Bridging the Gap Between Payers and Providers (ft. Bruce Lee)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences.

And now your host, Ed Marx. Ed here with another edition of Digital Voices, and I want you to meet my friend Bruce Lee. Bruce, welcome to Digital Voices.

Hi, Ed. Happy to be here.

This is gonna be awesome because we spent most of our time with providers and sometimes biotech, sometimes pharma, and sometimes on the payer side. And so, Bruce, you aren't just payers. You— we'll get into that, your whole background, a lot of financial services and such. But you also had a pretty amazing experience as a CTO for Centene. So we would definitely want to dive into that as we get going. And I think the first time we met, It was actually pretty recently. I've known of you in the industry, obviously with Centene and such, and we met at dinner in St. Louis a few months prior to this recording. And I was like, this guy's super interesting. One, he's got a cool accent, but I'm sure you're gonna get into it a little bit. You got some cool hobbies and things and obviously great experience. So that was when we first met. But Bruce, the most important question I ever ask any of our guests is what songs are on your playlist?

Oh, it's funny you should ask it. I'm having a bit of a throwback period at the time, at this time, and it's all the early Genesis albums. Wind and Wuthering, Nursery Crime, Trick of the Tail, Selling England. Songs like One for the Vine or Blood on the Rooftops just get me so excited. It's also fun because on YouTube you can see modern bands and young musicians covering them now and being reminded of why you loved them all those years ago. But yeah, I'd have to say early Genesis is my, uh, current fix.

What about Supertramp?

Oh yeah, we could go there. We could do that. Interesting group. They ended up breaking up because of the financial pressures around being successful, but great music. Love Supertramp.

Yeah, I, it just occurred to me when we were talking about early Genesis, I was thinking, oh, Supertramp, and you being from, you know, that part of the world. And the audience can't see it, but you have guitars in the background.

I do, I do. It's the hobby I enjoy.

Yeah, yeah. So let's talk a little bit about that. What are some of the favorite music that you like to play?

At the moment, it's just trying to learn some jazz standards, to be honest. They contain so much ability for the solo guitarist to play and accompany themselves at the same time. That's really the fun thing I'm doing. Playing in a band is always more fun than that because you're playing with other individuals and having a really great time. But sometimes those opportunities are a little bit limited, and constantly just noodling on your own is not so great. Having a purpose, and that at the moment is trying to play some jazz standards. Jazz standards. I've been working on Autumn Leaves recently and been enjoying that.

Yeah, I should have gave you forewarning and just had you play a little bit for us.

Oh no.

Are you in a band now?

No, no. The last dad band I was in, we went our separate ways, literally to Miami, to Pennsylvania, and that kind of thing. But trying to get back together with some guys and play a little bit where I am now because it's good fun.

Yeah, that seems like a great outlet. What about life message or mantra? Is there a quote or something or sort of words that you live by that drive who you are?

Yeah, I've been asked this a few times over the years, and the 2 things I've settled on that really resonate for me are to always be curious first. You know, you've always got to keep thinking there's a different way to think about the problem, a different way to do something or to approach a difficult situation. So always be curious, but then never forget it's always about people.

Oh.

You know, in the tech world, we can get so obsessed with how great the tech is and everything else, but it's people that make the difference. They either adopt the technology or don't. They either build it and operate it successfully or they don't. And so stay focused on people as your number one thing.

Bruce, what do you— how do you think you learned that? Like, it came right to the top of your mind, so obviously it's part of the fabric of who you are. Was there something that happened, or, you know, someone who taught you that?

Well, I think as essentially an engineer, you spend your life wondering why the rest of the world doesn't get it. It's so obvious to us engineers, you know, you connect A and B and C in this way, and it's going to work, and it's going to be great. And then people go, well, not for me, it's not great. And I don't really like that because, and so I think just frustration drilled it into me. And then often, I think in leadership roles, you're asked to, you know, come in and change everyone and change everything because the people they have can't do it. And what you find is most companies are filled with very smart people who care about what they do and are compassionate about what what they do, and they just need the right environment in which to bloom. And so, over the years, I've found it's been better to, if you like, renovate the people you have to a large degree. There's always occasional changes and tweaks you have to make, but I've never gone in with that wholesale change everybody and just bring in a whole new team kind of thing. I've always felt teams have the capability to do better than they're doing. And if you focus on those people and give them the right environment in which to thrive, you can transform companies and their technical abilities and what they can do and the confidence with which they do things, you know, without just having to fire everybody and hire a whole new team. So for me, yeah, people first.

