As a seasoned leader in the payor space who is now guiding digital transformation on the provider side, Tim Skeen possesses a rare dual-perspective on the evolving healthcare landscape. In this candid interview, Tim speaks of bridging the long-standing divide between payors and providers, maximizing data interoperability, driving innovation through responsible AI, and solving the IT leadership talent pipeline challenge.

Sentara Health is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees and 12 hospitals in Virginia and Northeastern North Carolina. The Sentara Health Plans division serves more than 1.2 million members in Virginia and Florida.

Q & A With Tim Skeen

Judy Kirby: Tim, most of your career has been on the payor side of the healthcare industry. Now, for the last five years, you’ve been the EVP and Enterprise CIO at Sentara Health. What intrigued you about a CIO position on the provider side?

I had always been challenged by providers pushing back on us payors. They distrusted us. So, I was interested in understanding how providers think, how they run their business, and what their challenges are, so we could fix that disconnect.

Coming from the for-profit world, where I had spent my whole career, to a not-for-profit was intriguing because you have a mission for the best outcome for the consumer, but also the community more broadly. Sentara is a healthcare provider, but half of our revenue comes from a 1.2 million-member health insurance plan, so being able to help the consumer on both sides of the healthcare continuum was really exciting and interesting to me.

Judy: What have you been able to bring from your experience on the payor side to help fix what is broken in the relationship between providers and payors?

Tim: The fact is that the five or six largest payors in the country are for-profit businesses. They’re trying to drive profits for the shareholders, and so, by nature, they want to win at everything they do. So, collaboration is never really 50-50. They want an edge. They don’t accept that a win-win can happen in a 50-50 partnership. This needs to be about improving the entire ecosystem. All boats rise together.

The flow of data in either direction and the ability to act on that data is the next challenge, and we can see the importance of that just by what Epic’s doing with their Epic payor platform.

After a full year of evaluation, we just signed a contract for a solution that will be linked into both our payor platforms as well as our Epic provider side platform, to start solving a lot of these problems, get data flowing, and allow transparency that is win-win for the provider and payor, and beneficial to the consumer.

Judy: Will that work for both your health plan as well as the other insurance companies you work with?

Tim: It will. We already have a lot of real-time data flow occurring with two of our largest payors, Elevance and Humana, through Epic’s payor platform. On the payor side, we are using population health vendors to connect to all the different disparate provider systems.

Judy: What will that do for the patient?

Tim: It’s a combination of things for patients. One is not having to repeat themselves on their health history, not having to fill out data that’s already populated. It’s about getting the best outcome for a quality gap, a risk, or care gap that they need to solve. Then, leveraging that data to apply various AI agents and bots to have a self-service and a digital interaction that sends them reminders in the channels they want to interact in. With more data, health insurance plans and providers can offer personalized services and communications.

Judy: How do you deal with the issue of prior authorizations? That’s an issue we hear a lot about.

Tim: Prior authorization is always a challenge. It’s a stick and carrot thing, right? You could argue that if you get into a pure population health, fully at-risk situation between payors and providers, prior authorizations go away. Because when I’m a provider and I’m at full-risk with the payor, I’m going to authorize services appropriate to the right cost of care. If I authorize an expensive procedure like an MRI when I really could have done a less expensive intervention, I don’t provide as much thought because the payor is bearing that burden. But if you’re looking for the best outcome, the right amount of diagnostics, the right amount of services, with the best clinical outcome on both sides at the right cost of care, it does change things.

The other thing they are doing on the payor side is refining their PALs (prior authorization lists) to make that less burdensome and more automated. A lot of AI technology coming out makes sure that an authorization request that someone submits is as robust as it can be. The connection to our clinical data gives the payor the data they need to authorize the service without a lot of administrative back and forth.

Judy: One of the things we hear a lot about from CIOs is concern about the division of technology within the organization. Some have AI and cyber, some have analytics and/or informatics, some are called a CIO, some are called a CDIO. What are your thoughts on where this all needs to live, and the differences between a CDIO and a CIO?

Tim: Three years ago, a consultant recommended that I be called a CDIO, not a CIO. But I was not going to do anything differently, and I already have a chief digital officer under me. I don’t really give a lot of credence to the title. I think the resource itself, what they’re capable of, what their skills are, and what the organization is best suited for, are more important. There are different environments where it may be a fit to federate some of those responsibilities. For me, given the 28 years of experience across all the different aspects of healthcare, it was important for me to have responsibility for all of those areas.

In my case, I have everything technology-related across our health plan and our healthcare delivery. I have analytics and AI. I also have operational responsibilities, which is another thing you’re seeing more often under the CIO. I had operational responsibilities at Elevance as well. I have the entire clinical access center underneath my organization, 600-plus resources for the call center, omnichannel interaction for self-service, digital outreach, conversational AI, and chatbots. All of those things are well-suited to be under the CIO because you’re controlling the technologies that enable an omnichannel approach to servicing the customer. It’s also reshaping how you’re serving customers. The consumer experience needs to be the primary focus, and that’s what our “One Sentara” north star is about: improving the consumer and care provider experience.

What I would say to any up-and-coming IT executive or CIO is that you have to learn the business. No matter what industry you’re in, understand the value chain, the workflows, and the business processes. How can you reimagine and re-engineer those business processes leveraging technology? Be able to speak and articulate those technology solutions in a way that the business can understand, and in a language that connects to them and their most pressing problems. Then you’ll be the best CIO or CDIO you can be.

Judy: Can you talk about how the federated system is working at Sentara?

