Olive Quarterly — Q2 / 2018 by Olive

MEET OLIVE 12

AI-A-A-S 14

OLIVE PARTNERS 44

TAKING THE ROBOT OUT OF THE HUMAN

O L I V E

THE INTERNET OF HEALTHCARE (IoH) 60

Q U A R T E R L Y

ISSUE 01

THE FUTURE OF HEALTHCARE HAS ARRIVED

CONTENTS /

Mimic

Workflow Name ACTIONS

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Times

Other Run Process

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Close Window Get Window Dimensions

Block - Run and Open Posting in Paragon

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INTRODUCTION

OLIVE PARTNERS

LETTER FROM THE CEO

MEADOWS HEALTH

MEET CROSSCHX

HANCOCK REGIONAL

DEFINITIONS

HOSPITAL 48

OUTEGRATION

OLIVE CONCEPTS

THE PROBLEM

TAKING THE ROBOT

THE PROBLEM

OUT OF THE HUMAN

S.H.A.P.E. METHODOLOGY

WITH HEALTHCARE

INSIGHTS 54

OLIVE SOLUTION

MEET OLIVE

AI-A-A-S 14

GETTING STARTED WITH OLIVE

HORIZON

OLIVE FEATURES

OLIVE WORKS

OLIVE LABS

OLIVE BUILDER

THE INTERNET OF HEALTHCARE (IoH)

AI AS A ROUTER

ERGOPHENOMICS 32

CROSSCHX

PUPIL 34

RECRUITING 64

APTITUDES 36

CORE VALUES

COGITATIONS

FEATURED WORKFLOW

EVENT CALENDAR

OLIVE PHD 43

INTRODUCTION

Q2 / 2018

LETTER FROM THE CEO /

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Thank you for taking the time to read our very first edition of Olive Quarterly. I’M THRILLED TO HAVE the opportunity to share all the great things

we have been working on, and to give you a sneak peek into our intrepid and exciting future. CrossChx is completely possible because of our faithful customers who have decided to grab the future with both hands, and steer it towards a destiny that promises better care for their patients through a vibrant and efficient healthcare industry. We are committed to our mission, and that commitment is only made possible because of our selfless employees and their families. Our employees have sacrificed so much to bring Olive to life and to make the Internet of Healthcare (IoH) a reality. When Brad Mascho and I started CrossChx 6 years ago, we never imagined we would be selling Artificial Intelligence. We knew from the very beginning that the problems in healthcare were intelligence problems at their core—early taglines for the company resembled something like “CrossChx, a healthcare intelligence company.” We knew intelligence was the key to bringing forth the Internet of Healthcare. I wanted to come right out and say we were building the Internet of Healthcare, but every time I put it in a write-up or a slide deck, I was discouraged from using that phrase and convinced to call it something else. Even without saying it publicly, people who know me recognized that CrossChx has always been about building the Internet of Healthcare. The thing that has been so exciting and so wildly unexpected is that AI is actually the answer, the key, the cornerstone, the talisman to building the Internet of Healthcare. We had a glimpse of this in the early days when one of our engineers, Larry Haines, used an old RPA tool called AutoIt to hack a funky integration to an otherwise inaccessible user interface in 2013. We didn’t end up using that solution because it needed to be synchronous and the lag was just too long. However, it did etch into my brain indelibly. Fast forward four years and Olive was born. I’ll save the story of Olive for later in this issue, but needless to say, I’m no longer afraid to say we’re building the Internet of Healthcare. If people still don’t know what that means, we’re happy to educate them. Onward,

Sean Lane CEO @CrossChx

INTRODUCTION

Q2 / 2018

MEET CROSSCHX /

M E E T CROSSCHX CROSSCHX IS A UNIQUE place that’s full of

We want this to be the hardest, most intense,

people who are driven by an audacious belief that

and most rewarding thing you’ve ever done.

they can invent the future of healthcare by creating

We want you to believe that the people we work

and deploying amazing technology. CrossChx isn’t

with are here to do their life’s work. We think if we

for the faint of heart—those who work here know

do things right, and build this Internet of Healthcare

before they’re hired that it isn’t going to be easy.

using AI, we will have the opportunity to carve a

The hours can be long at times, and the things

trillion dollars out of the cost of healthcare.

we do are so difficult that sometimes it seems impossible. But we also know that the world isn’t changed by reasonable people, and the joy we experience by putting technology into the world to make healthcare a little bit better everyday makes it all worth it.

Meet Cross

We are also bold enough to believe that we will, when we’re successful, increase life expectancy. If that doesn’t motivate you, then you probably won’t fit in at CrossChx. And that’s just fine. It can’t be for everyone. It won’t be for everyone. The question is... is it for you?

We aren’t interested in doing something small. We aren’t interested in being like everyone else. We don’t want to be “the best place to work.”

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To build the Internet of Healthcare (IoH) through Artificial Intelligence (AI). OUR VISION:

To carve a trillion dollars out of the cost of healthcare, and increase the quantity and quality of human life. OUR MISSION:

sChx (1pg)

INTRODUCTION

Q2 / 2018

ARTIFICIAL• INTELLIGENCE

COMPUTER• VISION

The modern definition of artificial

Computer vision is an interdisciplinary

intelligence (or AI) is “the study and

field that deals with how computers

design of intelligent agents,” where

can be made to gain a high-level

an intelligent agent is a system that

understanding from digital images

perceives its environment and takes

or videos. From the perspective of

actions which maximize its chances

engineering, it seeks to automate tasks

of success.

that the human visual system currently does. Computer vision tasks include methods

•

DEF I NI TIONS

DEFINITIONS /

for acquiring, processing, analyzing, and understanding digital images, and extraction of high-dimensional data from the real world in order to produce numerical or symbolic information, e.g., decisions. “Understanding” in this context means the transformation of

ROBOTIC• PROCESS AUTOMATON• (RPA) Robotic process automation (RPA) is the practice of automating routine

visual images (the input of the retina) into descriptions of the world that can interface with other thought processes, and elicit appropriate action. This image understanding can be seen as the disentangling of symbolic information from image data using models constructed with the aid of geometry, physics, statistics, and learning theory.

business practices with “software robots” that perform tasks automatically. This includes transaction processing, IT management, and automated online assistants. These software robots can replace humans when completing simple, repetitive tasks. Robotic process automation makes heavy use of artificial intelligence to train these robots.

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because recommendation engines use machine learning to personalize online ad delivery in almost real-time. Beyond personalized marketing, other common machine learning use cases include fraud detection, spam filtering, network security threat detection, predictive maintenance, and building news feeds.

ENTITY• EXTRACTION

MACHINE• LEARNING

Entity extraction, also known as “entity

Machine learning (ML) is a type of AI that

name extraction” or “named entity

allows software applications to become

recognition,” is an information extraction

more accurate in predicting outcomes

technique that refers to the process of

without being explicitly programmed.

identifying and classifying key elements

The basic premise of machine learning

from text into pre-defined categories. In

is to build algorithms that can receive

this way, it helps transform unstructured

input data and use statistical analysis

data into structured data, and therefore,

to predict an output value within an

GLOBAL• AWARENESS

makes the data machine-readable and

acceptable range.

Global awareness is an incredibly

available for standard processing that can be applied for retrieving information, extracting facts, and answering questions. Let’s look at the process of entity extraction and how it works.

Machine learning algorithms are often categorized as being “supervised” or “unsupervised.” Supervised algorithms require humans to provide both input and desired output, in addition to

In certain formats, such as document

furnishing feedback about the accuracy

files, spreadsheets, web pages,

of predictions during training. Once

and social media, text appears as

training is complete, the algorithm will

unstructured data. Being able to

apply what was learned to new data.

identify entities—people, places,

Unsupervised algorithms do not need to

organizations and concepts, numerical

be trained with desired outcome data.

expressions (dates, times, currency

Instead, they use an iterative approach

amounts, phone numbers, etc.), as well

called deep learning to review data and

as temporal expressions (dates, time,

arrive at conclusions. Unsupervised

duration, frequency, etc.) provides a

learning algorithms are used for

way for anyone who must make use of

more complex processing tasks than

the information to understand what it

supervised learning systems.

contains. Whether it’s an analyst who has a hundred or more documents to review, or an investigative journalist who just received a data dump of several gigabytes, they may not initially know what the information contains, or what they should be looking for.

INTRODUCTION

important concept that is core to the technology belief system of CrossChx. Global awareness is actually short for “global entity awareness;” it is the understanding or awareness of people, places, and things across multiple networks, systems, databases, or contexts. For example, in healthcare, it could mean knowing a particular patient’s identity across multiple doctor’s offices or hospitals. It could mean being able to identify a patient in different systems, globally. It could also mean the ability to confirm the identity of a physician, or a nurse. Global awareness starts with entity extraction, the ability to identify people, places, and things within data. If Olive, for example, is looking at

The processes involved in machine

a referral for a patient at a hospital in

learning are similar to that of data mining

Wisconsin, she has the ability match that

and predictive modeling. Both require

patient’s identity with the patient’s record

searching through data to look for

at other locations, like at the health

patterns and adjusting program actions

center where the patient went to college.

accordingly. Many people are familiar

The identification and matching of people

with machine learning from shopping

is monumentally important to building the

on the internet and being served ads

Internet of Healthcare, which is why these

related to their purchase—this happens

capabilities are built into Olive.