Yeah, no, I love that. Again, it is somewhat unusual. That's why I dug a little bit deeper into that. And it shouldn't be, but it is in the tech space often the case. So I love that. Tell us about life growing up. Where are you from originally?

I'm from a small village in the south of England. My parents ran the village shop. Shop, we would call it store as we would call it here. And I just grew up around working in the store, helping my dad with big projects like expanding the store physically and building extensions on our house, seeing my parents' teamwork around how they balanced who did what in the running of this business. And also grew up without anonymity because everybody in the village knew who I was because my parents ran the shop, which meant if I did what normal young boys do, break milk bottles, you know, That kind of thing, make patterns in the wheat fields of the farmers and get into trouble. They always knew who I was. My buddies didn't get into trouble because no one knew who they were, but everyone knew Mum and Dad ran the shop and I used to get into trouble. So that was where I started out, a little village in the south of England. Yeah, it's been odd to have ended up here.

Yes. Tell us about your journey now from a career perspective. Tell us about that transition across the pond.

Yeah. No, it's interesting. For me, it was a second chance story. And we talked about the guitars. Well, I was playing them a lot when I was 17 and 18, which meant I really messed up my education at that point, and I didn't make it to the university where I had a place. So, I got a second chance, which was to go to the next level down from a university, what we used to call a polytechnic. And instead of doing a degree, I was doing what was called a certificate. The certificate gave me access to a year in industry. So, I spent a year working for IBM. Then I was able to study and work hard enough to get onto the degree course. I was then able to do a project for a bank where I created a foreign exchange quoting system, you know, press 1 for US dollar, press 2 for pound, that kind of thing. Through that, managed to get into a bank, which was a big break for me. I then worked in London for a number of different banks and consultancies. I got over to Japan as a CIO at 28, 29, something like that. And that got me onto the global management team of what was then Paribas, a large French international bank. And I got to see up close how you run a big, you know, IT operation through that. But I always wanted to come to the States. I'd come to the States as an 18-year-old with a friend of mine, and I always wanted to live here. And Paribas, well, in New York, so I came in, I was the New York and America's regional CIO at 30, I think. Yeah, something like that. And then, then haven't left, been in the New York area. I worked for BNP Paribas and HSBC, doing lots of things both regionally and globally for them. And then I was really lucky to have the chance to then go work at the New York Stock Exchange and their global group, NYSE Euronext. And eventually I became the CIO there, um, in preparation for the acquisition by ICE, uh, that happened. So that was the New York Stock Exchange. Then I got to go work in Washington for Fannie Mae, big secondary mortgage thing. You know, just about every home in the country is financed by them. And that finally, after doing 5 years in Washington, it brought me to Centene in St. Louis, and great experience being the CTO there. So, I sort of always wanted to come to the States since being 18, and just managed to take a detour through Japan to end up here. That's how I got here.

No, that's awesome. And I do love and appreciate the certificate story, because Sometimes we give up too early, right? We didn't get the big shot at the university or whatever, but you took full advantage of the situation and as a result, actually got a lot of great exposure to different industries that ultimately led you to your full-time career. Did your— I don't know about your parents and if they're still alive or not, but have they been able or were they able to see your success since leaving home and then becoming big-time CIO?

They would, but as parents always do, my dad always wondered exactly what I did do. But yes, fortunately they, fortunately they did see that. Um, and honestly, it's been an honor. I know it sounds a little bit trite, but for a small, you know, guy from a small village in England to end up being CIO of the New York Stock Exchange, systemically important to the US economy, Fannie Mae, even more important to the sort of country hangs together and you can get the same mortgage rate all over the country and all that kind of stuff.

Yeah.

And then to Centene, which is 26 million members. You know, it's, it's been quite, quite a journey, and I feel, you know, quite honored really to have been given the, given the chance.

Heck yeah. I mean, that's like, um, you know, you, uh, playing with the Stones now. Right. Keith Richards, you know, taking over for Keith Richards on stage.

Yeah. If, if my rock career had been that successful, I wouldn't have needed the IT, I guess.

Yeah. No, that, that, that's great. No, I'm, I'm, um, I'm sure your parents, the whole village, uh, Super proud of you. So tell us about that transition then. So you, you have all this great experience on financial services and then payers. Did you ever think about healthcare? What was the draw for you?

