Humans are being digitized through new devices, apps and monitoring technologies, which are tracking, analyzing and storing this massive amount of data.

This data, and how people interact with it, can create conflicts of interest. And this is, arguably, true more in the healthcare sector than in any other. Approximately 30% of the world’s data volume is being generated by the healthcare industry. By 2025, the compound annual growth rate of data for healthcare will reach 36%. That’s 6% faster than manufacturing, 10% faster than financial services, and 11% faster than media and entertainment.

Aaron Narva, the CEO and Founder of Conflixis, a technology firm that helps businesses identify, investigate and manage conflicts of interest within their organizations, spoke to GRIP about sorting through this data to minimize risk.

Narva is well-placed for embarking on this type of business enterprise; he was a white-collar crime investigator who has worked on everything from money laundering issues to foreign corruption issues, to construction fraud.

“Conflicts is taking an old process, that is basically the collection of data from healthcare providers as a check-the-box exercise, into a data collection and analysis exercise that drives better decision making in healthcare organizations – better decision making about around legal risk, regulatory risk, but also research integrity risk,” Narva explained.

Narva’s technology digs down into where large healthcare organizations spend their money and why they spend it on the things that they do. He said healthcare is the only industry where you can see, in a granular way, the choices that people make every day in their jobs – and with data.

“That’s very difficult to see in other places. It exists in finance to some extent, but in healthcare you can see that. And the financial incentives in healthcare all often run at crossways to each other,” he said.

Prevalent conflicts

Relationships like those in consulting relationships are commonplace. Things we can see publicly are most readily observable, such as what pharmaceutical and device companies are paying to doctors. But there are certainly payments for services other than consulting. Physicians could have outside financial interests. For example, if a physician owns a piece of real estate, and there’s a clinic on that real estate, and the physician refers patients to that clinic, and charges below market rent for that real estate, well, that could be seen as a kickback, he said.

To some extent, the American fee-for-service model is almost what you could call a conflict with someone’s health, because the incentive in that model is to build more products and not necessarily to think of the patient’s health first, Narva said.

“I think our goal as a company is to say, OK, conflicts appear to be everywhere, but let’s analyze the data. Let’s analyze people’s decisions and help people figure out where it looks like a conflict – but may or may not be one,” he said. “Let’s find the true conflict and determine the mitigating actions that can be taken to protect the provider, to protect the healthcare organization, to protect the pharma company, to protect the payer, whoever it is that’s involved.”

Narva reckons: “Our health system is built around one big conflict of interest. What incentive do these professionals have in totally curing me or totally curing all people like me with that condition?”

His view is that, at least in the public healthcare sector, there are great restrictions on people’s ability to have outside business activities. That can help. But, he pointed out, there’s still that inherent conflict within healthcare in terms of what you’re trying to solve for, and where your interests lie. “As long as people are making incremental money based on incremental procedures and prescriptions, there’s always going to be a conflict.”

“We look for behavioral patterns and outliers – signals in the data that tell us that something unusual is happening. It doesn’t mean something bad is actually happening, though.”

Aaron Narva, CEO and Founder of Conflixis

“We’re not conspiracy theorists, we’re not in that business,” Narva emphasized. “In fact, we try to be judicious. But that’s the thing that’s interesting about a conflict. If you don’t have contextual information – which we really don’t often have – you have to get that directly from the parties. We often just see a payment or another action done,” Narva explained.

“I think governments and regulators and the public and payers and healthcare systems are starting to look at all these conflicts and say, in the absence of contextual information, where do we need to go and get that information to say, yes, this was fine. This is not a big deal and there’s a reason for this money.

“We feel truly that collaboration between industry and providers is really important to have better technology to create better therapies, to do better things,” Narva said.

Healthcare provider organizations and hospitals are spending a lot of money potentially as a result of conflicts of interest, Narva said, emphasizing that the conflict is leading to additional spend. This is one of the reasons why companies care about unearthing and solving for them – beyond the rules and laws about them.

Patient trust

I asked Narva about research bias, referral patterns, and patient perception. Even if a conflict of interest is not actively influencing healthcare providers’ decisions, the perception of a conflict could erode patient trust, I said.

