Seema Verma, Oracle of Progress at CMS & Beyond

Melanie Marcus: As one of the longest-serving administrators for the Centers for Medicare and Medicaid Services, you could argue that Seema Verma needs no introduction.

As former CMS Administrator, Seema led what is effectively the largest payer in the nation. Now, as Executive Vice President and General Manager for Oracle Health & Life Sciences, she serves one of the largest health systems: the U.S. Department of Veterans Affairs. And if that wasn’t enough, Oracle has one of the largest electronic health records with its acquisition of Cerner in 2022.

All of this brings one word to mind: “scale.”

So much of Seema’s work involves every part of the American healthcare system, including the push to advance interoperability nationwide and close gaps in care.

When I ask her about closing gaps in care, that’s where things get interesting. It’s not so much about gaps in care, in Seema’s view, but gaps in data.

That’s the underlying problem in healthcare, she says. But I’m pleased to say that her outlook is refreshingly positive, and I’m excited for our listeners to hear her ideas on the tools and technology that we’re using to fix it.

Let’s dive in.

Welcome to the show, Seema. It is an honor to have you here with us.

Seema Verma: Well, I'm glad to be with you.

Marcus: Today we're talking about bridging gaps in healthcare.  And this is a bridge you know quite a bit about, Seema. It's a bridge between knowing what we need to do to improve healthcare and making that happen in the real world. For patients and those who care for them.

You are helping to build this bridge with interoperability, innovation and policy. And I'm really looking forward to talking with you about each. But first, let me say this. As a former administrator of the Centers for Medicare and Medicaid Services, you led what is effectively the largest payer in the nation, if not the world.

Now at Oracle, you serve one of the largest health systems in the world, the U.S. Department of Veterans Affairs. And I should note that Oracle has the largest electronic health record in the world with its acquisition of Cerner in 2022. All of this makes me think of the word “scale.”

So here's my first question, and it's a bit of a metaphor. In all that you've learned about bridging gaps in healthcare at scale, what construction materials do we need to build this bridge?

Verma: Oh, that's a great question. Start with tenacity, I would say. I think when you're approaching something like this, whether it's any problem that I encountered when I was at CMS or even at Oracle, I think tenacity’s one. Vision is the other as well.

You have to have an idea and a vision of what things could look like and what they could be like—what they should be like. And then the tenacity to get there. So I think a lot of times we're not clear about where we want to go or what the policy should be, what the vision should be for a particular technology.

And so then that way people are more content to just do things the way that they've always done instead of saying, “Let's imagine a different future, a different world.” So I think it starts with that, which is identifying the vision. And then it's the strategy. Which is, “How are we going to get there?”

And then you've got to have that tenacity to be able to plow through that, because all along the way you're going to have barriers. You're going to have people that tell you, “Oh, you can't do that. That's not gonna happen. That's impossible.” And you're going to have things that come up that you didn't anticipate, and you have to kind of figure out how to keep going, how to go over that hurdle. Basically, how to move forward.

Marcus: I love that. Vision, strategy, and then tenacity.

You jumped into policy soon after college and grad school, running your own consulting firm for about 15 years until you became the administrator of CMS. You led CMS under the first Trump administration, and your term was one of the longest in CMS history.

Can you describe what your overall experience was leading the largest payer in the nation? I mean, the scale of covering 145 million beneficiaries is quite something.

Verma: Yeah. What an amazing experience. Extremely grateful for that opportunity.

There's so many facets of that job. You kind of touched on the enormity of it.

I think the other piece of it is it really does touch upon every part of the American healthcare delivery system. And so the ability to be exposed to those issues by the leading experts, we get this depth of knowledge. Depth, and I would say breadth of knowledge. I almost felt like I had done a Ph.D. in health policy. So the learning is tremendous.

And then the other aspect of it was that there are skills that you learn there that I think are difficult to amass over time. The ability to work in a large organization and that government is inherently bureaucratic and figuring out, “How do you move through? How do you get over the hurdles, under the hurdles, around the hurdles to get to where you wanna go?” I think that was a skill in and of itself.