Q2 / 2018

OUTEGRATION /

INTEGRATE WITH NOTHING. OUTEGRATE WITH EVERYTHING. UI vs. APIs and HL7

HEALTHCARE HAS MADE significant

• Many systems expose limited APIs,

• The CrossChx team expects that

investments into electronic medical

which are not sufficient to replicate

software changes will occur, and Olive

records (EMRs), patient portals, revenue

all activities a user performs in the

preemptively detects changes which

cycle software, and more. Most of

software. Creating new APIs to fill

could make her unable to complete

these technologies require expensive

these gaps would be time-consuming,

tasks. The CrossChx team will then

integrations in order to function as a

and would require a new release

update Olive as necessary.

cohesive community. Instead of taking

of the system.

the old approach of using APIs and HL7 feeds, CrossChx decided to use the UIs of the systems and tools that are already in place.

monitoring and alerting in place to

AUTOMATION TOOLS BECAUSE...

ensure Olive is back on track if an

• Olive does far more than simple,

OLIVE DOES NOT USE EMR APIs BECAUSE...

•O live is both platform and application

coordinate-based screen-scraping. Olive uses intelligent processes to accurately identify and interact with

unforeseen error is encountered once Olive is live. These are capabilities that other, more traditional automation tools lack.

other applications. She relies on

agnostic. She is designed to utilize any

existing technologies built into your

application UI, and create an API layer

operating system, which are designed

on top of the UI itself.

for this purpose.

•O live can be trained to use any

• The CrossChx team has robust

OLIVE IS DIFFERENT THAN OTHER

• Support issues are identified and

system simply by mimicking the

acted upon immediately. If the software

actions taken by a user within a

being automated changes, no code

system to accomplish a task.

adjustments are required to update Olive (in contrast to Olive using APIs).

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INTRODUCTION

Q2 / 2018

THE PROBLEM WITH HEALTHCARE /

THE PROBLEM WITH HEALTHCARE THE U.S. HEALTHCARE SYSTEM is advanced

become certified and meet a rather daunting set

in so many ways, yet one of the most glaring

of standards imposed by the federal government.

problems that still plagues the system is a lack of

It’s not clear that data sharing should have been

interoperability, or as we like to say, the lack of the

introduced into the requirements framework earlier

Internet of Healthcare.

or more aggressively, and it’s not clear if diagnosing

Software systems were adopted like an avalanche in healthcare over the last 20 years. We went digital as an industry relatively quickly; most of the impetus behind the accelerated rate upon which

that now does us any good. The reality that exists with healthcare technology is that we now have to figure out how to scale that technology to the next level.

software systems were adopted was driven by

As a whole, going digital was and is a good thing

federal mandates. They worked, and now very few

for healthcare. Data is now at least digitally

artifacts of healthcare remain outside of the digital

archived, and there is a somewhat universal

domain. During the rapid adoption period, many

standard of capabilities each provider has to

EMR systems emerged to fill the market gap. It was

perform their functions. But there are also several

a great, albeit complex, business for technology

downsides to the rapid adoption.

companies to get into. A handful of EMR systems have risen to the top of the pack, and enjoy most of the market share today. These systems weren’t really built with data sharing in mind—they were built to propel healthcare into the digital domain, and to create business tools that allowed healthcare constituents to work within those systems to care for patients and get paid.

The first downside is one that we already mentioned, but needs to be highlighted enthusiastically. EMRs were not built to share data. They weren’t built to exchange patient information with other systems. They were built as fortresses to protect the data of patients at each instance, and to make sure that data was available only within the walls of that system. Today, most realize that

It’s easy to throw stones at the software that

the closed-off approach to health data is not the

exists and excoriate them for their lack of data

right approach for the future. It is difficult to imagine

sharing capabilities. However, they were just a

that in the future, data won’t be more seamlessly

product of the requirements they had to meet to

exchanged to better care for people globally.

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There have been several initiatives that have

administrative costs, less human-to-human

opened up tributaries of data sharing, however,

experiences, and most importantly, subsequent

these point solutions have not become universally

decreased quality of care.

adopted or systematic by any means. To solve the lack of sharing and interoperability, humans have become the routersâ&#x20AC;&#x201D;humans are the interface between disconnected software systems, humans are the interface of data between different organizations. They transmit data through fax, email, printing, and mailing.

So how do you solve that problem? Some think you solve it by trying to rebuild the infrastructure, to impose even more requirements on data sharing, and to try to standardize and force interoperability between systems. While that may make a dent in the data liquidity problem, it will likely only further burden the human routers, and increase

We think the answer is different. We think the answer is to use operational AI to replace the human routers.

an already out-ofcontrol administrative cost profile. We think the answer is different. We think the answer is to use operational AI to replace the

The reality is that human work has changed dramatically with the rapid adoption of EMRs. Humans had to take on the job of the router, the data ingester, the data processor, the transmitter. This phenomenon has shifted the hours spent by humans from being in front of patients to being in front of computer screens, logged in to many user interfaces, shepherding the patient data into the right fields. We think this is a crisis. Licensed caregiversâ&#x20AC;&#x2122; quality of life have been pummeled by this new role, and the consequence comes in the form of burnt-out employees, skyrocketing

THE PROBLEM

human routers. AI to take over the button Olympics that humans are enduring. AI to transmit the data where it needs to go, and use global awareness to ensure the right data goes to the right place. The systems may not have to change. At least for now, we can add a layer of AI as a user on top of the EMRs that have been adopted. This AI layer will ease the administrative burden, reduce the skyrocketing costs, and turn the human-powered Internet of Healthcare into a technology-powered internet, without having to overhaul the immense infrastructure that has already been put into place.

Q2 / 2018

MEET OLIVE /

M E E T O L I V E OLIVE GOT HER START as a project at CrossChx

and clicking through too many UIs. The best we

in 2013. We didn’t have a name for her yet—it

could come up with was to add to their stack of

was Olive’s distant relative that we were building

work with our software. It was much sexier software,

when one of our engineers, Larry Haines, built an

but another screen nonetheless. We knew this

automated screen scraper to extract and input

couldn’t be the right answer; there had to be a

data into an EMR where APIs were non-existent.

way to automate their workflows, to get the data

In fact, we moved that product to the shelf after a

we needed, and to action that data without adding

few weeks of development to focus on a different

more burdensome work for the human. It was then

market opportunity. But there was some magic that

that we remembered the work Larry had done

we’ll never forget back in 2013 when Larry demoed

back in 2013.

his screen scraper. We watched as it is logged in like a human, extracted data from the screen, clicked buttons, and completed a workflow, just like a blazing-fast human was doing it. That moment was etched into our memories, and it would come back to us nearly four years later.

We remembered that magical moment when Larry’s program logged into an EMR and completed a workflow effortlessly. We started to think about whether or not we could make that simple screen scraping technology more robust, more durable, more scalable, and more pervasive. Fortunately,

As we were deploying software at CrossChx to

since 2013, many advancements had been made

help with care coordination and patient access,

in AI and machine learning—computer vision had

we noticed a recurring problem. Every provider

advanced quite a bit, and was available for software

used different software—even if we were able to

developers. We thought that if we could build a

get all the data out of those disparate systems, our

system, like the screen scraper, but using more

customers would still have to login to our software

advanced AI and build for scale and anti-fragility,

to make use of it. That meant they would have

then we could answer all of our problems and

to look at yet another screen. They were already

crack a code that no one has been able to crack

overworked, already logging in to many systems

yet in healthcare.

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THE OLD WAY

THE NEW WAY

There had to be a way to automate their workflows, to get the data we needed, and to action that data without adding more burdensome work for the human.

We decided to start building Olive in early 2017.

We liked the name Olive for several reasons:

We thought about marketing and packaging, and

first, it had the word “live” in it; and second, it could

what we should call this new AI bot. We had a small

mean a person, like a woman’s name, or a thing,

initiative already for a virtual intelligent amplification

like the fruit—AI is supposed to be a person and a

(IA) assistant we had called Olive, so we decided to

thing too; and fourth, it had this instant familiarity.

re-imagine Olive to make her the persona behind

At first, we couldn’t figure out why, but then it

this new AI-powered, healthcare super-employee.

dawned on us—it was because you say it all the

Olive had been around as an assistant in our software for about a year. We conceived the name

time when you say “all of.” So that was it. We named her Olive and that is her story.

“Olive” after a lot of brainstorming—we wrote 20 or 30 names on an iPad, and mulled over each one. But Olive stood out like a beacon among the clutter.

OLIVE SOLUTION

Q2 / 2018

AI AS A SERVICE /

I S

A SERVICE 14

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WE WANT YOU TO SAY, “ OLIVE JUST WORKS.” ARTIFICIAL INTELLIGENCE AS A SERVICE

We wanted to be different. We want customers

(AI-a-a-S) is a concept that we pioneered. It is

to think of Olive as their newest employee; she

unique to Olive, and is one of the main reasons

has a job to do, and it’s our job to make sure she

she has been hired by so many healthcare

shows up for work and gets her job done every day.

organizations around the country. We created

Simple as that. AI-a-a-S means you buy the service–

AI-a-a-S because we think the current purchasing

it always works, and if something changes, like your

model for AI is broken. If an organization wants to

software or your business rules, we’ll change with

buy an AI bot to automate something, they have

you. We want you to say “Olive just works.” You

to worry about licensing fees, software purchases,

shouldn’t have to consider the cost of changing

consultants, integrators, implementation costs

your AI bots if you want to upgrade your tool, or

etc. If the software they are automating changes,

add another step in the process of denial handling.

if business rules change, or if something breaks,

Olive is flexible, just like a human. It’s on us to make

the customer is on the hook to pay more money

sure she’s performing for you, and the end result is

to consultants and integrators to get everything

that your need is met. Your AI bot should work for

working again. It makes it hard to predict the

you—you shouldn’t work for it.

true cost of your AI bot, and puts too much of the “sausage making” in the hands of the customer.

