Making Value-Based Care More Efficient with AI w/ Reveeler CEO, Jay Ackerman

Value-based care is a great concept, providers get paid to keep patients healthy rather than just for treating them when they’re sick.

But it’s not easy, and the results don’t always meet the potential.

Can technology and AI help?

In this episode of the HealthBiz Podcast, host David E. Williams speaks with Jay Ackerman, CEO of Reveleer on how AI can automate time-consuming tasks, streamline fragmented workflows, and consolidate critical risk adjustment to improve value-based care.

🎙️⚕️ABOUT HEALTHBIZ PODCAST
Healthbiz is a CareTalk podcast that delivers in-depth interviews on healthcare business, technology, and policy with entrepreneurs and CEOs. Host David E. Williams—president of the healthcare strategy consulting boutique Health Business Group —is also a board member, investor in private healthcare companies, and author of the Health Business Blog. Known for his strategic insights and sharp humor, David offers a refreshing break from the usual healthcare industry BS.

🎙️⚕️ ABOUT JAY ACKERMAN
Jay is the President and CEO of Reveleer, leading the company’s growth and innovation in clinical data collection and analytics for health plans and providers. He focuses on scaling operations, driving business expansion, and advancing product innovation to enhance healthcare outcomes.

With over 25 years of experience in software and services, Jay has held leadership roles at major organizations. He was Chief Revenue Officer at Guidance Software, led global sales and customer success at ServiceSource, and served as President and CEO of WNS North America. Throughout his career, he has successfully driven growth, expanded markets, and strengthened customer relationships.

🎙️⚕️ ABOUT REVELEER
Reveleer is a leading healthcare technology company specializing in AI-driven solutions for clinical data collection, risk adjustment, and quality improvement. Designed for health plans and providers, Reveleer’s platform streamlines medical record retrieval, coding, and analytics to enhance compliance, optimize reimbursements, and improve patient outcomes. By leveraging advanced automation and machine learning, Reveleer empowers organizations to efficiently manage healthcare data while reducing administrative burdens.

With a commitment to innovation and accuracy, Reveleer helps healthcare organizations navigate the complexities of value-based care. Its comprehensive SaaS platform delivers actionable insights, ensuring payers and providers can make data-driven decisions with confidence.

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Transcript

David: 0:00

Value based care is a great concept. Providers get paid to keep patients healthy rather than just for treating them when they're sick. But it's not easy, and results don't always meet the potential. So I wonder, can technology and AI help? Hi, everyone. I'm David Williams, president of strategy consulting firm, Health Business Group, and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. My guest today is Jay Ackerman, CEO of Reveleer, whose AI powered platform enables value based care. Do you like this show? If so, I hope you'll subscribe and leave us a review. Jay, welcome to the Health Biz Podcast.

Jay: 0:42

Yeah, David, uh, thanks for having me. Excited to be here.

David: 0:45

Sounds good. Well, I want to hear all about, uh, Reveilleur, but first I want to hear about you a bit, and I want to know about, uh, what your childhood was like, and if there's anything from your childhood, any influences that have stuck with you through your career.

Jay: 0:57

Sure. Uh, well, I guess maybe I'll call out two things from my childhood. Uh, while I live in Los Angeles now, and I've been here for almost 30 years. I grew up, uh, in New England, so, uh, I think there's a great work ethic, uh, people from New England. So one, that's, uh, part of who I am. And number two, my father is a multi company entrepreneur. He launched two companies. I was fortunate to work in one for a number of years through high, uh, junior high, actually in high school, uh, and early part of my college days. And I took a lot of lessons from him. And so. Uh, New Englander, uh, Boston sports fan through and through and, uh, got to see, uh, somebody build a small business and take it to something meaningful. Sounds

David: 1:42

nice. Now for school, I see you were at, uh, Connecticut College and then went straight to NYU after that. Is that right?

Jay: 1:47

I

David: 1:48

did.

Jay: 1:48

I, uh, graduated 10 days later. I was at NYU for my, uh, master's.

David: 1:53

Nice. That sounds very good. Well, it sounds like you knew what you're, know what you're doing. Hope you were, knew what you were getting into at least.