Narva agreed. “There are many examples of this. Even in institutions where maybe no one broke the rules per se, or a relationship was even properly disclosed, just the fact that the relationship exists was enough to create a problem,” he said. “I think the erosion of trust is a major issue.”

The CDC just released its conflicts of interest reports for its vaccine committee, Narva said. The members disclosed the conflicts. And if anyone had a conflict, they didn’t vote on that issue. That’s exactly how it’s supposed to work!

“That is when the conflict mechanism has done its job, which is to say those people who had a financial interest in something happening just recused themselves and didn’t vote. But simply disclosing a conflict [as per regulatory requirements] doesn’t do very much in and of itself. It’s not a curative thing,” he observed.

Speaking of trust, Narva mentioned how trust in healthcare before COVID was at roughly 71%, but it has dropped to 40%.

“That’s a massive erosion in in trust. Institutional trust in general is going down, but when people find out that doctors have financial incentives to make a decision about their health, that really creates a problem,” he said.

“We can talk about research bias,” Narva said, “but it’s not just that someone has a stake in the outcome when they are doing research for a company they own stock in. That’s pretty rare.

“But someone could be a spokesperson, promoting a company’s drugs or devices, receiving money to learn all about a company’s drugs and devices in a way that’s not educational necessarily. How can that person be doing unbiased research for that company? Well, the answer is they could,” Narva said.

But, he added, without contextual understanding of those other relationships, we will never know.

“People are afraid to talk about this out in the open because it’s sort of just how business gets done. But consumers are going to be demanding more of this information and they want to better understand it,” he said. And that means there will be a lot more accountability around it.

But, for businesses, really, this is fine, because some decent percentage of these things turn out to be OK anyway, he said. Figuring out what is truly an issue is critical.

How the tech works

Narva walked me through what his technology does.

“We take data, different kinds of data, like provider self-disclosed data, which is usually mandated in health systems. We take health system data about where they spend their money and about outside relationships. And we look at public records data relating to relationships. And we do some proprietary stuff in terms of pulling data out of the public record. And we buy a bunch of data, too. So we buy data from different places. Then we match all that stuff together and look for patterns,” Narva explained.

Since a decent amount of enforcement is driven by whistleblowers, it’s often the perception that matters more at the end of the day, he said.

“We look for behavioral patterns and outliers – signals in the data that tell us that something unusual is happening. It doesn’t mean something bad is actually happening, and we would never go to a client and say, ‘here’s a conflict of interest.’ That’s not how this works,” Narva said.

“Health systems in general spend between 10% and 20% of their total budgets on suppliers that have material relationships with staff.”

Aaron Narva, CEO and Founder, Conflixis

“And we typically don’t use that terminology when interacting with our clients. We say, ‘here’s risk, and how let’s think about how you mitigate this risk.’

“You can look at the risks that come along with dealing with a supplier. What are the reasons that you’ve chosen that supplier – and are they the ones that are best for the health system or not. Are they the ones that are best for somebody else?

“We look for the areas of influence inside organizations to make certain decisions – pulling out the patterns to help people better understand the dollar impact and the risk impact of each decision that’s being made so that they can decide what they want to address,” Narva said.

This analysis of one’s own data is essential, Narva said, because you’re on the hook for data you’ve collected. Look at it the way a regulator or a payer or an investigative journalist would expect you to, he explained.

Stakeholders want this intelligence

Narva said that at the very beginning, he and his team were mostly interacting with compliance, but that has changed. “There are a lot of stakeholders in hospital systems that are very interested in what we’re doing,” he said. “It goes from physician contracting to compliance to procurement folks to, you know, all sorts of other positions. So you tell them about their risk, and there’s no consulting that we do. We give them the outputs depending on what they put in,” he explained.

“And we give them an idea of how to make sense of it all, after they get that output. They will hopefully start to collect data differently from providers and staff. That’s part of what we can help them do. And we can help them manage those relationships differently,” he added. “We look at what rules they are putting in place based on the data to reduce their risk and talk about new training components. A lot of providers have relationships with pharma and device companies and others. And many of these organizations would rather have it be out in the open and be able to show ‘here’s why this is beneficial to patients.’”