Honestly, it was the opportunity that came up and it had really interesting bones to the opportunity originally. So Centene particularly had been built as a set of acquisitions. And so there was a real need to do both a technical integration, but also a cultural integration. Every team you talked to at Centene remembered which company they'd come from and when they were Right? And they still talked in those terms. And that was reinforced by the systems that still had email addresses from all the different companies they'd bought, all that kind of stuff. So when I was approached, I really liked the 2 challenges that were set out. But more than that, I really liked the people. The team at Centene was a really great team led by Mark Brooks and others. And I just enjoyed meeting them and being part of the solution to the problem set they have. Over time, I'd have to say I actually grew to like the mission. I didn't come in going, healthcare is fantastic and I want to help people and all that kind of stuff. But when I saw the passion that people had and how they dedicated their whole careers to helping in this space and trying to make the system work better, I was really drawn to it. And given that I'd started my career in the most sort of capitalistic end of the spectrum, equity derivatives, interest rate derivatives, everything that crashed the global economy, basically, to then go through mortgages, which was a, with Fannie Mae, which was very, held the country together kind of thing. And then to arrive at healthcare for some of the most vulnerable in the country, I guess I hope there's been some arc towards doing something that's not only fun, but also useful. That's how I got here and had a great time.

Yeah, no, that's super. We often talk about healthcare being a little bit behind other industries. Did you find that to be the case? And if so, what were some things that you were able to bring to Centene to sort of advance them a little bit?

Yeah, there's often a lot of questions about how could financial services help the healthcare space and everything. But I think there's a little bit of false equivalency there to begin with. You know, it's not like the bank looks after your money, but then gives it to somebody else to give to you.

Right.

The bank is vertically integrated. I mean, there are some mortgage originators and some wealth managers. But generally, you know, if you're in a Chase Bank, you're in a Chase branch, and it's from there to your money is all within the thing. Payers have to work with providers, and provider is the product, not the to pay a thing. So I don't want to draw a false equivalency between those two. But the main thing I think financial services did do better overall was the integration. Now, it took them years, but they had drivers that were very pertinent to them. A lot of regulations said you had to put the same customers on the same systems and provide them with the same services when you bought retail banks, that kind of thing. There was also almost a maniacal focus in the early 2000s on the omnichannel experience in banks. You had to start it on the web, finish it in the You know, and eventually you could do something on your phone or at the call center. And so that omnichannel thing really drove a lot of integration. And then at the more investment banking end of things, there was things like global credit risk and global market risk and so on that just needed everything to be put together. So I think the main thing financial services did better as an industry growth, grown through acquisition, like a lot of the payers have been, that they got the integration done better to have a better foundation on which to build a digital enterprise. Yeah.

That makes total sense. I'm sure you discovered when you were at Centene that, and maybe Centene didn't have this challenge as acutely as some other payers, but there's always been a, a little bit of a chasm between payer and provider, which is unfortunate because we're all trying to serve the member and patient. Well, how do you think that can be improved? So if you did see it or, or know about it, again, I, I'm not implying that Centene had that issue, but some payers do and some providers do. Any ideas how you might bridge the chasm? Like how might they work better together basically is the question.

Yeah, I mean, the provider space is so diverse, right? I mean, it's everything from the mom-and-pop chiropractor who still sends in a fax all the way to a large hospital system. But I've been thinking about this a little bit because it is part of the challenge of the industry. And I think there are like 4 things we can, I think, collectively focus on to bridge the gap. The first being, in purely technical terms, We have to have the large provider networks and the large payers collaborate more aggressively on standards for data exchange and the times in the business model and the places in the business model where it makes sense. Eventually, those standards will get codified into regulations. In financial services, we never used to wait for the regulator to tell us how to do something. We would create a consortium, do it, and then the regulators would come along and codify it afterwards. And I think that's what we need to do as the larger groups. Second thing, I think there should be even greater consolidation in the provider side. I'm afraid it's just too, there's too long a tail. It's too long, too small. So I would encourage more provider consolidation to make the, make the number of people facing off to each other just smaller. Third thing, not from a technical point of view, but from a business point of view, I think more risk sharing agreements and more outcome quality based deals would, would would really make a difference. If you've got to prove the outcome, you need the metrics, you need the data, you've got to exchange data. Hence, you have to bridge the gap and tech will do that. And then fourthly, this is one I've been hanging onto ever since I started in payer. I can't believe we as patients put up with how badly the—

Yeah.