Jay: 2:00

I'm not sure we ever really know what we're getting into, but yeah, I was, I was pretty focused on the path that I wanted to go down.

David: 2:06

Yeah. And then what were the things that you did before, uh, Reveleer? I saw a number of. Of, uh, number of places that you spent some considerable time building up your, uh, your skills, your resume.

Jay: 2:16

Yeah, I, you know, I think my, my career has had a couple of interesting chapters. I started, um, you could say kind of chapter one was in management consulting. And so shortly after finishing my MBA at NYU, I joined a professor's, uh, consulting practice, um, focused on manufacturing, activity based costing, kind of supply chain work. And I loved consulting and got exposed to some fantastic fortune 50 companies. I got to engage with really senior executives at a young point in my professional career. But then I, I realized I wanted to be an operator. Uh, as a consultant, I got to put forth a lot of great ideas and strategies. I didn't have to stand behind them and I just felt the tug to, uh, kind of follow through on those recommendations and I had an opportunity. To join a company exalt. We actually sold our consulting firm to them and they were coming brought together by a investor, general Atlantic. And I had a couple of fantastic operator stints. One with this company exalts. We were private when we went public. Then I joined a company WNS that was carved out of a British airways backed by another phenomenal investor. Warburg Pincus got to be part of that amazing story. And then a company service source that was in the tech sector backed by Housatonic. Partners and benchmark capital to create, um, two great investors. Um, and then here I am. Um, so I've had these amazing journeys in private companies, predominantly a couple that have been able to go public. Um, but all with amazing talent, trying to do something bold and innovative.

David: 3:59

That sounds like the, the way to go. So how about Revalier? What attracted you to the company in the first place? Other than the name sounds like a big party.

Jay: 4:07

Well, we, when I joined the company, we were called Health Data Vision. Um, and what drew me to the company was this transition that the company was trying to help the health, um, kind of payer marketplace make from tech enabled services to SaaS. And I knew a little bit about that and kind of experienced that in my time at ServiceSource. It is a difficult transition, um, but one I had, we had been successful in doing, and I thought I had the skills and experience to help, uh, Health Data Vision, now Revalir, be successful. And that drew me to it, uh, and I would, I guess, uh, honest, be a little bit honest here, a little bit of, uh, disclosure, not fully appreciating the complexity of healthcare that I was diving into. So, for the last eight and a half years. I've committed to being a student and trying to learn something new every day, uh, around the healthcare space that we're operating in.

David: 5:05

You know, any company dealing with, uh, healthcare technology or software has most have relied on investors and entrepreneurs coming in who assume, I must be pretty straightforward. You know, we solve harder problems in technology. And so it ends up taking longer, costing more, being more difficult than, than expected. So thank you for, uh, for joining in and becoming part of the healthcare, uh, healthcare crowd. Yeah. Love it. All right. So I want to talk about value based care a little bit and what is, what is that concept? What does it mean? It sounds good, but what is, what does it really mean?

Jay: 5:35

Yeah, I mean, it's look, it's it's a it's simple in concept. It's hard in execution. Um, and those who are are living yet can't always control. They can't control all the variables either. So what value based care is about trying to align the incentives between those who participate in the care delivery chain to deliver a better outcome for the members or patients they serve. So principally get the insurers, members. Um, and the providers to work together to care about whether you are, uh, healthy, how you maintain your health, how you, when you have to engage with a care provider that's happening earlier, and hopefully in kind of a less costly and kind of, uh, easier, you know, easier location and not everything becomes an ER visit, um, and that routine interventions are done to get something early and not have it progress. So trying to put the systems, the tools, and the incentives in place. to bring that to life, and that's what value based care is about. I mean, think about some of the things in your own life that, if that person you engage with that provides the service to you was paid based upon whether or not you actually got the outcome that you're looking for. And, uh, you know, I think it's, it's a bold goal. I believe it is the right way for healthcare, but it is not without its challenges.