Tim: I have control over all those things I just mentioned, but federation in the business areas works very well for creating the interaction model and the matrix around point-to-point interaction. Being able to understand where somebody needs to go. People can go directly to each other. They don’t need to go up the chain, across to me, and then come back down the chain. The trust people have in the matrix and the responsiveness built into the interaction model are what make it all work. Without those, it breaks down.

Judy: What is your organization’s AI strategy? And especially when you’re talking about a federated organization, how is Sentara handling AI governance?

Tim: It’s a great question, and I don’t know what the perfect answer is yet. We saw this coming almost three years ago and took it to the board so we could start getting ahead of it. We’ve established an AI governance structure focused on responsible AI. It has a triad at the top: the chief physician executive, our general counsel, and me. The chief analytics officer and the chief health informatics officer co-lead the governance committee.

You want governance, you want responsible AI, you want to make sure you’re not going to do harm, that you have a human in the loop. But it’s also about establishing the data and AI literacy program. AI has been around for 30-plus years, and different types of AI have different levels of risk. So, when most people say AI, they’re referring to GenAI, and that gets the general counsel nervous.

Literacy and understanding are really important because people are going to be talking about AI all over the place. We have nurses, radiologists, call center people – they’re all approached by vendors and consultants who are all leading with AI. “We’re an AI solution!”

For RPA automation, you don’t have to go through the AI steering and governance. We have been doing RPA for 30 years. So, there are differences. The point of making it federated is twofold. There are entry points all over the 34,000-plus colleagues we have, and you don’t want to centralize innovation and the leveraging of GenAI, because it is all about individual productivity.

So, there is personal productivity, and then there’s broader, larger productivity with ambient technology to help with clinicians’ documentation, so they can spend more time with their patients. There is observational AI that helps with virtual nursing, reducing fall risks, and helping with hand-washing and room turnover. Many of those are GenAI, so governance is an important piece of it.

We’re using a “taker-shaper-maker” model. We’re taking as much AI as is well-founded and proven to work in our existing vendor stack. We’re shaping by investing in a few startups and other vendors, co-developing solutions, and helping to shape their model. And then we’re doing a little bit of making, building some of the models with our own data science. We’re also doing some of our prompt engineering and creating agents with our own Sentara ChatGPT private instance that we created and went live with about six months ago.

Judy: You serve on several boards. How has that helped you as a CIO, and how do you balance your time and any potential conflicts of interest?

Tim: I had done board work for Elevance-invested entities. After I left Elevance, I spent a year in private equity working on deal teams in healthcare tech, and I also did more board work. I found out that exposure to healthcare tech and to the private equity and venture capital world was an incredible way to become knowledgeable and understand what’s emerging. There’s a real upside to serving on boards, where you’re exposed to different people, different types of solutions and technology, and you learn from others. It keeps you sharp because you’re having to keep up-to-date with that environment as well, which is broader than just the aperture I am looking through as the CIO of Sentara.

When I came here, one of the things that was discussed was my desire to continue as part of boards, the argument around that benefit, with a commitment from me to balance my time, and make sure that Sentara was the top priority.

From a compliance standpoint, I disclose those interactions and, in some cases, create a formal plan to make sure we comply and avoid conflicts of interest. If there are conflicts of interest that a plan cannot remediate, then I have to eliminate that conflict. I really appreciate Sentara’s flexibility, because I think there is a benefit to all I am learning, which benefits the organization.

Judy: A big concern I hear about over and over is the lack of up-and-coming IT leadership in the future. We’re also seeing a lot of outsourcing, and a downward trend of people entering college for computer science. What are your thoughts around the void in the future of leadership?

Tim: Part of the problem on the health systems side, versus the for-profit payor side, has been the huge gap in compensation. Historically, you had a lot of the strongest talent working in the payor space, and I think that’s starting to even out, which is great to see. It’s not just about IT either. On the clinical side, we don’t have enough people going to medical school. We’re going to have a dearth of clinicians, which is problematic as well. That is why allowing resources into our country, or allowing a global economy of those resources, both clinical and technical, is critical.

But in terms of encouraging more young people to go into technology, I wish I could solve that problem. When I mentor people, I tell them that, in addition to their technology chops, being a critical thinker and a problem-solver are more important than how well they are at writing code. That will be what the real job is going forward. Go learn the business and be curious. Understand the whole business value chain. Most people don’t understand how Medicaid works, how Medicare works, payors and providers, the full life of a claim, the payment cycle, and all those things. Learn all of that. And, have a passion and an interest in technology as it relates to solutions and innovating. So, it’s trying to inspire people to do that.

Where else can you inspire people better than the world we’re living in today, right? When somebody walks into our cancer center with cancer and walks out cured, what is more inspirational than that? Everyone is dealing with some health issue in their inner circle of family or friends, or some frustration with the healthcare environment. Why not help improve that?

Judy: How do you achieve that inspiration in a remote or hybrid environment where team members are not seeing the patients or the outcomes first-hand because they’re sitting at a desk somewhere far away?

Tim: That was a problem for IT before COVID and working-from-home because people were sitting in an IT office with other IT folks. So now, being in a hybrid mode, it’s a different way of managing. It’s a challenge that the CHRO and I have to figure out.

Judy: If you hadn’t become an IT leader, what other career do you think you were cut out for?

Tim: What I really wanted to be was an NBA player, but you’ve seen me. I’m 5’9″ at best, so my point guard days ended at high school. For me, it was always about problem-solving and efficiency, which is how I got started in consulting. I have a mind that is always trying to think about the most efficient way to eat my meal, travel from A to Z, or whatever, so it would have to be something around business process re-engineering, or figuring out the best way to change a manufacturing process or production line.

Judy: Outside of work, what is something you love to do when you have the time?

Judy: What’s your favorite country to visit?

Tim: New Zealand

Judy: Mine too!