There's the whole piece about politics and how do you navigate through that? How do you navigate being in a very public role? The media attention. And then I would say the last year with COVID was a unique experience in and of itself. That was all about crisis management.

It's like, how do you get things done when the world is completely upside down and still having to lead, strategize, have a vision, execute, and have that tenacity all the way through that? So I feel very fortunate to have gone through that entire experience. But it was so multifaceted, right? That it isn't just one area. You are learning a lot. You're learning to execute, you're learning to do things at scale, the politics—there's just a lot of different aspects to it, but truly an experience of a lifetime.

Marcus: For sure. Thank you for your service. And during COVID, I can't even imagine.

But one of the things you got done beyond COVID, you initiated “patients over paperwork.” Which just makes me think about some of the things we're doing now. Can you talk about that a little bit?

Verma: It started very, very early on in the administration. The first Trump administration was very focused on repeal and replace. And when that didn't work out, it was almost a moment where there really wasn't a strategy. And at that point it felt like it was sort of my job to set the strategy for the next few years.

And that was informed by doing a nationwide listening tour and we just went across a diversity of organizations, whether it was rural providers or big academic centers, businesses that were trying to innovate, EHR companies—I mean, just the whole gamut. And got a lot of feedback from that. And from that, that's really where we set the strategy.

But I think one of the overriding issues that we heard about was just the incredible burden that providers were under. I still remember visiting a hospital in the Northeast, and this physician talked about how she had owned a practice for 20 years. But all of the regulations that had come out—MACRA, the new requirements for EHRs—it was overwhelming. And she had sold her practice and she still talked about being up late at night, working on paperwork, working on reporting quality metrics. And so it really seemed that these are the people that we need to take care of people, and they weren't being taken care of. It was an incredible, incredible burden.

And this even predated COVID. We heard a lot about the burnout in COVID, but this was actually going on long before. And it was really just a lot of the administrative tasks that these providers were forced to do—whether it's just dealing with their EHR or dealing with all the insurance company requirements.

It was a far cry from what they had gone to school for. They were about science, they were about patient care, helping people, and it felt like they were being deterred in a different direction. So that's where the whole concept of “patients over paperwork” came out. It was a deregulatory effort and we did not only a listening tour, but we had multiple RFIs where we asked the community to tell us what are the most burdensome regulations.

I always say you get the best advice from the front lines. People that are actually doing the work.

Marcus: Absolutely. Well, so from policy and deregulation, now you've gone into technology. So today, as your LinkedIn profile says, you're working to bridge the gap between clinical research and clinical care at Oracle. Your goal, much like ours at Surescripts, is to improve patient outcomes and care delivery.

What do you enjoy most about working at Oracle, especially in terms of the impact you're making on patients in the broader healthcare system?

Verma: Well, after going to CMS, which was an amazing experience. We were delivering change at scale, and so it took me a long time to figure out, “Where can I go that's going to have the greatest impact?”

And I thought that we were having a lot of impact when I was in government. But I think after leaving government, I felt like even though we'd spent a ton of time, worked on a lot of great projects—$35 insulin, interoperability, the patients over paperwork, rural health—we had a list of all these things that we had gotten done. And yet it still felt like, “Did we really have an impact?”

And so I had the opportunity to meet the team at Oracle and I couldn't have been more impressed with the vision and the mission. So Larry Ellison, Mike Sicilia, Safra Catz—they had spent basically a career transforming different sectors with technology. Whether it was  banking, whether it was restaurants—hospitality businesses in general were sort of transformed by a lot of Oracle technology.

And then during COVID, they saw a lot of the dysfunction in the health system very up close. And they thought, “Gosh, we should be able to take everything that we've learned and bring it to the healthcare sector.” And so that was the acquisition of Cerner. And for me, it felt like the work that I'd be able to do at Oracle and the work that I am doing is a continuation of the work that I was doing at CMS. A lot of the problems, the intractable problems that we had at CMS, I think can be solved by better technology.