OLIVE SOLUTION

Q2 / 2018

OLIVE WORKS /

With OliveWorks, your facility can fully automate and eliminate human intervention for entire workflows, with a direct path to measurable ROI. OliveWorks automates repetitive, high-volume tasks that are fairly consistent across facilities, EMRs, and external tools, to ensure the quickest possible time to implementation. With OliveWorks, customers pay one consistent price per workflowâ&#x20AC;&#x201D;regardless of EMR, patient volume, facility size, or any other variables that would typically impact the cost of an automation. RPA is used as the main automation tool, with computer vision/OCR and other AI capabilities leveraged where needed.

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OLIVE FEATURES

Q2 / 2018

OLIVE WORKS /

Olive Authorizes Procedural and medication prior authorizations

Prior authorizations (PAs) are a reality of doing business in healthcare. Whether a patient needs an echocardiogram, an MRI, or a prescription often times a prior authorization is required. Too many times patients show up for a procedure that is not authorized. A few things happen: either the patient waits as the staff works with the insurance company to get a pre-cert, the hospital goes at risk to perform the procedure hoping they get the approval after the fact, or the patient has to reschedule their appointment and come back after the approval is received from the insurance company. In the event a prior authorization is needed for a medication, a patient has to make multiple trips to their pharmacy and could have to wait days for the authorization to come back for their prescription. Staff at health systems who are trying to provide care to patients are bombarded with faxes and paperwork to make sure their patients get the medication they need. Sometimes, This burden is due to systems that arenâ&#x20AC;&#x2122;t integrated, a stone-age process of faxing, filing because we are all human, things fall through the cracks and a patient becomes overly and logging into multiple pieces of software. frustrated. They blame the hospital and Olive Authorizes is our product to help you have an overall bad experience, and most turn this burden into a seamless process. Olive will directly connect to your fax machine, importantly are not on a quick path to better health. your EMR, and insurance portals to initiate prior authorizations for both procedures and HOW / Before the visit (procedure): Olive medications. logs-in to the EMR and looks at the schedule. She looks for patients who are schedule WHO / Ambulatory imaging, diagnostics, for procedures that frequently require presame-day surgery (ASCs), and acute care approvals from insurers. She then looks for settings. Target is either CFO, Rev Cycle, the pre-approval and if it is not there, she Patient experience, or medical director. looks up the patientâ&#x20AC;&#x2122;s insurance provider and All are affected. submits the pre-certification request. When an authorization is returned, Olive puts that

Insurance providers require prior authorizations for many procedures and medications. This requirement creates a massive burden for your health systemâ&#x20AC;&#x2122;s staff and your patients. Nurses, doctors, and administrative staff are spending valuable time retrieving faxes, signing into portals, and filling out information over and over again just to get their patients the treatment they need.

OLIVE QUARTERLY

WHY /

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approval in the patient’s record. Now, when the patient comes in for a visit, the preapproval is in the record and the procedure can be performed. Olive will generate a report from the EMR of all cases where a prior authorization wasn’t acquired prior to a procedure being performed, Olive will then go through the list, look up the insurance information in the EMR, and submit the prior authorization request to the insurance company. Once the authorization is received, Olive will update the patient’s record and revenue cycle will now be able to successfully bill for the procedure. AFTER THE VISIT (PROCEDURE) /

Olive will look at the faxes coming in for any medication PA request from a pharmacy. Once Olive receives a PA fax, MEDICATION /

OLIVE FEATURES

she will look up the patient’s information in the EMR and then fill out a prior authorization to the relevant insurance company through the Surescripts portal. Once the authorization is received, Olive will update the system and can fax a the approval back to the pharmacy for quick action. Dealing with PAs costs health systems in several ways. First, the staff hours associated with the huge volume of paperwork. Second, the lost revenue when a procedure was performed and an authorization was never received. Third, the patient experience when they have to wait, or even worse have to reschedule their appointment. Lastly, the lost revenue when an appointment slot is wasted because no prior-auth was acquired prior to the visit.

Q2 / 2018

OLIVE WORKS /

Olive Verifies Automated insurance eligibility checks

Too many patients who have insurance coverage are going to self-pay. Olive’s job is to stop that. Olive will use state of the art automation and AI capabilities to ensure that if a patient has coverage your Revenue Cycle team knows about it and can successfully submit a claim. OLIVE CLOSES THE GAP.

Hospital operations are hard enough. We believe a hospital should never miss a payment or put the patient through a collections experience that is completely avoidable through technology. Olive Verifies is our product to solve this pervasive problem. Revenue Cycle and Patient Registration staff in an ambulatory setting. WHO /

Often times registration staff collects insurance information manually from patients and then manually checks their benefit information before, during, or after a visit. This process takes an enormous amount of time, almost always generates an overwhelming backlog and is prone to human error. Typically, unresolved. WHY /

Before the visit: Olive verifies insurance benefits of patients scheduled for appointments by accessing the schedule and looking up the latest insurance information HOW /

OLIVE QUARTERLY

including eligibility status, deductible and co-pay and then writes that information back into the EMR. Olive can produce a report from the EMR of patient encounters, retrieve their insurance information, and check against eligibility portals to make sure the revenue cycle staff has the most up to date information. AFTER THE VISIT /

If a patient’s insurance information is not properly resolved or collected before a bill hits, Olive will check the patient against Medicaid and other relevant portals as a last effort to ensure that patient didn’t have insurance at the time of care before it gets mistakenly moved to self-pay. Olive can use any ambulatory EMR. Olive can also use eligibility portals such as Availity to complete the insurance lookup. If the organization doesn’t have a system like Availity, no problem, Olive will check her own internal clearinghouse and use portals to make sure she does the most comprehensive search possible.

have hired Olive to help them with this problem. Our experience and technical expertise has made us a market leader in providing AI solutions to close insurance coverage information gaps. Olive will make your staff’s quality of life better, save huge costs associated with your staff doing this arduous task, save your patients from going through a burdensome, embarrassing, and avoidable collections process and find revenue that is falling through the information gap today. Olive verifies your patients’ insurance coverage. By hiring Olive, you will improve your operations, your bottom-line, your staff’s morale, and your patients’ experience with your health system. Hire Olive today and finally put this problem in your rear view mirror.

We want to help you completely solve this problem not just provide you a capability. We are committed to make sure Olive is trained on your process and your systems to find coverage for all your patients who have it. Many health systems

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Olive Updates Claims status updates

spend an inordinate amount of time checking the status of the claims they’ve submitted to insurance companies. Insurance companies haven’t made this easy either. They all have different portals and different user interfaces. Revenue cycle staff has to log in to dozens of systems to check thousands of claim status just to find out which claims are getting paid and which ones may need to be worked more to get a successful payment. REVENUE CYCLE TEAMS

Olive logs into your insurers’ portals for you. She checks all of your claim statuses and compiles a beautiful report for you every single day so you know exactly how much payment to expect and which payments need extra attention. HOW /

Insights

H Health System

Olive’s Performance Portal 18 kBh OF 26 kBh USED

Est. Time of Depletion: 6/21/18

Buy More 0 KbH

26 KbH

13 KbH

METRICS Patients by Date

Availity Percent Over Time

176.71

100% Patients this Week

12.66%

100% This weeks Availity % (v.s Last Week)

Weekly Average Last Week

This Week

Average Availity Percent Availity %

30 20

0 Nov 26

0 Sa

Dec 3

Dec 10 Dec 17

Dec 24 Dec 31

Jan 7

Jan 14

Jan 21

Jan 28

Feb 4

Feb 11

Feb 18

Feb 25

Olive Hours Over Time

Successful Eligibility Checks by Date

4.59

6.28

23% This weeks Hours Worked (v.s Last Week)

Average Hours Worked

Availity %

24.54

Successful Checks this week

Weekly Average

Last Week

5 5

This Week

takes a large burden off your staff and streamlines operation, ultimately resulting in more predictable payments. Manually checking insurance portals for claim statuses is costing you large amounts of money today. Imagine the amount of other things your staff can be doing when Olive takes over this burdensome task. Not only does it remove hours of wasted human costs, it also ensure nothing falls through the cracks.

0 Nov 26

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WHO /

Billing and Rev Cycle.

Let us know what additional metrics you’d like to see in your dashboard

PROJECTS In-Progress Name

IT Setup

Signed Contract

Olive’s First Day

Eligibility Check

Health systems often times treat patients covered by dozens of insurance companies. Not only do they have to figure out the jigsaw puzzle for submitting these claims accurately, they then have to play ”wait, check, wait, check” just to know if the claims are going to get paid. The reality is, highly skilled and trained staff members are spending hours logging into insurance portals and collecting claim status information just so they can figure out how much money is coming in, when it’s coming in, and what claims they may have to spend more time working through. WHY /

OLIVE FEATURES

Passwords

Completed Name

Run Status

Outcome

kBh Usage

Availity

Running

1.4

Patient Verification

Last Run: 3/9/2018 1:20:34

Successful

5.6

CREDENTIALS Name/Label

Name/Label

Add new Credentials

Have other tasks Olive can help you with?

