Why the Same Surgery, Same Doctor, Same Insurance Can Costs 3x More – Dr. Allison (Alli) Oakes, Trilliant Health

When you have garbage that goes into your models, you get garbage out. I was so excited to talk to Alli Oakes. She's the VP and Chief Research Officer at Trilliant Health. We talk about claims, we talk about price transparency, and we talk about what it takes to have real effective responsible AI in healthcare today. There's an incredibly huge problem in transparency in healthcare. Despite there being all sorts of rules and mandates that pricing should be easy to understand and clear, it's almost impossible to understand how much an actual procedure is actually going to cost you when it's go time. Alli notes that sometimes, depending on your employer, your plan and other things that you don't control, the price to get the same procedure can be three times greater, just depending on your circumstances. Same doctors, same hospital, maybe even the same insurance company. It's bonkers. So. Her innovation at Trilliant is really leveraging price transparency and provider data to make sure that patients are getting the best deals and the best opportunities for high quality care. It should be a right. You'll have to listen to Alli's explanation to get the full picture, but they're doing some really interesting work understanding market trends through looking at provider data and helping people to understand where the leakage is, where's the data and the profits leaving the system and making it harder for everyone else. Really one of my favorite hot takes came from this episode where Alli explains that we should be using evidence to launch and test and evaluate new technologies and programs quickly, and we should be bold about using that same type of data to de adopt when technology is costing too much and delivering not enough. Rapid experimentation is great, but you have to make sure that you're culling the dead weight as you move forward. I am sure you'll enjoy this data backed episode with Alli Oakes, VP and Chief Research Officer at Trilliant Health. We clap it in. So 1, 2, 3. Amazing. Hello and welcome to the Tech Glow Up. I'm Nathan C and today I'm talking with Alli Oakes, VP and Chief Research Officer at Trilliant Health. Alli. It is so great to talk with you.

Likewise

Alli, can you introduce yourself and help me understand a little bit? What does the Chief Research Officer do at Triliant Health?

Yeah, absolutely. Well, thanks for having me today, Nathan. like you said, I'm the Chief Research Officer at Triliant Health. I'm a health services researcher by training. and in terms of what our team does at Triliant Health, we use all different types of data. Claims data, health plan, price, transparency, data, as well as our provider directory to understand sort of emerging and different trends within the healthcare ecosystem.

Are there specific problems that you're most focused on or that your research. that you enjoy the research most of, out of all of those areas?

Yeah. I think there are a couple themes that we focus on a lot. One is sort of this mismatch of supply and demand mm-hmm. That we have in our healthcare system.

Got

And how we can make sure we're getting the right care to the right patients at the right time. but we're also really focused right now on health plan price transparency, which is a relatively new data source, but what it reveals is just. This variation across the healthcare system, that doesn't make a lot of sense. So within the same market, the same procedure costing very different amounts of money, depending on the provider and the payer. So those are some of the major things that we think about and are tackling right now.

Ah, the idea. That, depending on like where in your community you go, you might have a 3, 5, 10 x mm-hmm. Difference in the costs that you're, experiencing in your care is like, just mind boggling when so often. Right. Like when you need healthcare, it's like urgent. Yep. and it's like personal. Yep. And it's like high. Importance. And so knowing that there's that extra layer of like tightrope walk, is yeah. Is like really daunting.

Yeah.

I'm curious, how did your origin in, this kind of work, how did your origin in health technology, start? What got you on this path?

Sure. so sort of thinking back, growing up I was always really interested in health and healthcare. Mm-hmm. I think for a lot of people that often makes you think maybe you'll be a doctor mm-hmm. Or a provider of some kind. but after undergrad, I was very lucky to work at the NIH for a couple of years. at the Institute for Mental Health and there about 50% of the job was working with patients and 50% was data. And it was, while I was there, I realized I was a lot more interested in the data side and sort of system level thinking. That goes into healthcare and that was what led me to find the whole world of health services research and health economics. So that was what I pursued academically, and got a graduate degree. But following that, have tried to work at different stakeholders. so I've worked on the provider side at Penn Medicine and the Philadelphia va. Have worked on the payer side, sort of at an internal health services research team at Anthem and now at Trilliant where this sort of, Third party player that can leverage data to really try and get at the heart of the issues. we don't have a vested interest in telling one anyone any particular answer. so our focus is really just leveraging the data to help our clients and partners understand what's going on within their particular market and how they should be thinking strategically about things.

Yeah. Ooh, that's kind of an interesting place. To be, if you're agnostic

Yeah.

About what the data is, but, excited about delivering it. Mm-hmm. Sometimes that means you're gonna have customers who have very specific data that they want in a very specific way. Mm-hmm. Or there might be people who you need to convince that this is its own. Mm-hmm. Like why it's even important.

Mm-hmm.

Most people come to you. Like looking for when they want to better understand their data.

Yeah. usually sort of a, a principle or underlying question is just what's going on in my market.

Okay.

Yeah. But I mean, healthcare data is so fragmented and siloed. So if you think about a particular hospital. Or even a particular payer, they generally have really good visibility into what's going on within their own four walls. or within their own patient population.