We're also very lucky to be living in the era of AI, and so a lot of the things that we are trying to get done, I think can be done with technology. We can address workforce burnout. We can address challenges in rural health. We can address burnout in a way that we have never been able to do that no government policy is going to be able to accomplish. But I think that technology can.

So if we think about quality of care, giving better tools to providers on the front lines so that they know what's the next best action that they need to take. How do they enroll a patient in a clinical trial? Many times they're not even aware that there's a clinical trial available, but we can bring all of those tools to the bedside. And I think that what we're trying to do here will be part of the new revolution in healthcare around AI.

Marcus: It is exciting. I think it's a great time to dig a little deeper into your perspective on really bridging gaps in healthcare, and specifically the bridge between knowing what we need to do to improve healthcare and making it happen in the real world.

And this seems like a large gap because bridging major areas in healthcare and technology like interoperability, systemic innovation, and policymaking, among others, is a big job. So let's set the foundation for what we mean when we talk about gaps in healthcare. When people talk about gaps in healthcare, what do they mean?

Verma: Yeah, gaps could be gaps in care. But I'm going to go with gaps in data because I think that a lot of what we're talking about here, sort of the underlying problem in healthcare, is around gaps in data.

When you go to a doctor's office, they don't necessarily have all of your health information. I think most of us could say that there are different pieces and parts of our healthcare record that are spread all over a variety of different providers, hospitals, outpatient, inpatient, labs. And it's all over the place. And so you can imagine for us as patients, it's hard to feel empowered and knowledgeable about our health, and we don't even have all that information at our fingertips. And even if we did, how would we make sense of all of it?

And the same thing for our doctors. We kind of wonder, “Oh, they're asking the same questions over and over.” Well, even in an era of better interoperability, they get a dump of data and it's just all disorganized and it's duplicative.

And so a lot of times, even though they have it, it might be easier for you to just give them your whole health history again because it's too difficult for them to have to navigate through pages and pages of information or a medication list. So I think a lot of what we're talking about starts with the foundation of data. And that's why when I was at CMS, one of the main things that I focused on was interoperability.

I felt very strongly that if we had complete medical records that followed us through our healthcare journey from the time that we're born through every health interaction through our entire lives and we had these complete medical records, it would not only be better for us as patients, for our providers to make decisions that were well-informed, but ultimately for innovation and for science and for the new era of cures and treatments. Imagine having those complete medical records.

So if you think about vaccines, for example. And the very first vaccine trials that were done, they were done on paper, right? So people were recording all of this information. They had to analyze the results, and it took so long to do those things.

Now, in an era with digital health, you can imagine the pace and the acceleration of innovation, and even now we're using technology to think about how different drugs should be formulated using AI. But it all starts with data, right? You can't use AI without having a lot of well-organized data, and that's why I think Oracle's positioned really well because at its core, its roots—it's a database company. That's where they started. And so everything that they've done is all about data.

Marcus: That makes so much sense. And it makes me remember one of our guests in Season 4 was Troy Tazbaz from the FDA, and he actually thought out loud like, “Well, maybe AI will be the forcing function for healthcare to get data into place, to get our data organized.” So that was a good view, I thought.

All right, so we've bridged the gap between knowing what we need to fix and fixing it so we can help healthcare heal itself. What positive outcomes could we see for patients?

Verma: Yeah, I would say in the short term, right? So just think about in the past year, what we see is a lot of the ambient listening tools where it can listen to the patient–doctor interaction and help the physician put together their note, right? That's just one very, very small thing.

But imagine what that means. It means the doctor, you can actually have a conversation with the doctor and they're going to look you in the eye instead of clicking on their computer and doing data entry. You're actually going to have a conversation with them.

And I think that does a lot to restoring the erosion in trust that we've seen with the healthcare system. We've seen that that's changed a lot in the last 10 years. So having a better relationship with your doctor. Your doctor being able to spend more time with you. And if they're able to spend more time with you, they're looking you in the eye. I can't imagine that that's not going to lead to a better experience for the patient and for the doctor. So I would say that that's table stakes. We're already starting to see that.