David: 6:55

So one of the hard things has been about You know, there's a lot of challenges with it, but it could be, you know, how do you measure, you know, what's the baseline, how do you attribute the gain to, you know, one party, uh, versus another. And some of these things I have a feeling are addressed with technology, they're addressed with better data, AI, and so on. But I remember back when things started, before we talked about value based care, there were things like, you know, pay for performance. And really the way that that was paid for was by getting people to shift from branded drugs to generics. You could measure the value. You know, of that, but I imagine things have, have come along and as you mentioned, you've been there eight and a half years. What have you seen in terms of the evolution, uh, of value based care over that timeframe?

Jay: 7:36

Yeah. Well, uh, I mean, I guess I could call out a couple of things, uh, over that, that timeframe, you continue to see the way that, um, parties are measured to change, keep moving the goalposts back and maybe, uh, bringing them closer together to try to raise the bar and drive for higher quality outcomes. Absolutely. And that'll continue. And like in every good business, you know, you're asked to kind of lift performance, lift results, and why not ask, uh, payers and providers to try to do better for the patients that they take care of. Um, anyway, that's one in terms of the actual work to succeed, uh, interoperability, there's still a lot of work. There's been progress on that front. Probably not enough. Um, many of the EMRs still don't, they don't talk, they don't take data well from other parties. Um, but we're able to access a broad set of community level health data through HIEs now in a way that we couldn't do, uh, eight years ago. So that's a phenomenal advancement. I think Gen AI and all the interest that's taking place across the globe in pretty much every facet of life has been helpful in the healthcare space because, look, in healthcare, people tend to, um, adopt slower. And there's been this kind of watershed moment where, uh, early dialogue on AI machine learning was, um, met with a lot of, let's call it concern and resistance. And now like everybody's woke up and like, of course we're going to use AI. And, you know, then there's the next question of like, how are you using it? And how are you protecting the data? But it's created a willingness to engage at literally every level inside of a, of a, of a payer, even kind of a large, um, you know, risk bearing provider group.

David: 9:25

Now, in order to participate in value based care these days and to be successful, what are some of the requirements, what are the, some of the boxes you need to check to be able to do that? And then what are some of the challenges that are still out there?

Jay: 9:38

Yeah, I think, you know, for quite box one, you have to understand the, the health profile of the people that are in your care, regardless of whether you're a payer or provider. One way that that often is done is through how risk adjustment that's a way to kind of put basically a score on top of each person's head that defines the kind of anticipated cost to care for them. You have to be able to do that well, and you need to do that well to have the dollars that it's going to take to properly care for. You know, those member in, you know, in your control, uh, and the tools have changed quite a bit to allow people to do that. Well, um, and as those tools have advanced, the call external parties that are there to protect and oversee, let's, you know, kind of insert CMS. You know, or inspecting it, um, heavier to make sure that people are, you know, are, are, are accurately reflecting that, that there's good detail on it and that it's being used to then provide proper care. So, I mean, I, I love, I love the attention that risk adjustments getting those who, who you can jump on it and kind of point to some of the bad actors. But overall, I think it's doing exactly what it should do, which is to help. Uh, a plan, forecast what it's going to cost to maintain and take care of their membership and for a provider group, you know, to understand what they've got to be prepared to handle. And I mentioned that community data and having that community data, um, you know, really helps understand and round out that overall health picture because you can get care now and in so many different settings. And your primary care physician may not have the data, um, from when you went to an urgent care may not have. information from an ER visit when you were on vacation and pop, something happened and you had to, you know, go get something in an urgent care, uh, environment. They may not have information on meds dispensed by some other doc that you've seen. Uniting that and then kind of understanding that, how that shapes your profile is super important.

David: 11:53

You have both providers and payers participating. In value based care, you mentioned a couple of areas where they have the same needs. Is there a convergence between these groups or is there like a very distinct set of things that you would use to serve payers versus providers?