You have used 18 kBh of your 26 kBh bucket. To have more Olive automate more projects, purchase more kilobot hours here.

Buy More

Olive can work with any insurer’s web portal. If a web portal has a user interface that is unfriendly to our software robot, Olive has several partners she can work with to get the data she needs to make sure her report to you is comprehensive and complete. Our product, Olive Updates, is designed to give your staff their time back. Revenue cycle teams are already operating under an avalanche of work. Olive updates

With the exception of Olive, we are all human, and sometimes humans make mistakes. Unfortunately, that can result in a denial that wasn’t caught and a missed opportunity to remedy a claim resulting in a loss of revenue. Olive Updates wants to help you eliminate this burden on your staff, making their quality of life better and expanding their focus into areas that were traditionally neglected because they didn’t have the time. We think you should get paid for the treatment you perform and you should know about it if there’s an issue with a claim without having to spend hours sifting through dozens of websites, thousands of claims, and compiling spreadsheet after spreadsheet.

Q2 / 2018

OLIVE WORKS /

Olive Sorts Document classification for faxes and sorting them in the relevant folders, or forwarding them to the right person

Olive Reports Consistently compiles and distributes reports for decision making Today, humans in your organization are spending their valuable time logging into disparate systems to extract information, download data, and compile reports on a weekly, and sometimes daily basis. It’s the same monotonous task, everyday. Unfortunately, the systems aren’t built to automate the report you need, so the human is once again stuck doing it. That’s where Olive comes in. Olive can gather up all of the data needed, compile it however you like it, and disseminate it to the right people every week, every day, or even every hour. She can also login to digital dashboards, and update them with the latest information. Imagine if you had someone working full-time to gather information from all around your enterprise, and put that intelligence into a beautiful dashboard for you and your leadership team to see everyday. That someone is Olive.

OLIVE QUARTERLY

I hate to say it, but faxes are still reigning supreme as the secure communication platform of choice in healthcare. That means that your humans have to stand at-theready, watching the virtual inbox of the fax. When documents come in, your humans have to figure out what they are, put them in the right folder, or forward it to the right stakeholder. Some organizations get hundreds of faxes every day; some get hundreds of faxes an hour. That’s a lot of time that your humans are spending on something that should be done by computers, and is just another example of how humans are acting as routers... the most expensive routers on the planet. That’s where Olive comes in. Olive can read each fax that comes in, and make sure they are put in the right folder for action, pushed it to the right stakeholder, and in some cases like prescription prior authorizations, Olive can take care of the whole process without a human involved at all. Let Olive take over and turn your dusty fax machine into an AI-powered information hyperloop.

Olive Manages Maintains, sets up, and disables inactive Active Directory accounts As your organization breathes, people come and go. While this is natural, it puts a heavy burden on your IT team to setup new accounts, get rid of old ones, and make sure they aren’t creating duplicate user accounts. Today, this is a very manual process that consumes a big portion of your IT team’s time. You need them focusing on the hard problems, not playing custodian to the ebbs and flows of accounts. That’s where Olive comes in. Olive has been trained to set up accounts after being triggered by an email of another system, and then constantly clean up your existing accounts to make sure that there aren’t duplicate or dormant accounts. Olive is like a Rumba for your accounts. Now your IT team can work on that pesky integration... until Olive is hired to do that next.

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Olive Valuates Subrogation valuations

Olive Extracts Pulls data from remote EMRs Many organizations that support providers with a service (like revenue optimization) have their humans logging in to hundreds of remote EMRs and data systems daily to extract the data they need to perform their service. That’s where Olive comes in. Olive is trained to login to remote EMRs and data systems, and extract all the relevant data needed. Now that Olive has that covered, your humans can spend their time focused on what really matters; the patient care you provide.

OLIVE FEATURES

The subrogation process is complex, and involves lots of human hours to value episode and communication valuations back-and-forth with insurance companies. That’s where Olive comes in. We’ve used neural nets to train Olive on how to do subrogation valuations, so she can now join your team and take a huge volume of work off of your humans’ plates.

Olive Engages

Olive Resolves Finds and reports duplicate medical records

We have an unfair advantage at CrossChx when it comes to patient matching. It’s core to our If you’re like most healthcare systems, you have a patient portal. history as a company, and we have developed the most sophisticated And if you’re like most healthcare and accurate patient matching systems, not very many patients algorithm in the market. The good use the portal. Right now, the news is, we’ve built that matching process of getting a patient on algorithm into Olive’s brain. Olive your portal takes a lot of handcan go through all of your patient holding and constant nudges from records across all of your EMR your humans. That’s where Olive systems, and even those from comes in. systems you acquire to find any Olive can use various methods duplicates. This way, you can like email and SMS to help get ensure your patients only have your patients on your patient one MRN across multiple systems, portal. Once they’re on, Olive can and that they are linked, giving help engage them with important you a more comprehensive picture information, like discharge of that patient’s care. The days of instructions, normal lab results, and sticky notes and backlogs in the post-visit follow-up. Let Olive help medical records office are over—let you increase your portal adoption, Olive handle your patient identity and increase engagement without resolutions. your humans having to lift a finger.

Patient engagement

Q2 / 2018

OLIVE WORKS /

BETA

OLIVE LISTENS Ambient listening for medical transcription Imagine if there was a transcriptionist sitting in on every patient exam in the office of every physician. Imagine if your physicians only had to approve notes before they were entered into the EMR, instead of spending hours at night or in the morning playing catch-up. Imagine if we could help you give your physicians their lives back. That’s what we hope to do with Olive Listens. Olive Listens in on every exam through an inconspicuous, far field listening device, and correlates the words spoken to a historical lookup of exam notes. Olive can then make an educated guess through machine learning as to what the notes should look like, and all that your physician has to do if confirm Olive’s guess and fill in anything that may be unique to the visit.

OLIVE QUARTERLY

OLIVE CHECKS

OLIVE SCHEDULES

Reviews billing codes to make sure that all of the necessary procedure information is documented

Looks at staff schedules to make sure coverage meets anticipated census levels

Olive can use historical data and neural nets to help identify whether or not the proper information is documented to match the billing codes used to decrease denials.

Using machine learning, Olive can look at previous schedules and census levels to determine the right volume and mix of staff in anticipation of census levels. Olive can then apply that knowledge moving forward to ensure that the right mix and volume of staff are scheduled. If she notices an issue, she can alert management to her findings.

OLIVE NOTIFIES Sends out normal lab results to patients Many of the lab results patients receive are normal, and it is very time-consuming for providers to send these lab results to patients one-by-one. Olive will check lab results, and if they meet the “normal” criteria, she will send them directly to the patient.

OLIVE COMMUNICATES Sends out discharge instructions and postvisit follow-ups to patients When patients leave after a visit, it’s important to make sure that they know what things they need to do to keep themselves healthy. Olive can use your portal and other communication tools to make sure that patients have all the information they need, and to periodically check-in to see how they’re doing. Olive can reduce readmissions by ensuring that your patients have the right information and data they need to stay healthy.

crosschx.com/oq

OLIVE REMINDS

OLIVE OUTEGRATES

Sends out appointment reminders and confirms appointments.

Provides quick outegration for other software

No-shows are no good for anyone. They are lost revenue, and they don’t help your patients get healthier. Olive can be your machine learning-enabled appointment reminder system—not only will she login and see all of the patients scheduled for a visit, she will also figure when to text them, and what to say to increase the likelihood of them confirming their appointment and ultimately coming in for their visit. She’ll also determine if there is a greater risk of a no-show by using machine learning, and will spend more time and attention on reminding those patients of their visit.

OLIVE FEATURES

There’s a ton of software out there that can help your healthcare organization run more smoothly or provide better care. Unfortunately, bringing new software into the fold can be very burdensome. Software often requires expensive and OLIVE CREDENTIALS time-consuming integrations and Automates licensure and change management. Let Olive be credentialing process your outegration solution—Olive can make sure that the software In healthcare, staying on top of has all of the data it needs from the licensing and credentialing of your organization to get up-andyour professional staff can be a running quickly. In many cases, she burden. Fortunately, much of that can also act as a user, and perform process is a perfect candidate for whatever task on the software your Olive to automate. Olive can login humans would normally perform. to the relevant systems, collect You can see the benefit of the the necessary documents, and software without the troubling constantly check to make sure integration, and without having to everyone is up-to-date. If additional retrain your staff. data is required that Olive can’t pull herself, she will contact the professional to start remediation.

Q2 / 2018

OLIVE WORKS /

BETA

OLIVE REFERS Helps with referral management

OLIVE DISPATCHES Uses Uber, Lyft, or other ride services to provide rides to patients who need them the most Sometimes, transportation is the only thing standing in between a patient showing up to a visit or missing it. Using machine learning, Olive can determine if a patient is a good candidate for your organization to offer a ride to in order to avoid a no-show. Once she’s identified good candidates, she will reach out to the patient to see if they need a ride, and if they agree, Olive will dispatch the ride through Uber, Lyft, or another transportation service, and let you know that they’ve accepted a ride and are in en route to their appointment.