The universe is. So my last hope is that pressure from patients for just a more integrated payer-provider experience will get people to work Yeah. Having said all of that, though, I don't have false expectations. The health ecosystem is incredibly hard to change. And you see so many tech companies come with all the hype, disappear pretty quickly. I mean, you can even look at someone like Oracle who's spending millions and still finding it hard to get traction. And it's beyond the payer and the provider at that point. It really is the system. There are too many misaligned incentives and rents in there that you have to change. We changed them in the mortgage business at Fannie Mae. We fundamentally changed them by changing the risk profile of the deals and who took the risk when. And we got 70 days of mortgages down to 10 days, and it was possible to do it on your phone.

Yeah.

And seeing it there, I hope it's not far away for health insurance and payers that we can again bridge that gap. But you have to deal with the incentives and the rents somewhere along the way.

Yeah, no, that's very insightful. And I agree, especially on the consolidation, because almost every industry You can name 3 or 4 leaders in that industry that account for 80% of the market. And, you know, whether it's automotive, payers, what have you. But when you look at healthcare, you could take the 3 or 4 biggest and you might be at 20%. Yeah.

If you're lucky.

Yeah. Yeah. So yeah, it's, it's a different animal as a result. Well, I really want to focus sort of the rest of our time on leadership, but before we get there, what is your focus today and what do you, what do you do today and, and Yeah, I'm on the board of a company and I do some advisory work and I speak to a lot of companies about a lot of different things.

And my focus at the moment, not to add to the hype cycle, but it is people and AI. And it's both of those things together. Benefits and harms is another combination. What's practical versus what the hype is could be another combination. But I really think you've got to get in and understand the AI thing at the moment as a leader in IT. And you've got to confront it for what it means to you and your Yeah. Your themes. And it was funny when we were having that first dinner in St. Louis, one of the topics that came up was everybody was saying, well, you know, we said AI was going to replace radiologists, so we wouldn't need radiologists anymore. But now we've got a shortage of radiologists. You know, even though we've got AI reading the stuff, we still have a shortage of radiologists. And I think for me, that typifies, you know, some of the practical thing, the hype thing, the trying to predict the future without really being engaged in it. But you have to keep your eye on everything. While everyone's worrying about images being read by machines to replace radiologists, we might actually see the first practical thing in the provider side being robots that can help nurses lift patients.

Yeah, right.

It's not just a robot in a factory that can take something from this shelf and put it on that shelf. You could have Bob, your robot, standing next to your nurse and saying, I need the patient lifted. And patient lifted. Things could come at our business and our business model from so many different places at the moment. I think people have to be really open and really paying attention. So that's where my focus is.

So Bruce, I'm going to change up some of my leadership questions on you on the fly here because you, you already covered a lot of them that are really important, fundamental to becoming a great leader. Let's just say you're speaking now to the graduating class of the Polytech Institute. What are 2 or 3 words of wisdom you would drop on them for their career?

I think I would say what I said at the beginning a little bit, and I'd say, you know, first of all, be curious and be open.

Right.

Don't get yourself locked into defending. We always remember the people who were zealots. We need zealots. We need people who really love their tech and they think it's the best thing ever. But if you're going to be a leader, you've got to be willing to say the idea that you had yesterday isn't the best idea today. I always joke with people and say, every IT decision is right until it's proved wrong. And because mostly they're a decision in time, they're never right absolutely. You choose this tech because from everything you know today, that's the best thing to do. It can be 6 months, it can be a year, it can be 5 years, but someone will come along and say, why did you do that? That was so dumb. Well, it wasn't dumb then. It might be dumb now. The ability is then you change, right? So I'd say be open, be curious, be ready to change things. The other thing I learned later on that I wish I'd learned earlier is that I'm always surprised to find people in companies who are prepared to see things fail for their own political ends.

Yeah.

Now, maybe they have a different view of what's the right outcome, and we can give them the benefit of the doubt. But I wish I'd learned sooner that people will literally let projects fail, systems go down, patients and people be harmed in some way if that made their case that everything had to change, you know, it was easier to make, or whatever it was they were going for, budget approval, you know, whatever it is. I just always assume everybody's in there with the right intentions and they're all on the same team. I've learned to be wary of that. And it took me too long to become wary of that, I would say. Yeah.