Jay: 12:08

Well, you know, for us, um, so if I look back my, the eight plus years here, the first six of them, we were just focused on the payer side of the equation. And then we had risk bearing providers start to come inbound. And we saw that actually the tools and the workflows that we built, uh, can be used to support the provider. And now here we are kind of, let's call it two plus years into that journey of serving both. And we can see in some markets that we're in kind of a nice network effect. Where that, uh, that data is being shared, uh, uh, I would say freely, easily from payer to provider, and it's allowing them to work more closely together, um, to identify those members at risk, um, to, uh, engage them and get them in and make sure that preventative care is being done and proper follow up. Uh, and so we have ability to have a payer, uh, I, um, uh, launch a campaign with a set of providers for those providers to use our tools to engage the members, to capture the clinical data on that, validate that the work has been done, and to feed it back to the payer. Uh, and so we're excited to see that continue.

David: 13:18

One of the things I've always been interested in is whether value based care is supposed to feel different as someone who's a patient. It's clearly different for a provider. Uh, or for a payer, it's quite dramatically different, but like, I, I often think like, am I in a value based arrangement, uh, is that different? And is the patient, patient going to notice it and something they should pay attention to and maybe act differently? You know, that's

Jay: 13:45

a great call out. Um, I, uh, uh, I think if, if you, if you are aware of value based care as this payment model and let's call it a, you know, a B, a behavioral model that we're trying to kind of shift people. into or parties into, then you will see some of the actions that a provider's taken or even a payer and you'll understand why that, why you got that mailing from your insurance company telling you it's time for your annual wellness exam, or why your provider may be calling you to check on medication refills. Uh, and you're like, what, why would they, why would they be worrying about me in that way? So, um, yeah, you can see signals of it, um, for sure. And, um, you know, one thing we're trying to do with providers through our tools is to identify the care gaps to focus on when the patient is in their office. And if we do that well, that provider, when they have that, that window of time, and we all know that's that window's brief, right? It's 12 to 15 minutes, maybe 15 to 18 minutes. That the provider can give more focus to their patient. Um, so while our ultimate goal is to accelerate value based care, like we do have this kind of big audacious goal that will bring more fulfillment to the life of a provider by allowing them to be more effective in that window of time. And I know that weighs on so many physicians who are out there.

David: 15:15

Talk about how the, you know, you, you, you mentioned that it's a role for technology. How has it been leveraged in value based care and that may be specifically by Revalier? What are you offering? What is your lane, uh, within this space?

Jay: 15:28

Yeah. So our lane, uh, today, um, our lane centers around, uh, what's called, um, three, four kind of core areas for payers and providers. One is this understanding of this health profile, call it there. You know, their RAF score, but really like what is the acuity level of each person, person in their care. And we've built the, the workflow, the data acquisition capabilities in the AI to bring that data together to understand it, to read it and surface it up for somebody to validate it. So that's, let's call it like, um, swim lane one or call it superpower one, superpower two. Similar in the way it works, uh, is to help close care gaps. And that's to really to make sure that if there's a, you know, a condition that's developing to try to, uh, intervene and get you in and, and, and to have that addressed. But that could be a regular colonoscopy. That could be ensuring that someone with high blood pressure is coming in at the right interval, um, to have their blood pressure checked and their care plan, uh, evaluated and readjusted. So. We built the tools for the payers and providers to identify those gaps, trigger the focus on it to close the gaps and feed that back in, which is important data to CMS for CMS to rate how well they're doing. It ultimately impacts quality bonuses. And look, they do a great job taking care of you. They should get recognized and properly compensated for it. So those are two of our kind of big swim lanes and areas of, uh, I think unique differentiated capability. And. Uh, you know, what's allowing us to stand out is how we're using machine learning to read all this information. Uh, like one data point I call out a lot, cause I think it just speaks to why AI is important. Uh, within our system over the last 12 months, we ingested over 1. 1 billion pages of data. That's over like 330, 000 pages every single day of the year. And you need to have some really intelligent technology to read it. Cause you're not going to be able to put enough people against that. To do it and do it efficiently and do it accurately.

David: 17:47

Yeah. I can imagine like, you know, you sometimes see those offices in the movies stacked with papers and stuff, but this would be a lot worse. This would be like a whole museum.

Jay: 17:54

Yeah. I think back to X Files and whenever they would wrap up the episode, right? You would see this cavernous, um, warehouse with all these stacked file cabinets.