Moreover, we're also seeing a big increase in demand, right? A lot of us have had struggles getting a doctor's appointment in the last three or four years, especially with primary care. So this is going to provide more capacity.

I think it can also help the paraprofessionals that are out there—whether it's nurse practitioners, physician assistants—that they actually have better tools at their fingertips, whether it's around diagnoses or if they have a question, if they want to look up something.

Some of the AI tools are able to do a great job on summarization. So they can take all of the data sitting in the record from disparate sources and actually make sense of it and provide a concise summary. All of that helps the provider be more efficient.

On the backend, we're seeing AI being deployed for revenue cycle. There's a lot of back and forth. 25–30% of our dollars are spent on administrative tasks in the United States. Imagine if AI can do some of that work that gives us more resources for patient care.

Marcus: Great vision, great results. As you said, you need the strategy. You need the vision first and then the strategy.

So what will it take to bridge the gap completely?

Verma: There's so many different dimensions of this. AI is moving a lot faster than I think people have ever really realized. And so you're going to see a lot of AI agents that are available, and there's going be a lot of different sources.

I think the most important thing for organizations to think about, No.1, is their data, right? That data does have to be organized. We also hear about AI creating hallucinations and giving advice that may not be appropriate. But a lot of that has to do with the underlying data and having it organized. So that's one thing. You can't have an AI strategy if you don't have a data strategy. That's number one.

And then I think you have to have a platform that allows you to not only use AI, use all of the agents that are being developed. You may want to develop some of your own. And then you need an AI platform that allows you to coordinate all of these AI agents.

And so I think in the short term we're using one or two or three, but over time there's going to be a lot of AI that we're using and we have to kind of think about how all of that comes together. This is happening a lot faster than I think anybody really imagined.

And people are using AI for coding as well. So we're seeing a lot of software coming to market a lot faster and quicker. So I think that when we talk about bridging the gap, I think that we're going to be applying AI to a lot of the problems that we have in healthcare. Whether it's around quality, whether it's around access, whether it's around revenue cycle, prior authorizations, we're going see this rapid deployment of AI agents across the entire healthcare system. And in the beginning I think it's going to be more common problems that we're all facing, right? Prior authorization is a good one. And then I think it's going to become more bespoke over time. As different institutions have more unique problems, they're going to want to develop their own AI agents to develop some of their unique and specific needs.

Marcus: It is an exciting time. A time when we can start to see acceleration in solving some of these things.

So you mentioned prior authorization, and we've spent a lot of time talking about prior authorization on this podcast. So can you just dig in a little bit more on prior authorization?

Verma: I talked about the listening tour that I did, and this was actually the number one issue that providers brought up. And so we’ve been working on this one for a long time. Before I left CMS, we actually put out the very first regulation on prior authorization. The Biden administration made some changes, and then I think what we've heard now from the second Trump administration is they're also putting out some new things around prior authorization. So bottom line is, this is a bipartisan issue because it's been such a pain point that I think both sides will acknowledge.

Look, prior authorization is a necessary tool. If you talk to payers, they say, “We see a lot of claims for care that's not appropriate or there's a more cost effective, higher quality way to address this issue.” And so prior authorization is really the checks and balances to make sure that we don't have inappropriate care, that we are delivering high quality, evidence-based care. And this type of oversight does help keep premiums down, keep costs down. So it is a necessary function.

But I do think that there's a lot of burden in the back and forth for doctors and providers on the front lines. Getting a prior authorization, understanding what they need to put in this authorization. If you talk to the plans, they'll say, “We get a lot of requests in that aren't even necessary. It doesn't even require a prior authorization.”

Other plans will say 90% of their requests actually get approved, and it's really only 10% that are problematic. Well, if that's the case, then we should figure out how to automate this just to make the process go quicker and faster. Understanding that it is important for payers to have this function.