OLIVE QUARTERLY

OLIVE COLLECTS Sets up payment plans for delinquent patients Collections are hard, but they’re an important part of your revenue picture. Olive can help make collections a little easier. Olive can login and monitor accounts receivable, and when she sees that a patient has exceeded a predetermined threshold for payment, she can reach out to the patient to give them the opportunity to setup a payment plan through a third party.

Referral management can be a difficult and time-consuming task. Olive can help by reading all of the faxes that come in, and identifying those that are referrals. She can then enter the referral into your system, and alert anyone across your system that a referral has been received and processed.

OLIVE EXCHANGES Sends medical records to requesting facilities Medical record exchange is a costly reality in healthcare. Your humans spend a large part of their day, week, or month receiving requests for medical records, pulling the information, and transmitting it to the right organization (often times through fax). Olive can do all that for you— she will listen for requests, make sure all of the right authentication has occurred, pull the relevant information from the home systems, and transmit them to the requester through whichever medium is requested.

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OLIVE ENRICHES Uses LexisNexis to enrich patient demographic data OLIVE BRIEFS

OLIVE MATCHES

Customized Alexa skill briefing for KPIs across the organization

Connects patients who opt-in to clinical trials which they are eligible

Olive has teamed up with her friend Alexa to provide you a customized briefing about your organization’s key information through any Echo device. Olive will login to the relevant systems and pull together reports in real-time so that when you evoke her by saying “Alexa, Open Olive,” she will give you a full briefing on the data and intelligence that you use to run your organization.

OLIVE FEATURES

Finding cohorts for clinical trials is a tough job. Fortunately, we’ve trained Olive on how to comb through vast amounts of data located in disparate systems to select candidate cohorts based on specific criteria. Coupled with Olive Engages, Olive can select a cohort, and engage the patients to see if they wish to participate in a trial—saving your organization lots of time and money.

Patient demographic data like full name, social security number, address, and other contact information can be critical for effective operations. Using Lexis Nexis’ world-class databases, Olive scours your current system, and makes sure that the information you have on every patient is up-todate and accurate. Olive ensures that you never miss a payment because you had inaccurate or outdated information.

Q2 / 2018

OLIVE LABS /

With OliveLabs, we work together to make sure Olive is custom-made for your organization. WE KNOW THAT OliveWorks won’t cover

everything you may want to have Olive do inside your organization. That’s why we created OliveLabs. With OliveLabs, we understand the business challenge you are looking to solve and we build Olive to solve your unique requirements using the latest AI and automation technologies. We manage Olive’s initial learning curve and then any ongoing support and maintenance is there as you need it. OliveLabs is right for an organization that truly sees AI and automation as part of their transformation, and want to apply Olive to a vast number of areas across their organization. Since OliveLabs workflows are customized, pricing is customized too, with kilobots.

OLIVE QUARTERLY

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Kilobots

FIG. 1

WE THINK OF artificial intelligence as a utility, and

the kilobot hour is the foundation of our OliveLabs product offering. Kilobots provides a flexible way for enterprises to invest in AI as an infrastructure and spend based on use, just like a utility. We think that the near future will make it clear that artificial intelligence is as important to your business as electricity or the access to the internet. With that in mind, we have created a flexible approach to paying for artificial intelligence like it is a utility. Electricity consumption is measured in kilowatt hours, which

FIG. 2

your utility provider sets a rate for, and the more kilowatt hours your consume, the higher your electric bill at the end of the month. If you plug in bigger and more complex pieces of equipment, they consume more energy thus increasing your bill. For Olive, we invented the kilobot hour. The kilobot hour works much like a kilowatt hour of electricityâ&#x20AC;&#x201D;the more Olives you plug in, the more kilobot hours you consume. The bigger and more complex the work is that Olive is programmed to perform, the more kilobot hours she will consume. Buying a reservoir of kilobot hours to kick off your enterpriseâ&#x20AC;&#x2122;s OliveLabs experience is a great way to start transforming your organization through artificial intelligence.

OLIVE FEATURES

Q2 / 2018

OLIVE BUILDER /

With OliveBuilder, use our suite of tools to build your own automations. WHEN WE STARTED to build Olive, we thought that

of user experience we saw firsthand. The results

we would just use one of the many in the market.

speak for themselves. Mimic is a world-class

We tried them all, and we were disappointed. It

platform... and soon the world will get to use it too.

wasn’t that the platforms were bad, it was that they were bad at healthcare. Healthcare is a unique animal—it isn’t your standard enterprise. The technology stack is different, the use cases are arcane, and the security requirements are vast.

We’re excited to announce a new program called OliveBuilder that extends our platform to any developer who wants to build their own Olives. Healthcare organizations like hospitals or other healthcare companies can get access to Mimic

Disappointed that we couldn’t use something off

through the OliveBuilder package to build Olive

the shelf, we decided to look at this an opportunity

for their own use, or to sell commercially to other

to build something perfect for Olive, and perfect

customers. Mimic, like Olive, is built for healthcare,

for healthcare. That’s when we decided to build

and it is the only RPA/AI solution built specifically

Mimic. Mimic is a very sophisticated RPA platform

for the challenges you face in healthcare. You

with advanced computer vision, machine learning

wouldn’t use an ERP for your EMR, so don’t use a

cogitations, and healthcare-specific aptitudes built-

generic RPA tool to build a healthcare bot. Whether

in. We’ve always had a world-class design team at

you’re building Olive to solve unique business

CrossChx, so we decided that if we were going to

problems within your own organization, or want to

build a platform for healthcare focused intelligent

create a vibrant new business line by building and

automation, then we were to make it beautiful. We

deploying Olive to other healthcare organizations,

set out to make it better than anything we saw on

we think OliveBuilder is your answer.

the market, and to overcome the shortcomings

OLIVE QUARTERLY

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Mimic

Workflow Name ACTIONS

Mouse Click - Start Button

Find activities Native

Click Native Text

Mouse Mouse Click Click Native Text

Times

Other Run Process

Mouse Click - Start Button

Close Window Get Window Dimensions

Block - Run and Open Posting in Paragon

Get Window Keyboard

Mouse Click - Start Button

Send Keys Send Control Keys Send Keys / Enter

Click Native Text

Text Get Window Text Get Native Text Utilities

OLIVE FEATURES

Q2 / 2018

ERGOPHENOMICS /

E R • G O P H E N O•MICS :

OLIVE QUARTERLY

THE SCIENCE OF OLIVE

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WE NEEDED A SPECIAL WAY to represent the

The ergo-phenotype can have two other

way humans worked at scale. We needed a way

permutations that are valuable. The first is a

to differentiate between every human worker, the

polymorphism. A polymorphism is an ergo-

systems they use, and how they complete tasks.

phenotype that is very similar to the original ergo-

We needed a new science, so we made one—we

phenotype with a slight variation. Polymorphisms

call it Ergophenomics (û(r)gō.fē’nōmiks); “ergo” for

would typically represent edge cases in a workflow.

work and “phenomics” for the study of phenomes.

When automating ergo-phenotypes, it’s important

Ergophenomics is the science of phenotyping how humans work. Like how a phenotype is the expression of the environment on a genotype, the ergo-phenotype is the expression of work on the ergo-genotype. The ergo-genotype is characterized by the actor (could be a human or a robot) manipulating the software and the software information itself. For example, right now I am typing on Google Docs, so the ergogenotype would be (Lane, Sean + Google Docs). In the healthcare setting, it could be something like (Smith, Mary + Meditech 6.15). The expression of

to discover and account for all the observed polymorphisms, or edge cases. The second permutation of ergo-phenotypes is an isomorphism. An isomorphism is an exact match to the circuit of an ergo-phenotype. Practically, if a isomorphism is present, then someone else in the organization is conducting the same workflow. It’s often important to know how many actors are performing the same work in an organization. 1. DURATION DISTRIBUTION The minima

and maxima times to complete the circuit. 2. AVERAGE DURATION The average time to

complete the circuit. 3. DAILY/MONTHLY OCCURRENCES How many

times the circuit occurs in a given day or month.

work on the genotype can include workflows—those workflows are discovered by using graph theory

4. DAILY/MONTHLY AGGREGATE DURATION

to look for circuits or paths. These circuits or paths

How much total time is spent conducting a

can illuminate workflows amongst a large amount

circuit in a given month or day.

of work. The ergo-genotype plus the circuit (the workflow) is a ergo-phenotype. The notation of an ergo-phenotype looks something like this: Lane, Sean + Google Docs + HC0259. That’s to say, Sean Lane was typing on Google Docs, and performed a circuit which is the 259th circuit discovered in your enterprise, so it gets the serial number HC0259.

5. DAILY/MONTHLY COST The Daily/Monthly

Aggregate Duration multiplied by the hourly labor rate (for Olive, use the Kilobot/Hour Rate). See page 29 for reference. 6. OLIVE COST AND SAVINGS ESTIMATE

How much the organization would save per year if Olive was to complete the tasks versus human labor. The science of Ergophenomics may seem geeky, but it is a critical piece of analyzing data provided by Pupil (see pages 34–35 for reference), and using artificial intelligence to transform your enterprise.

OLIVE FEATURES

Q2 / 2018

PUPIL /

PUPIL

OLIVE QUARTERLY

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Pupil enables AI at scale, and can effectively carve millions of dollars out of the administrative costs you face today.