David: 18:05

So machine learning has clearly been a focus and now people are, you know, understanding that a bit more, but generative AI, as you mentioned earlier, has been. Something where now everybody can see it. They kind of get machine learning, but you know, generative AI, everyone's got the, the, uh, you know, they, they used to, they used to working with it. In a, in a sense, how does that factor in to any value based care broadly? And then what Rebolator is doing?

Jay: 18:30

Yeah. Um, complex topic. Uh, we've been in the, let's call it the machine learning AI journey since 2018. Yeah. First with a partner that, um, Was better resource than us. Uh, and then, uh, we brought some of that tech in that was developed for us and then built up our own, um, AI team and set of AI capabilities. Um, so today we're, we are. Much of the tech that's deployed in, um, performing the things that I just spoke about a couple minutes ago is more traditional machine learning, um, sophisticated rules, engines, and libraries. We are, um, We are using, um, Gen AI today to advance, um, our rules, engines and libraries. It's amazing how just having Gen AI, we can fine tune and enhance those engines. We're using Gen AI as a way to reprocess much of our work and evaluate the, call it the efficacy, the accuracy of what our engines are putting forth. And you look, I think in, as we look towards the back half of this year, we will do more, um, we'll do more with, with Gen AI and you'll see Gen AI come to life in some of our core tools. But today Gen AI is kind of an enabler and an enhancer of

David: 20:01

So there's a new administration in Washington for anybody I heard paying attention or what, you know, uh, what do you see as an impact on value based care? If a,

Jay: 20:12

uh, well, early days, um, uh, look, I'm going to give you just my guess. My, my guess, um, based on kind of people that I know are now, um, participating in the healthcare side in this new presidency. Um, there are some people that are, uh, in pretty senior positions that are big advocates of Medicare Advantage. Um, and so I, I, I don't think you will see walking back of Medicare Advantage. You might see acceleration. There's a significant focus, as we all know, on reducing, um, Fed costs, and One area that's come come out very quickly, right, is a desire to cut back on Medicaid, the federal portion of Medicaid. Yeah. And so I think you'll see that that's going to put the burden on states, um, burden on many states that aren't equipped to take on that added cost. And you talk to a payer. And a provider on Medicaid and they'll say that their costs are a hundred X percent of what they're getting paid. So no one's making money on that. I think that will cause some adjustment in Medicaid offerings. Uh, does it change value based care? No, but I think it's going to put just a lot of pressure on the system. You know, when Trump was first in office, there was a view that, uh, he was going to blow up Obamacare, right? He was quite vocal about that coming into office. And then four years later, he had actually overseen some changes to strengthen, uh, the ACA marketplace. And now that's a, that's a pretty stable, um, insurance market. It's taken on a lot of new lives through. The Medicaid, uh, re, you know, um, kind of readmission. Yeah. So I think ACA will, um, stay strong. Probably doesn't hurt that one of the big ACA insurers is also backed by, uh, a family member. Yeah. It

David: 22:16

doesn't, it doesn't hurt. Maybe they get their own, um, meme coin as well. All right. So we'll, we'll come back and talk about that, but I want to leave a minute for the last question, which is if you have any book recommendations, anything good that you've read lately.

Jay: 22:28

Uh, any good, uh, book recommendations? Yeah. Yeah, um, I, uh, well, you know, I just wrapped up one book and this is, uh, I'm going to recommend it because it's helped me understand him, uh, better, and so I just finished the Elon Musk, um, biography by Walter Isaacson. Yeah. It came out in 23. I only just read it over the holidays. And, um, look, that's a person who is front and center with Trump now on a lot of things, and I definitely understand the way he operates far better than I ever did before, and it's a fascinating read.

David: 23:04

Whether you

Jay: 23:04

like him or not, it's a fascinating read.

David: 23:06

That book was recommended to me about a year ago, and I did read it. Um, just right around that time. And I did find it quite, uh, quite insightful. So I will, I will second your recommendation. Well, Jay Ackerman from Reveleer. Thanks so much for joining me today on the health news podcast.

Jay: 23:23

Thanks for having me. It was a pleasure.