We want to hear from healthcare. Tell us what's working. Tell us what's not working. Tell us what needs to be done." And then, instead of going through the rulemaking process, which would have had us years before implementation, said, "All right, who here wants to just raise their hand, a coalition of the willing, right, and say we're here for it?" Like, let's go solve this. Let's fix it.
And so they started to engage. I've never seen an administration engage with the private sector as deeply, thoughtfully and honestly and in real time as this. We're not setting up formal meetings. We're on Slack channels, communicating with the entire industry at the same time and solving real problems. So, we're solving them faster than we ever could if we would have continued in the regular way that things have happened.
MHN: What do you mean that you're on a Slack channel with people? Are companies that are part of the Interoperability Framework actually talking directly to each other through Slack?
Valdes: Yes, across the entire industry. It's the coolest thing I have seen in my almost three decades in healthcare. And CMS [Centers for Medicare & Medicaid Services] has been very come one, come all. These are not selective companies who can participate; it's anybody. And even if you aren't a product company or an EHR or a network or a conversational AI company, they created categories of "Friends of the ecosystem."
So, if you're a friend of the ecosystem – a consulting partner, somebody who is an engineer who supports a lot of provider or payer organizations – you can sign up as a friend of the ecosystem, and they are very quickly going through the signups and getting more and more folks on. You get added to Slack. You can only have one or two people per company on Slack because the government's funding it, and we have work streams.
It's so funny because the industry jokes that, "Oh, now I have two full-time jobs, right?" You have the job of your company, and now you have this job of fixing. How are we going to operate healthcare for the industry, but you're on with, like, 700 of your closest friends. It's actually very cool.
And when I say to the nitty gritty ... so, common problems. We have to remember that CMS historically has not been the operators; they're not the ones putting the policy in place and driving all that. So you need the operators at the table.
So, when the operators come in, and I'll just use an example – patient matching. Everybody in the industry does patient matching differently. It can cause information blocking and challenges. So, what should patient matching really look like? And so someone, the volunteer coalition of the willing, says, "I'm going to put pen to paper and I'm going to put something out there, and you guys are all going to comment on it, and you're going to say why it is right, why it is wrong, how you would improve it, how you would change it, and, all of a sudden, we all go, "Yeah, this looks good. We agree." Boom, it's part of the framework, and everybody adopts it.
Honestly, I think it is a huge story because we've never seen private/public come together in such a ... I don't want to say casual, because it's very intentional, but in a co-working environment in order to solve these problems.
MHN: So, instead of a competitive environment, as if fighting against each other in a way?
Valdes: Remember, historically, it was like, OK, we've created a policy and a rule that we think is going to solve a problem. We're going to let you comment on it for a long number of months, then we're going to regulate it and put it in rulemaking, and then that's going to go for a long number of time frames, and then a couple of years later, we might see it. So you never get from the policy side into the operational weeds of where things really break down.
It's oftentimes not at the policy level, but it's very clear, especially in these working groups, where everyone coming in from different angles has a different perception of what a policy might mean. Or, you know, is this a gray area? Is it clear? Do we need clarification?
And so with the health tech pledge, what the government did, I thought was incredibly smart from a CMS perspective, is they set the goals. This is the goal that we want to hit. Here's how we think we're going to get there. But then they said, "Hey, private sector, come in and tell us how to get it done."
So, private is building all of the foundations. Some of the other things we're doing is the conversational AI group, which is one of the health tech pledges. Obviously, things have come up around, well, how do we make this trustworthy? How do we interact with consumers in conversational AI when their medical records are being brought in?
Again, pen to paper, someone in the group put together and said, "OK, here is a nutrition label, or ... we don't know what it will ultimately be called, right? But here's a nutrition label. Let me not only write it down, but let me show you a visualization so that all conversational AI apps will agree," because it will become part of the CMS pledge framework that this is best practice everyone will agree to do it.
And so one of the cool things that came out of this is patients accessing their own information through third-party apps. It is still relatively new in our country. And so things like, OK, well, we might be high-trust certified, so that you know, all apps ... you can't just come in and not have any privacy or security, and best practices in industry.
Instead of everybody saying, "I don't trust this person, I don't trust that person, I don't like this" – we're actually solving for problems, putting in place new rails and new frameworks that bring native trust and, quite frankly, getting to the bottom of the, like, why can payers and providers not exchange information? You know, we have to get rid of this, and we have to say, "OK, how can we make it nice and easy for everybody? What are the big rocks we have to move, and let's at least get them down on paper and bring in whoever we need to, to help us solve and break through those problems."
MHN: It reminds me of the car industry, where there are standard best practices that every company must include in a car that all makers have come to agree on. Like, every car has mandatory safety features, like seat belts, stability control, airbags, etc.
Valdes: That's a great analogy.
MHN: So that's something companies are basically developing through those channels? What exactly needs to be within that essential framework that everybody needs to have in their AI?
Valdes: There are work streams, and the work streams are meeting every single week, depending on how far they are or not – every week, every two weeks or multiple times a week. If we find a really sticky item that we need a smaller, like, Ninja team to come together and circle around. Then, there might be smaller, more frequent meetings with smaller groups, but it's always a multi-collaborative stakeholder group coming together to say, "I want to help with this. I have a passion or interest in this subject. I have experience in this subject. I'll come help." But everything gets posted publicly, and everyone gets to comment on everything. So, we're truly building it as an industry together.
MHN: Since so many people are working on an initiative, how do things get finalized? Who says, "OK, this is done"?
Valdes: Well, the administration has said, "We want you work streams to figure this out."
So, what's possible to do by the end of March? And then for the final for July, like, what are the final requirements? We can't figure out everything at once. So, everyone's been building toward ... while they're building toward July, they are building toward the first deliverable, which is the 31st.
There's going to be another Demo Day, where people come live on stage, and, you know, Amy's [Gleason, acting administrator of the U.S. DOGE Service] statement is always real patients, real pipes in production. This cannot be in a demo environment where it's not really working. I don't want any Figma screens. I don't want any videos that are made up – [it needs to be] real.
So, they send out surveys, and they say, "Who's going to be ready?"
And they prioritize multi-stakeholder collaborations over people who are doing things on their own. They're saying, the more partners you have in this flow, and the more connections, and the further you are to the pledge, the more likely, in a hierarchy, that you're going to get time on stage to do this demo, to say, "I'm meeting my pledge. I'm making progress."
But we also talk very openly around what really isn't possible to get to by March. Is there anything in July that we just as an industry can't accomplish because we just need more time? So the administration is like, give us the feedback, and so they're ultimately, we're just documenting this is the framework, the details, the things that the private sector has said, "Here's what we need to do."
And remember that CMS, in this case, is also a builder because they have said that CMS is going to join the networks. They're publishing a National Provider Directory. They have already met part of their pledge, which was that they put Clear, ID.me and IAL2 technology on medicare.gov. So, they have deadlines to meet too.
This is the first time I've seen an actual movement emerge in healthcare, and I think that's the right word.
