Customer Spotlight: John Budaj, Fallon Health

In our new customer spotlight series, we’re shining a bright spotlight on healthcare interoperability leaders. We’re starting with John Budaj, Vice President of IT at Fallon Health. A very engaged stakeholder, John sits on our Customer Advisory Board (CAB), playing an active role in helping 1upHealth identify health plan priorities and ways to address their top challenges, as well as providing feedback on our product roadmap.

We recently had a chance to sit down with John to ask him a few questions about his career path, approach to interoperability, and technology strategy, among other key topics. We hope you learn as much from John as we did.

Career Path & Personal Insights 

Can you share a bit about your career journey? 

I have more than 30 years’ experience in the healthcare payer space. I joined Fallon Health in 2011, and have spent the last 7 years leading our IT organization. Prior to that, I held leadership and individual contributor roles at ConnectiCare, UnitedHealthcare, MetraHealth, and The Travelers. During my career, I have had the pleasure of experiencing both the business and IT sides of the house.   

What led you to your current role, and how has your experience shaped your approach to health data interoperability?   

Being an analytical person and having worked in various Informatics and Medical Economics roles throughout my career, I have a deep appreciation for how important data is in positive decision making. As I transitioned over to IT, I saw firsthand how inefficient the exchange of data between constituents in our industry can be and the negative impacts that could have for us all. This led me to approach data and interoperability differently – to push the status quo for better outcomes.     

Who have been some of the key mentors or influences in shaping your career path in healthcare and interoperability? What lessons have you learned from them? 

Over the years, and through various roles, I have worked with so many wonderful people that had a positive influence in shaping my career. I am especially grateful to the former CIO at ConnectiCare who gave me a chance to transition from a business role to IT. If it wasn’t for this opportunity, I wouldn’t be where I am today. As far as interoperability goes, I thank Denny Brennan of Mass Health Data Consortium (MHDC) who formed the Data Governance Collaborative bringing payers and providers together in Massachusetts to work collaboratively on standards-based data exchanges.     

Approach to Interoperability 

How has your health plan approached the challenge of health data interoperability?  

Fallon Health has taken a pragmatic approach to health data interoperability. We believe it is a worthy and necessary initiative for the industry and view it as an opportunity rather than a challenge. Today, we work closely with providers and vendor partners to positively impact and maximize their approach to interoperability, which is consistent with our history. Fallon Health has been at the table with payers and providers in Massachusetts, helping to further the cause for several years, even before initiatives like DaVinci, FHIR, and CMS regulations came to fruition.

How has CMS’ interoperability mandates (such as CMS-9115 and upcoming CMS-0057) influenced your strategy? 

The mandates have brought some welcome visibility around interoperability, but also some challenges. Generally speaking, when it comes to mandates, you want to comply and meet the letter of the law. However, in this case, compliance alone may not be enough. We need to look at this as the jumping off point to bigger and better opportunities to engage with our provider communities that will have positive impacts on the communities we serve.

Healthcare Tech Strategy 

What role does technology, specifically FHIR APIs, play in your interoperability efforts? 

Since CMS-9115, FHIR APIs play a significant role in our interoperability efforts and will continue to play an even larger role as we work to comply with CMS-0057. With the help of 1upHealth, we have a FHIR platform that allows us to meet the current and future Access API requirements but also allows for other opportunities.   

How do you manage the integration of patient data from multiple sources across the care continuum? 

We rely on our strategic partnership with 1upHealth to help us navigate this problem. As data begins to come in from payer-to-payer, clinical connectivity opportunities, and other sources across the care continuum, we will utilize our FHIR repository as the centralized point where we can determine what needs to be integrated to our internal systems.   

As data exchange continues to grow, how is your organization addressing scalability challenges in managing and integrating patient data?  

As stated above, we currently plan to leverage our FHIR repository to be able to scale internally and externally with our partners being able to leverage this data directly from the repository for their own consumption. 

Business Value & Collaboration

Can you share any specific examples of how better data sharing has driven improvements in your quality scores?  

Providing high quality care and coverage to our members is central to our mission. But it’s not something we can do alone. As a not-for-profit health care services organization, we work closely with providers to enhance care and services. Successful data sharing is key to helping deliver equitable, high-quality coordinated care. This is especially important to Fallon Health, as we are predominantly focused on government-sponsored programs, serving some of the most complex members in the Commonwealth of Massachusetts and Western New York.   

What strategies are you using to collaborate with providers, payers, and other stakeholders to improve data exchange?  

We have been long standing participants within MHDC. Any time you can get organizations together to begin to build standards, the more apt organizations will be to invest in moving toward that technology. I strongly believe that we must collectively evolve our way of thinking. Data should not be seen as a competitive advantage where every organization wants to keep what they are asking for and how they are asking for it a secret. How organizations decide to strategically use that data should be the differentiator.

Future of Healthcare Interoperability 

How do you envision the future of health data interoperability evolving over the next 5-10 years? 

I would like it to evolve at a faster pace. And given the recent momentum in standards, I expect that to be the case. However, if technology is reliant on one another, I do think payers and providers need to be held to similar compliance dates. CMS and ONC (or ASTP/ONC – Office of the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology) will need to execute in lock step for things to move more seamlessly.

What innovations or trends in interoperability are you most excited about for the future of your health plan? 

I feel that interoperability has the potential to level the playing field. It gives community health plans, like Fallon Health, the ability to acquire data from providers they previously were unable to. And it allows those same payers to provide actionable data back. That will have a positive impact on shared members and the communities we serve. This is a huge opportunity, and I, for one, am excited to see how things play out.