IMAGINE IF WE could see everything that a

to look for workflows that are repeated, and to

human workforce is doing on their computers, and

determine whether or not they would be good

from that, determine what they are doing that is

candidates for automation.

repetitive and could better be done by a software robot. Imagine if we could look across an entire organization and discover the repeated workflows, and gather insight about the way the human workforce is actually working. This is all possible with Pupil. Pupil is a technology built on the principles of computational ethnography and deep process mining that uses the science of ergophenomics to understand how humans work at scale, and to make introducing AI into the workflows as efficient as possible. Pupil is an invisible application that sits on every computer workstation in your organization, and constructs a digital map of how your humans work by listening to every click, every keystroke, and every action they take on the machine. The actions harvested from our invisible application

Pupil enables AI at scale, and can effectively carve millions of dollars out of the administrative costs you face today by streamlining work with Olive and enabling an enterprise approach to surge into AI with a wide aperture, and unflinching eye. Pupil also allows you to visualize all of the work that your humans are doing, and watch play-byplay as work is taken over by Olive. Pupil removes the anecdotal collection of information about workflows, and takes the guessing out of the equation, so you can know what work is being done in your organization, and what things could be automated. Pupil is a revolutionary tool that turns your adoption of AI into a formidable infrastructure driven by data to optimize your organization and reduce costs at massive scale.

feed a master global network graph which is used

OLIVE FEATURES

Q2 / 2018

THERE’S AN APTITUDE FOR THAT /

THERE’S AN APTITUDE FOR THAT YOU ARE PROBABLY familiar with other AI solutions,

healthcare functions. We’ve decided we want

like Alexa. Alexa is a powerful tool in and of herself,

Olive to be the most powerful AI capability for the

but she is made orders of magnitude more powerful

healthcare industry; through the use of aptitudes,

through her Alexa Skills store. Users can download

Olive can be a meaningful addition to any team with

skills to that give Alexa “superpowers,” like reading

capabilities that far exceed that of a single human.

Olive is a very powerful tool on her own, but with the addition of Aptitudes, she can have superpowers.

Aptitudes are developed by our team of engineers, and they are made specifically to help Olive do her job better. We’re vigorously developing more and more aptitudes to make Olive the obvious choice for healthcare automation, and to truly set her apart from generic bots built on

favorite podcasts from a podcast app or controlling your smart home devices like your oven or your thermostat. Olive is no different—like Alexa, Olive is a very powerful tool on her own, but with the addition of Aptitudes, she can have superpowers. Aptitudes range in capability from enabling Olive

other platforms. As we move into the future with OliveBuilder, we will be extending the ability to create aptitudes to our growing developer network. Olive will be able to lookup providers, understand medical terminology through ontologies and dictionaries, and much more.

to send an SMS to looking up a patient’s eligibility instantly from hundreds of Medicaid providers. Olive is built for healthcare, and as a result, her aptitudes are created to make her better at doing

OLIVE QUARTERLY

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OLIVE FEATURES

Q2 / 2018

COGITATIONS /

COG•I• TA• TIONS Not all the automations Olive does can be performed by simple actions. In some cases, we need to use machine learning and deep learning techniques to accomplish tasks. We call these cogitations.

OLIVE QUARTERLY

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COGITATIONS ARE ANY use of neural nets

or machine learning algorithms by Olive to accomplish a task. Olive likes to learn from humansâ&#x20AC;&#x201D;she looks at historical data of how humans responded and reacted to various data scenarios. By consuming historical data of how humans have made decisions, and the data they were presented with when they made certain decisions, Olive can learn to respond the way a human would to various data scenarios. The specific cogitation used depends completely on the specific use case Olive is employed to solve. Some use cases are better suited for neural nets; in those cases, we evaluate multiple types of neural nets to determine which one would be the best to use to make the most accurate decisions

OLIVE FEATURES

Q2 / 2018

OLIVE PHD /

OLIVE POWERED BY

OLIVE PHD + LEXISNEXIS

INSTANT AUTHENTICATE FOR HEALTH CARE Olive integrates with LexisNexis Instant Authenticate for Health Care to discover, verify, and authenticate patient records, while ensuring the highest level of identity resolution. She improves the efficiency of your workflow automations by filling in the gaps in patient data with available public records, and

OLIVE PHD + LEXISNEXIS

SOCIOECONOMIC HEALTH ATTRIBUTES

maintains secure standards for patient identity. Olive integrates with LexisNexis Socioeconomic Health Attributes to use social determinants of health to make predictions about patient activity, and takes intelligent action when appropriate. With the power of LexisNexis, Olive PhD becomes smarter than ever before.

Olive then provides actionable insights to your team, so that environmental, financial, and other personal factors that influence a patientâ&#x20AC;&#x2122;s behavior and health outcomes can be addressed.

NO INTEGRATIONS

OLIVE FEATURES

FULL AUTOMATION

AROUND THE CLOCK

Q2 / 2018

FEATURED WORKFLOW /

FEATURED \ WORK / FLOW 40

OLIVE QUARTERLY

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Manual Meditech Workflow >

Use Google Chrome to access Meditech Web Ambulatory

From the home screen, select “Ambulatory”

Select “Compile” in the top right of the screen, then “Preview,” followed by “OK”

Enter in each provider in the “Provider Name” Search

In order select “Radiology,” “Active,” “New,” and “Order Details”

“Orders Report by Provider is ready to view” will pop up in the top right hand corner of the screen

Click on “Orders Report by Provider” to view report .pdf of all Radiology Orders

Yes, search next patient

Complete Deliverable ONE

OLIVE QUARTERLY

Are there any more patients in the list?

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Application will launch and load home screen

Click “More” in the top right of the screen to access drop down menu

top right to yesterday’s date by selecting the proper date from the calendar view

Reports home screen will load

In the drop down menu, select “Orders Report by Provider”

Click “Administrative,” “Community Wide Scheduling,” and “Scheduler Desktop”

Search for the patient by first-name and last-name

Select the patient from the search results

View the snapshot view of the order displaying Procedure description, status, account number, and location

Hit “Exit” at the bottom right to view the patient order

The patient’s account will load and will show “Hold Queue”

Select “Click Home Screen”

Change the date fields in the

FEATURED WORKFLOW

Q2 / 2018

2018 EVENT CALENDAR /

MAY 6–9, 2018

MAY 8–10

HLTH: THE FUTURE OF HEALTHCARE

AMIA CLINICAL INFORMATICS CONFERENCE SCOTTSDALE, AZ

LAS VEGAS, NV

JUNE 11–12

JUNE 13–15

JUNE 13–14

AI IN HEALTHCARE SUMMIT 2018

NG HEALTHCARE SUMMIT

SAN FRANCISCO, CA

HOUSTON, TX

AI INNOVATION FOR HEALTHCARE AND LIFE SCIENCE SUMMIT PHILADELPHIA, PA

AUGUST 27–29

SEPTEMBER 5–7

SEPTEMBER 11–13

HEALTH: FURTHER

ARTIFICIAL INTELLIGENCE SUMMIT

THE HEALTHCARE ANALYTICS SUMMIT

NASHVILLE, TN

SALT LAKE CITY, UT

SAN FRANCISCO, CA

OCTOBER 15–17

NOVEMBER 4–7

HOSPITAL AND HEALTHCARE IT CONFERENCE

EXPONENTIAL MEDICINE SAN DIEGO, CA

CHICAGO, IL

2018 EVENT CALENDAR OLIVE FEATURES

Q2 / 2018

MAY 13–15

7TH ANNUAL HEALTH TECHNOLOGY FORUM (HTF) CONFERENCE STANFORD, CA

JUNE 14–15

JUNE 24–27

JULY 15–19

AI & MACHINE LEARNING FOR CLINICAL TRIAL AND R&D ADVANCEMENT

HFMA ANNUAL CONFERENCE

MICROSOFT INSPIRE

PHILADELPHIA, PA

LAS VEGAS, NV

SEPTEMBER 16–19

OCTOBER 10–11

OCTOBER 11

HEALTH 2.0

WORLD AI SUMMIT

DIGITAL HEALTHCARE INNOVATION SUMMIT

SANTA CLARA, CA

(HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION)

WASHINGTON, D.C.

BOSTON, MA

AMSTERDAM, NL

NOVEMBER 26–30

NOVEMBER 28–29

AWS RE:INVENT 2018

FORBES HEALTHCARE SUMMIT

LAS VEGAS, NV

NEW YORK, NY

DECEMBER 3–5

DECEMBER 5–6

DECEMBER 9–12

AI WORLD CONFERENCE

THE 3RD ANNUAL AI SUMMIT

HEALTH SYSTEM 100 2018

NEW YORK, NY

NAPLES, FL

& EXPO BOSTON, MA

OLIVE QUARTERLY

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MEADOWS HEALTH /

MEADOWS HEALTH

OLIVE QUARTERLY

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“ We’ve been working with CrossChx to develop where we can deploy this artificial intelligence in our system, and frankly, I’m overwhelmed by the number of opportunities.” MIKE HAGAN

AVP of Revenue Cycle Operations, Meadows Health

IN THE COASTAL, tech-hub cities of the world,

Meadows went live with their first Olive project

you’d be hard-pressed to find someone who has

in July 2017, where she was employed to run an

heard of Vidalia, Georgia. Three hours outside of

eligibility report in Meditech, check for eligibility

Atlanta sits a city with a population of fewer than

using Availity, and re-populate the update into

11,000, with a name that most people have only

Meditech. Olive’s impact was immediate and within

seen on onion cases in the grocery store. But Alan

three months, Kent, along with Bondurant, Meadows’

Kent, Chuck Bondurant, Mike Hagan, Billie Sue

CIO, and Hagan, Meadows’ AVP of Revenue Cycle,

Durden, and other leaders at Meadows Health are

saw so much potential for AI and automation that

determined to prove that towns like Vidalia can be

they decided to bring Olive’s development and

pacesetters for the future of healthcare.

execution in-house with an ASOC (Automation

“A driving influence here has been our absolute

Support Operations Center).

commitment to the philosophy that you should not

Within the first month, the Meadows ASOC team had

get poorer quality care just because you happen

identified over 35 CPAs (Candidate Processes for

to live in a rural area,” says Kent, Meadows’ CEO.