Well, see, you just stole my next question because it's sort of like, what did you learn the hard way? And it's true. I mean, I've run into that myself and it's just so hard to believe that some people might be that way, but you can't be naive, right? Is your warning. You know, how about, you know, one thing you're most proud of? You look back in your career and it's still going. So it could be something that's going to come up, a new proud moment. tomorrow. But looking back right now, what's one or two things that you're most proud of?

Well, beyond family and beyond obviously having a beautiful wife who supported me through all these career transitions and followed me all over the world, there's a couple of things that jump out at me. Early on in my career, I got to build the first, what was called bilateral netting system in foreign exchange. That sounds very technical. But basically, instead of us sending you $100 million and you sending us $120 million, we would just send $20 million. We would net the $100 against the $120 and just exchange $20. Seems pretty simple. Well, what it did is it expanded the foreign exchange market because all the limits were set on the amount of money you could settle in a day. And so with technology and with partnership and with working with banks and things and protocols and standards and what we would call APIs today, we didn't call them back then, we were able to fundamentally change the way the foreign exchange market works. And when you're like 24 and you go, I have changed the whole way it actually works. You get emboldened with the idea that technology really is a transformation capability. So I love that. And then the other thing I would point to is I really was proud of the work we did at Fannie Mae to improve the culture for the people that were there. When I got there, employee engagement was in the 20s and 30s.

Yeah.

It was post the 2008 crash. People were still not willing to put a a car parking sticker on their car because their car would get attacked because they were associated with Fannie Mae. And we managed to get that employee engagement up to high 80s, early 90s over 3 years and get it ranked as one of the best places to work for IT. And that was a really big cultural change. Lots of emphasis on rebuilding trust, rebuilding skills, refreshing teams with new talent from the bottom up. Yeah, really, really great. The team that worked with me on that was really first-rate.

Yeah. Yeah, that's great. Only because you brought it up, I'm going to ask one additional question. So you've been married a long time and you have a family and you've gone through a lot of changes, moved all around the world and things like that. How would you answer in one word the secret to your marriage success to date? And how, what would be the one word you think your wife might say? And you can test it on her later today and you let us know, but you know, what's, what, What's one word that you think might help other people?

Try and be kind in your relationship.

Kindness.

Kindness. I mean, our partners give up so much for us. You know, I've sat in this room where I'm sitting now on incident calls while there are 20 family members sitting 50 feet away waiting for me to join them for dinner. And it's my wife that's explaining my absence and covering for me. And so when you leave this desk and you go there, it's not about you anymore. It's not all like that thing that you were just involved in where 50,000 people couldn't work and it was all that hype. You know, you then have to go and engage and be kind and recognize that life is just as important as work and requires just as much care and attention. And I think that comes down to kindness in the end.

Yeah.

Yeah.

I love that. This has been a super fascinating conversation. We talked about everything from Janis, and I had to throw in a little Supertramp there reference, talk about your guitar playing, and that's probably how you also maybe de-stress a little bit.

It certainly is. Yeah.

Yeah. Your life message came through multiple times about being curious and how important that is and always about people. And then we talked about the way you grew up and it sounds like a really beautiful spot in, uh, southern England, right? It was southern England. And, uh, and then your career, it's been an amazing career and still continuing. Uh, but you've, you've worked around the world and for some big organizations all of us recognize, but you always kept people at heart and you, you had some great ideas for how to make the Payer-provider relationships work a lot better. And then the great word on marriage, and that's just to be kind. What did we miss, or is there anything you want to double down on? I'll give you the last word.

Thanks, Ed. That's quite the summary. I really appreciate the conversation. I think what I would like to leave everybody with is the idea that we're in this moment, this, let's call it AI moment, but it's also other things are changing. Networking is changing. All sorts of things are changing. I just want people to feel that they're engaged and part of the change. And it's not being done to them, but it's being done with them. I'm not suggesting resistance, you know, don't take that coding copilot, you know, whatever. But I am suggesting that it's only the experts who can judge whether it really works or not, how it's best to be used, how it's safe to be used, and what's the right thing to do with this. And the IT team really is the expert. So once again, into the reskilling we go, we have to learn this stuff, and we have to engage on it. So I think that's where I really want people to think it's, It's an exciting moment and we have to engage because we are the experts.

Bruce, you're a good human. Thanks for being a guest on Digital Voices.

Thank you, Ed. It's been a pleasure. Appreciated doing this. Thank you for listening to Digital Voices Podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review.

And most importantly, thanks again for listening.