Changing tack slightly, Narva said: “Here’s something interesting. Health systems in general spend between 10% and 20% of their total budgets on suppliers that have material relationships with staff. So, if you have a health system that sends $10 billion a year, they’re going to spend at least a billion dollars a year on suppliers that are actively trying to influence their staff, whether that’s good or not.”

Businesses are paying attention

Narva said the organizations that never thought about conflicts of interest are starting to pay attention, especially insurance companies – Medicare and Medicaid especially. Why? Because it’s the appearance of one that we often discover rather than a true conflict, he said.

“Have you ever met an insurance company that wouldn’t use the appearance of something untoward to push back on a reimbursement or payment? No, that’s risk and that gets factored into how much your policy costs you – it’s how much the insurance company pays out. Think about Medicare advantage. They respect the number of dollars per patient, and if they see that there’s $4 per patient being spent that is potentially being influenced by a physician financial relationship, you think they’re not going to push that button?” he asked rhetorically.

“Absolutely. Now I am not going to sit here and tell you that conflicts of interest mean there’s a definitive path where a conflict of interest leads to a higher insurance premium. My role is to look at the data, see that a provider has a financial relationship and some behavior changed. That’s all I can see and must manage. Then the organization has to analyze it. I’m not making the call,” he reiterated.

“We tell firms ‘listen we found 14 things that we think you should look at in your audit, or we think that you should look at these items on an ongoing basis or get a little bit more information about them.’”

And referring back to what he said earlier, he added that it can also lead to lost money – organizations buying things they should not have bought.

Recordkeeping

Narva stressed that he tells organizations they need to manage their relationships, which means having some kind of documentation there explaining how the relationship works.

“So, for example, some hospital systems will not allow providers to utilize medical devices where they own royalties. OK, fine, But put into some sort of record that you know about this risk, have identified it, and have a document that governs this relationship. It’s a risk, but it’s been mitigated. It helps the organization say it has vaccinated itself against this reputational and regulatory issue.”

Narva said it should be remembered that something might not be a conflict of interest, even though it really looks like one, because it is in the best interest of the patient or it really is the best solution.

“Let’s say that a drug company comes out with a new drug that is better than any existing drug. And let’s say that they have five prominent doctors who know all about this, and they want those doctors to tell the world about how great this drug is. And they pay those doctors a lot of money to go to conferences and talk about this stuff. They are telling people about a better way of doing things. And that could be a good thing,” he pointed out.

“But where you have a drug company that has a drug that is no better than any of the alternatives and costs 20 times as much as the alternatives – and the result is that doctors go from prescribing a generic version to this very expensive non-generic version – that’s an example where there is a potential legal issue. Now there’s a medical necessity issue and the decision is potentially being driven by a financial relationship or a kickback,” Narva said.

What this means in 2025

I asked Narva about his predictions for this year and beyond in terms of compliance departments staying focused on risk mitigation in the manner they had grown accustomed to – or would they perhaps take on a bit more risk?

“From a compliance perspective, I think it’s hard to tell what exactly is going to happen in this administration and because of this administration. I think when it comes to conflicts of interest, this administration is clear about where it stands on conflicts of interest. There’s a mention of conflicts of interest and research right in the Make America Healthy Again policy paper they issued.

“And Marty Makary, who is going to run the FDA, is a guy who is very focused on waste and unnecessary prescription drugs. I think those things are aligned,” Narva said.

“In terms of government spending, for every dollar that the government spends on healthcare enforcement, they make like three or four dollars back.

“Whether or not the Trump administration is pointing the light in the right direction is not for me to say. But if they do something about waste and streamlining costs, that is moving in the right direction in terms of healthcare outcomes.”

The tail of wrongdoing is long, and compliance officers know this. It would be unwise to take the foot off the pedal now in any risk area, Narva said.

“This administration will use what it has at its disposal to do what it wants to do. And that’s something people should be thinking about carefully.” he concluded