Automation) across their organization.

Rather than using limited resources to operate his health system in the same way it’s been done for decades, Kent acknowledged the exciting opportunity and challenge to create transformative change in a historically stagnant space.

To plan for the reallocation of staff hours once Olive took over the eligibility process, Meadows sent Billie Sue Durden, their Director of Patient Access, to Disneyland for the Quality Service course taught by the Disney Institute. Now, she’s working to train

As one of our earliest partners, Meadows has

her staff to be focused on more direct-patient

been working with CrossChx to create that

interaction, such as front-end customer service and

transformative change for over three years,

their currently understaffed call center.

most recently with Olive.

OLIVE PARTNERS

Q2 / 2018

ASOC /

A•S•O•C / AUTOMATION SUPPORT OPERATIONS CENTER 46

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My COO and I were military intelligence officers in our past lives, and we both spent a lot of time in operations centers. FROM OUR EXPERIENCE,â&#x20AC;&#x2030;â&#x20AC;&#x2030;the operation center

was very effective way of focusing on a particular mission by putting an unflinching eye on the problem to solve it swiftly and overwhelmingly. We borrowed this experience to create the Automation Support Operations Center, or ASOC. The ASOC is for organizations who see automation and artificial intelligence as a meaningful component in the transformation of their enterprise. When our customers are very serious about implementing AI and want to put forward the most aggressive effort for transformation, we build them an ASOC. The ASOC focuses, unflinchingly, on finding tasks and workflows throughout the entire enterprise that are good candidate processes for automation (CPAs), after which the ASOC team applies the CrossChxcreated S.H.A.P.E. (Scaling Humans through Advanced Process Engineering) methodology to prioritize the CPAs for execution. Our engineers quickly train Olive on how to perform the tasks selected, and once implemented, the intelligence portion of the ASOC takes over. The intelligence team then monitors all the Olive operations throughout the enterprise, and constantly measures the ROI impact on the organization. The ASOC is for the committed, for the ones who are the strategically focused on using AI to transform their organization.

Are you the next ASOC Director?

OLIVE PARTNERS

Q2 / 2018

HANCOCK REGIONAL HOSPITAL /

HANCOCK REGIONAL HOSPITAL

FOR YEARS, Linda Lane, Hancock Regional

and Availity. Through Availity, Olive checks for

Hospital’s Director of Patient Financial Services,

insurance eligibility for both Medicare and Anthem

knew that their real-time eligibility process was

patients. In both portals, if Olive finds that the

primed to be improved and optimized. Doing the

insurance information is not valid, she copies and

best they could with limited staff and resources,

pastes the patient’s information into Meditech

their billing department was often forced to

as a “task” for the billing team. This allows the

send out claims without knowing if the insurance

billing team plenty of time to get the insurance

information was accurate, and then wait 30 days

information resolved before bills are sent out,

to see if a denial came back.

three days after the patient’s registration.

When we first told Linda that Olive could help their team manage their eligibility process, the light bulb went off. She had always wanted a team member to at least run the previous day’s self-pay registrations against Indiana Medicaid, or to run Medicare registrations against Medicare to see if the patient had a replacement plan or not, and knew that these were tasks that Olive could perform. But Olive is taking things a step further for Hancock—every night, a report is compiled of all of the previous day’s registrations, which she runs through two web portals: Indiana Medicaid

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“ One of our biggest metrics is our days in accounts receivable, and we anticipate Olive being a huge factor in reducing them.”

LINDA LANE

When Wendy Francis, an Insurance Claims Analyst,

Director of Patient Financial Services,

first heard about Olive, she sounded “too good to be

Hancock Regional Hospital

true.” Within only a few months of being live, Olive was able to eliminate denials for no-coverage by working with Francis’s payer. From the beginning, Linda anticipated Olive being a big factor in reducing their days in accounts receivable, one of the department’s most important metrics—in the 6 months that Olive has been live, Hancock has reduced their days in AR by 8. With an average of 250-300 patient visits daily, Olive will continue to get smarter—and work harder— for Hancock.

OLIVE PARTNERS

Q2 / 2018

TAKING THE ROBOT OUT OF THE HUMAN /

TAKING ROBOT THE

THE OUT

OF HUMAN

WHEN YOU EMBARK on an AI journey within your

to replace some of what humans do. Humans

organization, you are going to encounter pockets

shouldn’t be robots, and robots shouldn’t be

of resistance. This resistance is mostly generated

humans. Unfortunately, in healthcare, due to

by some fear, and lack of knowledge on what to

intense regulatory requirements and siloed

expect. The current zeitgeist around AI is tension

systems that don’t interoperate, humans have been

and trepidation about whether or not it will take all

doing the work of robots.

of the human jobs, so you need to be equipped to answer those types of questions when as you talk to your co-workers. We genuinely believe in scaling humans. We believe we will be able to achieve so much more as a humankind with the assistance of AI. We think that in the healthcare enterprise alone, we could free up a vast amount of resources to make healthcare better, more affordable, and even increase the quality of life of its workforce.

How many nurses’ or doctors’ hours are spent in front of a computer terminal instead of in front of a patient? How many administrative professionals can’t get to some of the more impactful, challenging, and more analytical work that they want to do because all of their time is consumed by reports, logging, transcribing, transmitting, submitting, and other repetitive robotic tasks? The answer is a ton. Imagine what healthcare

The best way to explain what Olive does and how

would be like if we could take the robot out of

it will impact the humans she works with is to say

the human. Think about how much better off

“we’re trying to take the robot out of the human.”

the workforce would be. That’s the world we are

This phrase helps put it into perspective—Olive

dedicated to building.

is not trying to replace humans, she’s just trying

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OLIVE CONCEPTS

Q2 / 2018

S.H.A.P.E. METHODOLOGY /

S • H • A • P • E

M E T H O D O

MANY OF OUR CUSTOMERS have embraced Olive

The SHAPE Methodology stands for “Scaling

quickly and holistically. Some, including those with

Humans with Advanced Process Engineering,”

ASOCs, have come up with dozens of business

and it is used by CrossChx and our customers to

processes or operations they want Olive to take

manage larger, multifaceted implementations of

over within a matter of weeks. To handle the influx

Olive. SHAPE is used to identify, quantify, qualify,

of business processes, we developed the SHAPE

prioritize, and track candidate processes for

Methodology.

automation, or CPAs.

* SCALING

HUMANS WITH ADVANCED PROCESS ENGINEERING

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The chart is constructed with an x and y axis

capabilities, prospect throughout their enterprise

and quadrant like the following.

for processes or operations that can be made better or more efficient with Olive. Often times,

IMPACT

Organizations, after some training on Olive’s

an operations analyst, or equivalent, will meet with department heads throughout an organization to explain Olive, and ask for ideas of things she could help out doing within their domains. The resulting lists are the candidate processes for automation (CPAs). Once CPAs are identified, step two of the SHAPE methodology is to create a process notation, or PRONOT. The PRONOT is the serialized shorthand to which the CPA will be referred from that point forward. The PRONOT consists of the following elements: ORG NAME / SERIAL NUMBER / SPONSOR /

1 1

SPEED

Each PRONOT is graphed using the last five numbers in the PRONOT. The y-axis position will be calculated by adding the first three numbers. In the above example, the sum is 9. The x-axis position is calculated by adding the last two numbers. In the above example, the sum is 8. Using y=9 and x=8, the PRONOT 0001 would be charted like the example below: 12

QA 001

HUMAN HOURS REQUIRED ON A SCALE OF 1-4 / ERROR VULNERABILITY ON A SCALE OF 1-4 / POTENTIAL TO INCREASE REVENUE OR PROFIT

IMPACT

DATE RECORDED /

ON A SCALE OF 1-4 / ACTIONABILITY ON A SCALE OF 1-4 / VOLUME PER DAY ON A SCALE OF 1-4 /

1 1

SPEED

The PRONOT will be formatted like this (X’s are

PRONOT 001 clearly falls into quadrant “A”, or QA.

variables for letters, #’s are variables for numbers):

QA PRONOTs are always prioritized first, because

XXXXXXX/####/XXXXXXXXXXMMDDYYYY/#/#/#/#/#

they are the most actionable and have the highest

Here’s an example: OXFORDGEN/0001/LANE/04122018/4/3/2/4/4

potential impact. Conversely, PRONOTs in QD are prioritized last. The prioritization between QB and QC is really up to your organization and could vary

The PRONOTs are then used to chart the CPAs on a on a case-by-case basis depending on whether or graph to determine which one should be prioritized. not you value speed or impact more. Often times, organizations that are new to Olive choose speed over impact in order to get traction throughout the enterprise, and then over-prioritize impact once significant traction is achieved. The SHAPE Methodology is simple, yet effective. Once we are able to integrate SHAPE into the overall initiative, it greatly increases the speed and efficiency with which you can use AI to transform your organization.