But at the same time, I think providers can understand the necessity for it, and I think we can all agree that there's a better way to do it. There's a better way to automate it. We're building solutions so that when you order a test or a medication that you know right away that it requires prior authorization, we can auto-generate that.

And then on the payer side, we can help payers adjudicate that request as well.

Marcus: There is a lot of work happening here. So let's go back to the acceleration for a moment. Acceleration with AI and acceleration with, you mentioned some of the work in the administration around prior auth. Both organizations, Oracle and Surescripts were 1 of the 60 who signed the CMS commitment last week at the White House. I didn't know if you wanted to speak a little bit about that.

Verma: Yeah, I think during the first Trump administration, interoperability was a high priority. We really did understand the importance of data to innovation, so I'll start there. We also understood that not having ready access to data was inhibiting the system. It was inhibiting us from innovation. It was inhibiting us from delivering high quality care to patients. And sometimes it was a matter of life and death, not having that data available.

And so I think with the second Trump administration, they're continuing this. In the first administration, the rule has gone into place. It was an improvement for sure. We all have data possible with our patient portals, but now we have five patient portals and our data still remains disparate. So I think this effort by the administration is a strong step forward and I hope it's the final step, right? They're suggesting that you can show a QR code and that there are trusted exchanges across the country that will aid you in being able to get your data on a real-time basis.

Marcus: Great. Well now it's one of my favorite times in the podcast where we look through rose-colored glasses and we leave with some inspiration.

If you could snap your fingers and solve one major issue in healthcare, what would it be and how do you think that change would impact lives of patients and providers and those who care for patients?

Verma: I'm going to go back to where we started. I really would like to see every patient, not only in this country but around the world, having access to their complete medical record. That every data element is stored somewhere that they have ready access to it and that it brings in an era of patient empowerment. You understand your data.

Perhaps we also bring in your genetic sequence, and so we understand your genomics and the impact that it's going to have on your health. And we can put all of that together. We can give you recommendations on how to take care of yourself, how to stay healthy, how to avoid being in the hospital.

And I think having all of this data together is going to bridge that gap between care and research. And with all of that data available, the ability to analyze it with AI, I think we're going to start to see treatments for diseases that we thought were incurable.

Marcus: Amazing. Music to my ears. It’s a personal passion area for me, so I’m happy to hear you say that.

Finally, what gives you the most hope and inspiration that healthcare truly can heal itself?

Verma: I think that what's happened with AI over the last couple of years is a gamechanger for the industry. We finally have tools that I think are going to fix problems in a way that money, legislation, regulation, have never been able to do.

We finally have some tools at our fingertips to take advantage of this. I'm really excited about Oracle's role. Now we have a big tech company. We've had big tech in healthcare in the past. But not quite like this, where the tech company isn't just providing infrastructure. They actually went in and did a very, very bold move, which was to buy Cerner.

And they did that for the patient base to understand healthcare, to get underneath the covers and go down deep and understand all of the workflows and how healthcare works. And so we've never had a company like this going all in on healthcare, trying to fix it and trying to transform it.

Marcus: That's exciting indeed.

So thank you so much for spending time with us here today, Seema.

Verma: My pleasure. Thanks for having me.

Marcus: Seema Verma knows about delivering change at scale in healthcare.

This change is fueled by an organized, structured approach to data.

“It all starts with data,” Seema says. “You can’t have an AI strategy if you don’t have a data strategy.”

What will happen as we close these gaps in data? And what will that mean in practical terms for patients?

To answer these questions, Seema would take us back to what matters most: patients and those who care for them.

Her vision is one where every patient has access to their complete medical record. Every patient would own and understand their health data. Providers would leverage their skillsets in medical science and patient care to help people, to care for them, instead of caring for the administrative burden of charting and paperwork.

In short, it will be an era of patient empowerment and renewed trust.

This is her vision of what things should look like, and it’s all about having the tenacity to get there.

It was truly great having you on the show, Seema, and thanks to our listeners for taking time to hear how there’s a better way in healthcare.