SVP & General Manager, Provider Solutions
Cover My Meds
Scott Gaines is a member of the HIMSS Innovation Committee and a HIMSS Fellow. He began his career in finance with Hyland Software in 2005. In a fortuitous turn of events, he was soon asked to join a small new team of about six Hyland employees focused on digitizing data for health records. Scott became a key part of the Hyland solution team as sales engineer, consultant and eventually an Asia Pacific healthcare practice manager as the company’s healthcare IT business took off. In 2014, Scott joined CoverMyMeds, a software platform streamlining medication “prior authorization” by electronically connecting providers, pharmacists, health plans or Pharmacy Benefit Managers to improve time-to-therapy and decrease prescription abandonment. Scott is excited to once again “be solving a big problem in healthcare with a lot of smart people on the ground floor.”
HIMSS: What important innovations are you seeing in digital health?
Scott: Now that we’ve digitized electronic health records, which was during the first part of my career, the opportunity is in better access to that information. Right time, right person, right workflow. I think we’ve turned a corner with APIs and specifically, FHIR – where EHRs are meaningfully supporting them. In turn, that will unlock a lot of other innovation.
We tend to think of small companies and new entrants developing apps, but now larger companies are doing it as well and finding new ways to solve new or existing problems. It has the potential to democratize access to the data, so you have more people solving problems in creative ways – while reducing the cost and complexity. There’s still healthy skepticism about how far interoperability will go between EHRs and I’m not sure we’ll solve that, but I do think APIs will drive innovation across healthcare.
HIMSS: What do you see as the most pressing needs on the horizon?
Scott: Consumerism is an area on my mind, both at my organization and as a patient, a family member and friend. I think the stat is now 40 percent of Americans are on high-deductible health plans – including myself. I’ve been surprised by the cost we need to cover, even for preventive care. We should be incentivized, not penalized. I agree with the intent to shift some of the burden to consumers to give us skin in the game – but are we incentivizing the right behaviors?
HIMSS: What’s the value for you in being on the HIMSS Innovation Committee?
Scott: The diversity of experience and perspectives on the Innovation Committee reflects the complexity and nuances of the healthcare system. Ian Hoffberg [Manager of Healthcare Information Systems for HIMSS] and Rasu Shrestha [Committee Chair, CIO/Executive VP at UPMC and UPMC Enterprises] did a really good job assembling committee members from public health, vendors, consultants, investors and more. I benefit from that because I’ve spent most of my career working with a vendor – so that’s my bias and it colors my perspective. Hearing from someone in an area like public health helps me have better context and keep the bigger picture in mind.
In my work at CoverMyMeds, the HIMSS committee gives me new ideas and helps me strike a balance between results for today – like revenues and managing cost pressures – to seeking innovation that will deliver for tomorrow. You have to do both. Keeping innovation top of mind makes it easier to deliver on what you’re accountable for in the future.
HIMMS: Anything else on your mind?
Scott: With all the technology solutions like API or FHIR, it’s still important to keep in mind innovation barriers and enablers outside of technology – whether it’s regulatory issues or concerns about keeping information secure. And people often forget about business process innovations. We need to make sure these aren’t barriers to exchanging information.