That's why you wanna be on the company plan, right?

But if a patient is getting their primary care at one hospital in a market or health system, but they're doing specialty care somewhere else down the road, that hospital isn't actually going to have visibility into that leakage or lost care, if you will. So given the amount of data that we aggregate and the way we clean it, it's this ability to really understand a particular patient journey.

Yeah.

And every single place that they get care who provides it and what it costs. And it's exciting to be able to put those pieces together.

Mm-hmm. It's so good. I, I'm honestly a little bit shocked. We've been talking about healthcare data and like economics mm-hmm. For almost 15 minutes. Mm-hmm. And I don't know that I've heard you specifically call out like how AI is gonna transform anything. Yeah. I'm a little bit shocked. do you have an opinion about, right, like, we're hearing all about AI is going to solve all of these problems, make workflows faster? Yeah. Obviously, like one of the things that AI really enables us to do is to understand, translate, and like mm-hmm. Get into data, in powerful new ways. How, how do you approach, large language models or, you know, the, the boom of AI in the work that you do at Trillium?

Yeah, so at Trilliant, for a number of years now, AI in the different categories of ai. We've been leveraging, you know, large machine learning models for a very long time, but now thinking about. The dawn of generative ai, we do really need to think about where is it likely to be effective and where is it likely to be ineffective. Mm-hmm. So though I'm often a skeptic of things, it does feel a little unavoidable. I do think one thing though, about things like generative AI or. You know, natural language models, it makes the cleanliness of the data that it sits on top of that much more important. Mm-hmm. So the idea of garbage in and garbage out is potentially a real multiplier effect when you then just stick some sort of generative ai Yeah. So luckily we've really put in the groundwork over the last five to seven years to make sure our claims data and our health plan price transparency data is organized in a way that we think there's the potential for, These sorts of generative AI technologies to plug it and actually leverage it, rather than potentially

mm-hmm.

Multiplying inaccuracies and potentially providing people with the wrong answers. So the cleanliness of the data has not changed and maybe has actually become that much more important.

Like for you to, to like maintain sort of the values around the product robustness as well as like the, the authority that the data that you're sharing, provides. In order to protect those key principles mm-hmm. You actually have to be more ready, more prepared, more organized. Yeah. which Right. Like often we hear about faster, less work, less time. Mm-hmm. And to, to be more organ like. I love that, that paradigm between those two. So, Possibly part of your answer to my next question. Mm-hmm. But, the show is called The Tech Glow Up.

Mm-hmm.

And a Glow Up is a notable transformation.

Mm-hmm.

What's the Glow Up that you see healthcare needs to have in 2026?

Needs to have?

Yeah.

Good data is one of those things, right? It's always been a challenge in our in industry, but as we think about AI and how, and where it plugs in good data is just going to become that much more critical.

Yeah.

I think the other place where we need an obvious G Glow Up is value. historically, again with sort of how much

was that bandaid

with the proprietary prices, it's no wonder that prices within our market are all over the place. Yeah. and are indefensible in a lot of ways. So moving forward, we need to figure out how to get that value equation in place if a particular patient. Goes to the same provider and receives the same surgery and they have one health insurance company versus another, that procedure should not cost three x. Yeah. Just depending on who the payer is. So value also needs to be a huge component of all of this.

Yeah. Like almost on all sides, right?

absolutely.

So as you think about the work and mission that you have at Trillian mm-hmm. what's the Glow Up, you see for the work that you're doing personally?

A core principle for us, though, we're really lucky at our company to be guided by this noble purpose and that we realize, you know, healthcare is something that impacts every single American in this country. It's unaffordable for many and increasingly becoming that much more unaffordable. So we really are trying to do our best to leverage data to help stakeholders across the industry make the best sort of evidence-based and data-driven decisions that they can make. but again, thinking about value, the amount of money that we spend on our healthcare system and the outcomes that we get, it all just really doesn't add up. So I think there's also this question of how do we potentially do more with less, and how do we bring down that spending and those prices? And I don't think patients are going to, nor should they be responsible for sort of shopping us out of this problem.

Mm-hmm.

I don't think that's how we fix this problem. So, another stakeholder, we're very focused on our employers. employer sponsored insurance in our country provides coverage for the majority of people. How can we be getting data into the hands of employers to make sure that when they are deciding what benefits to choose on the front end for all of their employees, they're actually getting health benefits that will bring value to

Yeah. people care about, right? Like another mobile app that'll tell you you're fat maybe isn't. Isn't what your employees are looking for.

Mm-hmm.

Sorry. If you're a mobile app that tells people they're fabulous.

There's definitely a few of those out there.

Alli, every innovator's journey, is never one that's taken alone. Mm-hmm. And especially in like the health tech space, how the role of mentors and guides and coaches. And right. Like how sometimes even very simple, just like I believe in you keep going, can have such an impressive, important impact on, on people's careers. Can you share how a mentor or a coach has been important for your career development and how you've gotten to where you are today?