OLIVE CONCEPTS

Q2 / 2018

INSIGHTS /

SIGHTS We provide a management command center dashboard to allow your organization to monitor, evaluate, and demonstrate the impact of all process automations. INSIGHTS WILL REPORT trends, accuracies, efficiencies, and

allow for adjustments to ensure the most operational value is realized by your organization. For example, these metrics could include total kilobots used to date, total Olive hours worked, successful claims to date, and the status of other projects in build. Metrics will be updated in real-time to ensure that you always have a complete and accurate view of Oliveâ&#x20AC;&#x2122;s deployment.

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Insights

H Health System

Olive’s Performance Portal 18 kBh OF 26 kBh USED

Est. Time of Depletion: 6/21/18

Buy More 0 KbH

26 KbH

13 KbH

METRICS Patients by Date

Availity Percent Over Time

176.71

100% Patients this Week

Last Week

12.66%

100% This weeks Availity % (v.s Last Week)

Weekly Average This Week

Average Availity Percent Availity %

30 20

0 Nov 26

0 Sa

Dec 3

Dec 10 Dec 17

Dec 24 Dec 31

Jan 7

Jan 14

Jan 21

Jan 28

Feb 4

Feb 11

Feb 18

Feb 25

Olive Hours Over Time

Successful Eligibility Checks by Date

4.59

6.28

23% This weeks Hours Worked (v.s Last Week)

Average Hours Worked

Availity %

24.54

Successful Checks this week

Weekly Average

Last Week

5 5

This Week

4 3

0 Nov 26

Dec 3

Dec 10 Dec 17

Dec 24 Dec 31

Jan 7

Jan 14

Jan 21

Jan 28

Feb 4

Feb 11

Feb 18

Feb 25

2 1

Looking for more insights?

Let us know what additional metrics you’d like to see in your dashboard

PROJECTS In-Progress Name

IT Setup

Signed Contract

Olive’s First Day

Eligibility Check

Passwords

Completed Name

Run Status

Outcome

kBh Usage

Availity

Running

1.4

Patient Verification

Last Run: 3/9/2018 1:20:34

Successful

5.6

CREDENTIALS Name/Label

Name/Label

Add new Credentials

OLIVE CONCEPTS Have other tasks Olive can help you with?

Q2 / 2018 You have used 18 kBh of your 26 kBh bucket. To have more Olive automate more projects, purchase more kilobot hours here.

Buy More

GETTING STARTED WITH OLIVE /

Set up an email address

et up a virtual S connect gateway

Set up a system account

Set up access to any additional tools that are part of your staffâ&#x20AC;&#x2122;s workflow

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olive@yourhospital.com

Let Olive do the rest

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OLIVE CONCEPTS

Q2 / 2018

HORIZON /

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FUTURE CONCEPTS

Q2 / 2018

HEALTHCARE

INTERNET

THE

THE INTERNET OF HEALTHCARE /

THE INTERNET OF Healthcare, or IoH as we call

The big “I” Internet that we all know and use today

it, is a concept that we created at CrossChx to

can sometimes best be described in terms of the

describe the world that we imagine in healthcare,

impacts it has made in our day-to-day lives. Ordering

while simultaneously describing the world that

a car service with the touch of a screen, shopping

doesn’t exist today. The IoH is both an analogy

for just about anything, or finding out pretty much

and a literal concept. In the literal sense, we

any information with a simple query are all examples

mean literally connecting networks—connecting

of how the Internet has affected most aspects of

health systems, connecting data, connecting

our lives. However, the experience we confront

patient information and history. We mean turning

when encountering healthcare doesn’t feel like the

healthcare from a series of intranets connected

“Internet” is involved. There is never a sense that

by high-speed fax machines, to a true internet

they know who you are, you are constantly “logging

connected by AI as the “router.” Analogously, we

in” by filling out paper forms and showing paper

think of Olive, our AI solution, as a router. Through

cards that you carry around with you like some kind

a series of Olive deployments at different locations

of physical cloud. You are asked to regurgitate the

logged in to different enterprise software, we are

medical history of you and your family.

effectively building our internet. Having Olive in your organization will be analogous to buying a modem for your PC in 1994. Olive will make up a veritable extranet, lovingly wrapped around the technology systems that already exist. Many organizations in the future will buy Olive just to get connected to the IoH.

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Imagine if we had a similar experience when trying to buy something on Amazon. Imagine if we went to buy a new throw pillow and we had to login to the app by providing 20-30 points of information (even though we’ve already provided this information

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before). Imagine if you had to present three or four different paper cards and take a picture of them with your phone. Imagine if you had to remember your previous purchases, and then enter in information about your preferences every time. The throw pillow guys would definitely go out of business. We think that part of the IoH eventuality will include many of these conveniences that more closely align with what people have learned to expect with the Internet.

FUTURE CONCEPTS

Q2 / 2018

A ROUTER

AI AS

AI AS A ROUTER /

TO UNDERSTAND THE fundamentals of the Internet

We think AI is capable of managing that complexity.

of Healthcare, it is important to understand a basic

We are building data exchange and transport

tenet that we believe, “AI as a Router.”

firmware into every Olive instance that is deployed.

Here’s what we mean by that. Right now in healthcare, humans are routers; they sit logged in to multiple systems, pulling data out, putting data in, interpreting information, and then transmitting information digitally and though fax machines. Humans are routers because many systems don’t talk to each other, and we’re not sure that they ever really will—not just because of the technology, but because of policy and privacy concerns. To make data really flow, there has to be some mechanism of universal trust. Some way to authenticate, to verify, to be very precise about the type of data you are exchanging, to whom you’re exchanging it with, and for what purpose. Most data transport layers aren’t equipped to manage that level of complexity.

OLIVE QUARTERLY

We are not just carving costs out of and bringing humanity back to healthcare by taking over the robotic tasks that humans do today—we are also building a network. In the future, every Olive logged in to every system across many healthcare organizations will be able to talk to each other to send data, process paperwork, authenticate and verify identities, and to make sure the data is there when the right people need access to it. It will start in the form of Olive sending a document, like a referral, to another Olive instead of faxing a form. It will then grow to manage the exchange of most of the information from system to system. As the network matures and the Internet of Healthcare is widespread, each Olive will be able to query every Olive to pull together all of the relevant

crosschx.com/oq

Humans are routers; they sit logged in to multiple systems, pulling data out, putting data in, interpreting information, and then transmitting information digitally and though fax machines.

data, with permission, and assemble it on-demand for the physician or the provider. While her router capabilities arenâ&#x20AC;&#x2122;t turned on today, and wonâ&#x20AC;&#x2122;t turn

on until we have buy-in from our customers, we are very much building the Internet of Healthcare one Olive, one AI router, at a time.

FUTURE CONCEPTS

Q2 / 2018

FIND JOY INSTEAD /

FIND JOY INSTEAD

Want to be a part of a team that is fundamentally changing healthcare? 64

OPEN POSITIONS ARE LISTED ON OUR WEBSITE:

crosschx.com/careers

TO BE A PART of CrossChx means greeting

overwhelming odds with innovative solutions— to find joy in challenges. We go from chaotic days to victorious nights and pick up right where we left off in the morning. Whatever comes our way, we’re all in this together. Starting a new chapter in your career can be a little awkward (and maybe intimidating), so that’s why we put you on our stage on your first week. It’s a deep dive, but we’re ready to welcome you into a great family of people and give you the support and resources you need to be successful. What we’re doing is no small thing. That means we take on impossible challenges, jump head first into the fray, and do whatever it takes to get it done. And every CrossChx’er will be right there with you. We take our perks seriously, and consistently evaluate the needs and wants of our employees in order to provide the best possible workplace. From insurance to recreation, we make sure to take care of our own. You’ll enjoy…

CROSSCHX

HEALTH INSURANCE

MATERNITY AND PATERNITY LEAVE

UNLIMITED PTO POLICY

ON-SITE GYM

401K PLAN

PARKING STIPEND

LUNCHES PROVIDED

CONDO IN FLORIDA

HAND-BUILT ARCADE

BARBERSHOP

BEERS ON TAP

#CHXPERIENCE

Q2 / 2018

OUR

CORE / VALUES

OUR CORE VALUES /

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Fight Above Your Weight Class

Create Something Daily

Put the Skunk on the Table

Take Initiative

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Some Are Smarter Than Some of Us, But None Are Smarter Than All of Us

Don’t Put Off Until Tomorrow What You Can Accomplish Today

EAFL

Pick Up the Freakin’ Phone

Sometimes You’re the Deckhand, Sometimes You’re the Captain

Excuses Are For Losers

Spend Smartly

We Only Pick the Best, So Prove Us Right

CROSSCHX

Q2 / 2018

For an immersive motion-graphic experience around our “Brain in a Jar” AI analogy, please visit crosschx.com/oq

Content, direction, and vision for Olive Quarterly provided by Sean Lane, Co-Founder and CEO of CrossChx.

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Q2 / 2018

99 E. Main Street Columbus, OH 43215

FOR MORE INFORMATION, VISIT:

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