Yeah. Well, I, I think your point that mentorship is important. I couldn't agree more. I've been really lucky and fortunate to have had wonderful mentors sort of throughout my career, so. I mean, starting in undergrad, the research I was doing there, but then at the NIH, Ellen Lele, working at Penn Medicine, Matth Patel, who really is a healthcare innovator and trailblazer. now working at Triliant Health, the CEO, Hal Andrews, all of these people have really one belief in me. Mm-hmm. But also pushed me in my thinking and challenged some of my assumptions along the way. and I would also say that all of them. In different ways or another probably gave me a little more responsibility than I was ready for at that exact moment. which has led me to grow and figure out new things that I enjoy doing and things I might want to do. more or less in the future.

and I, I literally was remembering the last time I was an asking this question mm-hmm. In the context of a healthcare conference. Mm-hmm. So like in October at Health. That particular perspective of like, they gave me more than I thought I was ready for mm-hmm.

You figure it out.

And I love that, that's like, that's the human relationship touch, right? Like that trust that, is what encourages that. Like it's nothing more than like. They gave me more than I was hoping for.

And you rise to the occasion and you learn new things along the way.

Amazing. Alli, we're down to the last question. Mm-hmm. I love to give people the opportunity to share a spicy soundbite, maybe a hot take on. technology, healthcare, ai, data culture really could be anything. Do you have a spicy hot take for me?

Well, this comes from, my days during my graduate work where I was studying low value care. But I do think there's this principle of less can be more actually. Mm-hmm. Or less is more. And I think we're sort of in the phase of more is better in healthcare and have been for a long time. but I think. Spending 18% of our GDP on healthcare, again, lower life expectancy in our country compared to the rest of the world and some pretty dismal outcomes, we have to take a hard look in the mirror and figure out how and where we can be spending less money on our healthcare system. Yeah. And get either the same or better.

Do you have a thought? The idea of like, healthcare is so important and so expensive?

Mm-hmm.

Like the less, with more, I feel like I have a hard time,

Yeah.

So usually that means I just don't have the data. So I'm curious, like how, how would you encourage people to think about less is more

mm-hmm.

in this context of healthcare.

I think there's a couple components right now. One is certainly price. Mm-hmm. we know that systematically if we can reign in some of that vari, it's too high and commercial prices that exist, yeah. We can systematically reduce our spending by some meaningful percentage.

Yeah.

second, just in terms of the amount of technology that's out there,

Yeah.

Each of those products should be demonstrating. Whether it's ROI or cost effectiveness, there needs to be data to support implementation of those things and when and where possible rapid experimentation, right? If some new AI tool gets deployed in a healthcare system, mm-hmm. Let's make sure it's being implemented in a way that we can test what its actual effects and outcomes are. Are there unintended consequences that we should be concerned about? Mm-hmm. Let's rip it out and try something else and try again. So I think a willingness to de adopt things is also really important and much needed.

Why did I ask this question at the end of the interview? Because, I work on the go to market side, so we're like slightly different sides of the coin here. But Right, like on the go-to market side, you might be putting out new ideas once a quarter. Mm-hmm. On the digital transformation side, you might be like reviewing what you're gonna be doing next year, like every half. Mm-hmm. Like the timelines for testing some of these, you know, like even just getting a deal inked, you know, I've talked with like large systems, when you're working on an enterprise system, it might take six months of arguing about the terms. Mm-hmm. So how do you learn how to test something in four, four weeks? When it takes. You know, 20 to get the contract signed. Yeah. it is like,

it's a challenge to

me, such a magic space to be in.

I think partnerships go a long way there, but also considering where we could be investing our dollar and things that maybe are a little less sexy. So, you know, things like primary care, right? Putting, if we think primary care is important and provides value to the system. Let's, you know, reconsider how it is that we're prioritizing and paying for it and put our, put our money where our mouth is. oh, and again, not expect everything to, when it comes to spending on primary care mm-hmm. That it's going to be cost saving. Sometimes it's okay to invest real money in that space.

I love that Alli. That was not only a spicy hot take, but like some real specific advice about how to make it meaningful for patients is definitely a takeaway that I am thrilled to have on our talk today. Thank you so much for joining me on the Tech Glow Up. Absolutely. From Vive. We've got one last thing.

Sure.

Okay. 1, 2, 3. Amazing.

Awesome.

Thank you.

Yeah.

So much. Can I ask you a favor? If you really enjoyed this episode, could you share it on your Instagram stories or maybe post the link with what you enjoyed on LinkedIn? The sort of sharing and engaging really helps small podcasters like me reach the audience that I know really cares about these kinds of conversations. If you've made it this far in the podcast, I really appreciate you. Thanks for listening. Please make sure to like and subscribe so that you never miss an episode of the Tech Glow Up. And hey, can I ask you a favor? If you really enjoyed this episode, could you share it on your Instagram stories or maybe post the link with what you enjoyed on LinkedIn? The sort of sharing and engaging really helps small podcasters like me reach the audience that I know really cares about these kinds of conversations.